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Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment for at least one month (henceforth called ‘misclassification’). Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.

Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment. Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.

BackgroundAxshya SAMVAD is an active tuberculosis (TB) case finding (ACF) strategy under project Axshya (Axshya meaning 'free of TB' and SAMVAD meaning 'conversation') among marginalized and vulnerable populations in 285 districts of India.ObjectivesTo compare patient characteristics, health seeking, delays in diagnosis and treatment initiation among new sputum smear positive TB patients detected through ACF and passive case finding (PCF) under the national TB programme in marginalized and vulnerable populations between March 2016 and February 2017.MethodsThis observational analytic study was conducted in 18 randomly sampled Axshya districts. We enrolled all TB patients detected through ACF and an equal number of randomly selected patients detected through PCF in the same settings. Data on patient characteristics, health seeking and delays were collected through record review and patient interviews (at their residence). Delays included patient level delay (from eligibility for sputum examination to first contact with any health care provider (HCP)), health system level diagnosis delay (from contact with first HCP to TB diagnosis) and treatment initiation delays (from diagnosis to treatment initiation). Total delay was the sum of patient level, health system level diagnosis delay and treatment initiation delays.ResultsWe included 234 ACF-diagnosed and 231 PCF-diagnosed patients. When compared to PCF, ACF patients were relatively older (≥65 years, 14% versus 8%, p = 0.041), had no formal education (57% versus 36%, pConclusionAxshya SAMVAD linked the most impoverished communities to TB care and resulted in reduction of health system level diagnosis delay.

Background: Community-based active case finding (ACF) for tuberculosis (TB) implemented among marginalised and vulnerable populations in 285 districts of India resulted in reduction of diagnosis delay and prevalence of catastrophic costs due to TB diagnosis. We were interested to know whether this translated into improved treatment outcomes. Globally, there is limited published literature from marginalised and vulnerable populations on the independent effect of community-based ACF on treatment outcomes when compared to passive case finding (PCF). Objectives: To determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people. Methods: Cohort study involving record reviews and interviews in 18 randomly selected districts. We enrolled all ACF-diagnosed people with new smear-positive pulmonary TB, registered under the national TB programme between March 2016 and February 2017, and an equal number of randomly selected PCF-diagnosed people in the same settings. We used log binomial models to adjust for confounders. Results: Of 572 enrolled, 275 belonged to the ACF and 297 to the PCF group. The proportion of unfavourable outcomes were 10.2% (95% CI: 7.1%, 14.3%) in the ACF and 12.5% (95% CI: 9.2%, 16.7%) in the PCF group (p = 0.468). The association between ACF and unfavourable outcomes remained non-significant after adjusting for confounders available from records [aRR: 0.83 (95% CI: 0.56, 1.21)]. Due to patient non-availability at their residence, interviews were conducted for 465 (81.3%). In the 465 cohort too, there was no association after adjusting for confounders from records and interviews [aRR: 1.05 (95% CI: 0.62, 1.77)]. Conclusion: We did not find significant differences in the treatment outcomes. Due to the wide CIs, studies with larger sample sizes are urgently required. Studies are required to understand how to translate the benefits of ACF to improved treatment outcomes.

Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p

The title compound, C21H20O2S2, forms a propeller-shaped structure with the tetrahedral C atom as the central hub and methoxybenzene and phenyl residues as radiating blades. Short C—H...π contacts are observed.

In the title compound, C15H17BrN2O2, both pyrrolidinone rings adopt envelope conformations. The crystal packing is characterized by short C—Br...O=C interactions [Br...O = 3.1730 (13) Å], leading to supramolecular dimers. Intermolecular C—H...O and C—H...π interactions are also observed.

In the title 2H-pyrazolo[4,3-c]pyridine derivative, C32H27Cl2N3, the dihydropyrazole ring adopts an envelope conformation and the piperidine fused ring a twisted-chair conformation. Two short intramolecular C—H...Cl contacts are observed. The crystal packing is characterized by dimeric C—Cl...π interactions involving the 5-benzyl ring, with Cl...centroid and closest atomic Cl...π distances of 3.778 (2) and 3.366 (4) Å, respectively.

In the title compound, C27H21NO2, the half-chair conformation of the alicyclic rings gives rise to a slightly folded structure of the central tricyclic tetrahydrophenanthridine unit. Tandem intramolecular O—H...N and O—H...O hydrogen bonds give rise to adjacent S(6) and S(5) rings, respectively, which dictate the conformation of the 5-aryl substituent. In the crystal structure, an intermolecular C—H...O contact generates chains parallel to [101]. Short O—H...π and C—H...π contacts are also observed.

In the title compound C32H31NO3, the allyloxy groups on either side of the piperidin-4-one ring are conformationally disordered. The contribution of major and minor components of the allyloxy group at the 3rd position of the ring are 0.576 (4) and 0.424 (4), respectively, and those at the 5th position are 0.885 (3) and 0.115 (3), respectively. The six-membered piperidin-4-one ring adopts a sofa conformation with the benzyl group occupying an equatorial position and the olefinic double bonds possessing an E configuration. Flanking phenyl substituents are stretched out on either side of the six-membered ring. π–π interactions with a centroid–centroid distance of 3.885 (1) Å give rise to molecular dimers and short C—H...π contacts lead to chains along the c axis.

In the title compound, C26H23NO, C—H...O hydrogen bonds generate a ribbon structure along the a axis. These ribbons further assemble into a one-dimensional sheet parallel to the ac plane via C—H...π interactions. The piperidin-4-one ring adopts a sofa conformation with the 1-benzyl group in the equatorial position, and the 3- and 5-phenyl substituents stretched out on either side. The benzylidene units adopt E configurations and the 1-benzyl group is disposed towards the 3- substituent of the piperidin-4-one ring.

The inversion-related molecules of the title compound, C26H21F2NO, associate into closed dimeric subunits via co-operative C—H...π interactions. Two non-classical C—H...O and one C—H...N intramolecular hydrogen bonds are also found in the crystal structure. The piperidin-4-one ring adopts a sofa conforamtion with the 1-benzyl group in the equatorial position, and the equiplanar fluorophenyl substituents in the 3- and 5-positions stretched out on either side. The 1-benzyl group is disposed towards the substituent in the 6th position of the piperidin-4-one ring. The 3,5-diene units possess E configurations.

The molecule of the title compound, C18H18O2, a symmetrically phenol-substituted divinyl analog, exhibits crystallographically imposed C2 symmetry. The phenolic and divinyl planar groups intersect each other orthogonally, with a dihedral angle of 82.7 (1)°. The structure is stabilized by a short intramolecular C—H...O contact. The molecules are held together by C—H...π interactions, forming a sheet structure parallel to the (201) plane.

The molecule of the title compound, C20H22O2, a symmetrically 2-methylphenol-substituted divinyl analog, exhibits crystallographically imposed C2 symmetry. The molecular structure is essentially planar. The structure is stabilized by a short intermolecular C—H...O contact. Cooperative C—H...π interactions generate an infinite one-dimensional chain of molecules along the a axis.

To quantify the effectiveness of hydrogen-bonding donors and acceptors for forming interactions, we here introduce the concept of statistical competitiveness, defined in terms of three numerical parameters namely, absolute, relative and exclusive statistical competitiveness. The concept can be applied to evaluate the effectiveness of a donor or acceptor in any chemical context. We have evaluated the efficacy of ether oxygen for hydrogen-bonding with respect to carbonyl oxygen and nitrogen acceptors. The quantification in terms of statistical parameters reveals a striking result that the population of hydrogen-bonding groups predominately dictates their effectiveness irrespective of their acidic or basic strengths. The quantification of the competitiveness serves to estimate better the outcome of crystal structure prediction and engineering methodologies, and molecular docking. [ABSTRACT FROM AUTHOR]

Background: In 2007, a field observation from India reported 11% misclassification among 'new' patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment for at least one month (henceforth called 'misclassification'). Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as 'new' had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of 'previously treated' patients among all registered patients treated under the programme at national level., Competing Interests: No competing interests were disclosed.

Background: Axshya SAMVAD is an active tuberculosis (TB) case finding (ACF) strategy under project Axshya (Axshya meaning 'free of TB' and SAMVAD meaning 'conversation') among marginalized and vulnerable populations in 285 districts of India., Objectives: To compare patient characteristics, health seeking, delays in diagnosis and treatment initiation among new sputum smear positive TB patients detected through ACF and passive case finding (PCF) under the national TB programme in marginalized and vulnerable populations between March 2016 and February 2017., Methods: This observational analytic study was conducted in 18 randomly sampled Axshya districts. We enrolled all TB patients detected through ACF and an equal number of randomly selected patients detected through PCF in the same settings. Data on patient characteristics, health seeking and delays were collected through record review and patient interviews (at their residence). Delays included patient level delay (from eligibility for sputum examination to first contact with any health care provider (HCP)), health system level diagnosis delay (from contact with first HCP to TB diagnosis) and treatment initiation delays (from diagnosis to treatment initiation). Total delay was the sum of patient level, health system level diagnosis delay and treatment initiation delays., Results: We included 234 ACF-diagnosed and 231 PCF-diagnosed patients. When compared to PCF, ACF patients were relatively older (≥65 years, 14% versus 8%, p = 0.041), had no formal education (57% versus 36%, p<0.001), had lower monthly income per capita (median 13.1 versus 15.7 USD, p = 0.014), were more likely from rural areas (92% versus 81%, p<0.002) and residing far away from the sputum microscopy centres (more than 15 km, 24% versus 18%, p = 0.126). Fewer patients had history of significant loss of weight (68% versus 78%, p = 0.011) and sputum grade of 3+ (15% versus 21%, p = 0.060). Compared to PCF, HCP visits among ACF patients was significantly lower (median one versus two HCPs, p<0.001). ACF patients had significantly lower health system level diagnosis delay (median five versus 19 days, p = 0.008) and the association remained significant after adjusting for potential confounders. Patient level and total delays were not significantly different., Conclusion: Axshya SAMVAD linked the most impoverished communities to TB care and resulted in reduction of health system level diagnosis delay., Competing Interests: The authors have declared that no competing interests exist.

Background : Community-based active case finding (ACF) for tuberculosis (TB) implemented among marginalised and vulnerable populations in 285 districts of India resulted in reduction of diagnosis delay and prevalence of catastrophic costs due to TB diagnosis. We were interested to know whether this translated into improved treatment outcomes. Globally, there is limited published literature from marginalised and vulnerable populations on the independent effect of community-based ACF on treatment outcomes when compared to passive case finding (PCF). Objectives : To determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people. Methods : Cohort study involving record reviews and interviews in 18 randomly selected districts. We enrolled all ACF-diagnosed people with new smear-positive pulmonary TB, registered under the national TB programme between March 2016 and February 2017, and an equal number of randomly selected PCF-diagnosed people in the same settings. We used log binomial models to adjust for confounders. Results : Of 572 enrolled, 275 belonged to the ACF and 297 to the PCF group. The proportion of unfavourable outcomes were 10.2% (95% CI: 7.1%, 14.3%) in the ACF and 12.5% (95% CI: 9.2%, 16.7%) in the PCF group (p = 0.468). The association between ACF and unfavourable outcomes remained non-significant after adjusting for confounders available from records [aRR: 0.83 (95% CI: 0.56, 1.21)]. Due to patient non-availability at their residence, interviews were conducted for 465 (81.3%). In the 465 cohort too, there was no association after adjusting for confounders from records and interviews [aRR: 1.05 (95% CI: 0.62, 1.77)]. Conclusion : We did not find significant differences in the treatment outcomes. Due to the wide CIs, studies with larger sample sizes are urgently required. Studies are required to understand how to translate the benefits of ACF to improved treatment outcomes.

Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis., Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF)., Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity., Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-0.58 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles., Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.

In the title compound, C(15)H(17)BrN(2)O(2), both pyrrolidinone rings adopt envelope conformations. The crystal packing is characterized by short C-Br⋯O=C inter-actions [Br⋯O = 3.1730 (13) Å], leading to supra-molecular dimers. Inter-molecular C-H⋯O and C-H⋯π inter-actions are also observed.

The title compound, C(21)H(20)O(2)S(2), forms a propeller-shaped structure with the tetra-hedral C atom as the central hub and meth-oxy-benzene and phenyl residues as radiating blades. Short C-H⋯π contacts are observed.

In the title 2H-pyrazolo-[4,3-c]pyridine derivative, C(32)H(27)Cl(2)N(3), the dihydro-pyrazole ring adopts an envelope conformation and the piperidine fused ring a twisted-chair conformation. Two short intra-molecular C-H⋯Cl contacts are observed. The crystal packing is characterized by dimeric C-Cl⋯π inter-actions involving the 5-benzyl ring, with Cl⋯centroid and closest atomic Cl⋯π distances of 3.778 (2) and 3.366 (4) Å, respectively.

In the title compound, C(27)H(21)NO(2), the half-chair conformation of the alicyclic rings gives rise to a slightly folded structure of the central tricyclic tetra-hydrophenanthridine unit. Tandem intra-molecular O-H⋯N and O-H⋯O hydrogen bonds give rise to adjacent S(6) and S(5) rings, respectively, which dictate the conformation of the 5-aryl substituent. In the crystal structure, an inter-molecular C-H⋯O contact generates chains parallel to [101]. Short O-H⋯π and C-H⋯π contacts are also observed.

In the title compound C(32)H(31)NO(3), the all-yloxy groups on either side of the piperidin-4-one ring are conformationally disordered. The contribution of major and minor components of the allyloxy group at the 3rd position of the ring are 0.576 (4) and 0.424 (4), respectively, and those at the 5th position are 0.885 (3) and 0.115 (3), respectively. The six-membered piperidin-4-one ring adopts a sofa conformation with the benzyl group occupying an equatorial position and the olefinic double bonds possessing an E configuration. Flanking phenyl substituents are stretched out on either side of the six-membered ring. π-π inter-actions with a centroid-centroid distance of 3.885 (1) Å give rise to mol-ecular dimers and short C-H⋯π contacts lead to chains along the c axis.

In the title compound, C(26)H(23)NO, C-H⋯O hydrogen bonds generate a ribbon structure along the a axis. These ribbons further assemble into a one-dimensional sheet parallel to the ac plane via C-H⋯π inter-actions. The piperidin-4-one ring adopts a sofa conformation with the 1-benzyl group in the equatorial position, and the 3- and 5-phenyl substituents stretched out on either side. The benzyl-idene units adopt E configurations and the 1-benzyl group is disposed towards the 3- substituent of the piperidin-4-one ring.

The inversion-related mol-ecules of the title compound, C(26)H(21)F(2)NO, associate into closed dimeric subunits via co-operative C-H⋯π inter-actions. Two non-classical C-H⋯O and one C-H⋯N intra-molecular hydrogen bonds are also found in the crystal structure. The piperidin-4-one ring adopts a sofa conforamtion with the 1-benzyl group in the equatorial position, and the equiplanar fluoro-phenyl substituents in the 3- and 5-positions stretched out on either side. The 1-benzyl group is disposed towards the substituent in the 6th position of the piperidin-4-one ring. The 3,5-diene units possess E configurations.

The mol-ecule of the title compound, C(18)H(18)O(2), a symmetrically phenol-substituted divinyl analog, exhibits crystallographically imposed C(2) symmetry. The phenolic and divinyl planar groups inter-sect each other orthogonally, with a dihedral angle of 82.7 (1)°. The structure is stabilized by a short intra-molecular C-H⋯O contact. The mol-ecules are held together by C-H⋯π inter-actions, forming a sheet structure parallel to the (201) plane.

The mol-ecule of the title compound, C(20)H(22)O(2), a symmetrically 2-methyl-phenol-substituted divinyl analog, exhibits crystallographically imposed C(2) symmetry. The mol-ecular structure is essentially planar. The structure is stabilized by a short inter-molecular C-H⋯O contact. Cooperative C-H⋯π inter-actions generate an infinite one-dimensional chain of mol-ecules along the a axis.

Fluoride is a naturally occurring toxic mineral present in drinking water and the root cause of many diseases and disorders. Present international drinking water standard set by World Health Organisation (WHO) for fluoride is 1.5 ppm. In order to find the wide spread concentration of fluoride in drinking water of fluoride contaminated aquifer, 30 bore well water samples have been collected from different villages of Natrampalli Union which comes under Tiruvannamalai Circle, Tamil Nadu, India. In the present work, an attempt to remove fluoride by the use of coagulant, Poly Aluminium Chloride (PAC) was made and is compared with the most common existing technique "Nalgonda Technique" where there was a reversible reaction. The coagulant used in Nalgonda technique is Alum [(Al2SO4)3]. Results of the present work show that Poly Aluminium Chloride (PAC) can be an effective coagulant for the removal of fluoride from water with a higher removal efficiency of about 75 - 85% in less detention time and also observed that the fluoride removal was dependent on initial fluoride concentration and dose of coagulants.