Seven papers on fused-ring heterocyclic ketones containing an N-tosyl­pyrrolo­[3,4-c]pyrano moiety. Corrigenda

Corrigenda to Acta Cryst. (2007), E63, o4363, o4364, o4434–o4435, o4436–o4437, o4438, o4489–o4490 and o4491–o4492

Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study

Objectives: Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal. Design: We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres. Setting: All 11 ART centres in the FWR of Nepal. Participants: All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres. Primary outcome measures: IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated. Result: Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation. Conclusions: In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap

Letter to Editor

Comparing Adherence in Cardiac Clinic Versus General Outpatient Clinic: Few Concerns and Way Forwar

Knowledge and attitude towards contraceptive methods for spacing and decision making factors regarding its use in postpartum women

Background: Though the permanent methods have been successful in our country the spacing methods lag behind and unwanted unplanned pregnancies continue to be high. This study was undertaken to explore the knowledge level, attitude and the factors influencing the potential use of spacing contraception among recently delivered women.Methods: This cross sectional study was carried out in a teaching institution using a structured questionnaire among recently delivered women willing to participate in the study.Results: Among the 404 women studied 74% were primipara. The level of awareness about spacing contraception was 70% though only 30% knew the correct use. The most frequent source of information was social circle and friends. Two thirds of women felt the need for spacing but 65.8% were not willing to adopt any modern method for fear of side effects and want of husband approval. Bivariate analysis showed that prenatal counselling (X2=41.33 P<0.001) and higher education (X2=16.6 P<0.001) were significant predictors of knowledge about spacing contraception. On bivariate analysis prenatal counselling (X2=3.83p<0.05) and prior discussion with husbands (X2=17.4 P=0.001) emerged to be the most significant predictors of positive attitude towards contraception. On multivariate analysis prior discussion with husband emerged as the most significant factor to predict the likely use of contraception for spacing (Adjusted OR-2.8; 95%CI 1.6-5.1).Conclusions: Prenatal counselling detailing about the contraceptive methods and doing away with the myths and involving husbands in these sessions would be important strategies to improve the effective use of spacing contraception among recently delivered women

Prevalence of abnormal Pap smear during pregnancy in a teaching hospital in South India

Background: The prevalence of cancer cervix is very high in our country. Women in our country typically present late when the disease is advanced. Screening during pregnancy gives an opportunity to pick up at pre-invasive/early stage as women come voluntarily seeking health care to hospitals. Abnormal cervical cytology is also associated with increased risk of adverse pregnancy outcome. This study was undertaken to determine the prevalence of abnormal Pap smear among pregnant women.Methods: This cross sectional study was carried out in a teaching institution among pregnant women using conventional cytology (with Ayer’s spatula) reported by Bethesda system after obtaining informed consent. The study was approved by institute ethics committee.Results: Among the 316 women studied the mean (SD) age at marriage was 22 (3) years. The mean period of gestation was 30 weeks. Only one participant (0.3%) reported high risk behaviour. The speculum examination was found to be normal in 99.7% women. There was one abnormal Pap smear report. Specific infection with Candida was reported in 14.6%; in none of these the speculum examination showed a characteristic discharge of candidiasis. Further a significantly higher prevalence of Candida infection was found in rural compared to urban population (Chi square 3.7, p=0.046).Conclusions: The prevalence of abnormal Pap smear is particularly low at 0.3% in our study group. However the prevalence of asymptomatic Candida infection which was missed on speculum exam because of lack of the characteristic discharge was high at 14.6%. Thus the authors recommend routine prenatal microbiological examination to detect candida infection

cis-1-Ethyl-4,4,6,8-tetra­methyl-2-tosyl-2,3,3a,4,6,7,8,9-octa­hydro-1H-pyrrolo[3′,4′:3,4]pyrano[6,5-d]pyrimidine-7,9-dione

In the title compound, C22H29N3O5S, the pyrrolidine ring is cis-fused to the dihydro­pyran ring. The pyrrolidine and dihydro­pyran rings adopt twist and half-chair conformations, respectively. The mol­ecule is in a folded conformation; the sulfonyl-bound benzene ring lies over the pyrimidine­dione ring, with a weak π–π inter­action [centroid–centroid distance = 3.6147 (4) Å]. A weak intra­molecular C—H⋯O hydrogen bond generates an S(6) ring motif. In the crystal, molecules are linked into a three-dimensional network by C—H⋯O hydrogen bonds

3-Benzyl-7-bromo-9-phenyl-2-tosyl-2,3,3a,4,9,9a-hexa­hydro-1H-pyrrolo[3,4-b]quinoline

In the title compound, C31H29BrN2O2S, the pyrrolidine ring is in a twist conformation and the tetra­hydro­pyridine ring adopts an envelope conformation with the methine C atom adjacent to the NH group as the flap atom; the two rings are trans-fused. The bromo­benzene ring and the nearest phenyl ring form a dihedral angle of 82.72 (10)°. The benzyl phenyl and the tosyl phenyl rings are oriented at a dihedral angle of 75.57 (11)°. An intra­molecular N—H⋯π inter­action is observed. In the crystal, mol­ecules are linked into chains running along [101] by C—H⋯O hydrogen bonds and the chains are cross-linked via weak C—H⋯π inter­actions

1-Ethyl-2-tosyl-4,4,6-trimethyl-2,3,3a,4-tetra­hydro-1H-pyrrolo[3,4-c]pyrano[6,5-b]quinoline-11(6H)-one monohydrate

In the title compound, C26H30N2O4S·H2O, the pyrrolidine and dihydro­pyran rings adopt envelope conformations and they are cis-fused. The sulfonyl group has a distorted tetra­hedral geometry. In the crystal structure, the mol­ecules are linked into a ribbon-like structure along the a axis by O/C—H⋯O hydrogen bonds involving water mol­ecules and C—H⋯π inter­actions involving the sulfonyl-bound phenyl ring. Adjacent ribbons are cross-linked via C—H⋯O hydrogen bonds involving a sulfonyl O atom and C—H⋯π inter­actions involving the pyridinone ring

3-Benzyl-9-phenyl-2-tosyl-2,3,3a,4,9,9a-hexa­hydro-1H-pyrrolo[3,4-b]quinoline

In the title compound, C31H30N2O2S, the pyrrolidine ring adopts a twist conformation while the tetra­hydro­pyridine ring is in a half-chair conformation. The two rings are trans-fused. The pyridine-bound phenyl ring forms dihedral angles of 17.7 (1) and 48.1 (1)°, respectively, with the tosyl and benzyl phenyl rings. The mol­ecular structure is stabilized by an N—H⋯π inter­action involving the benzyl phenyl ring. In the crystal structure, mol­ecules translated by one unit along the a axis are linked into chains by C—H⋯π inter­actions involving the benzene ring of the tosyl group

3-Benzyl-7-meth­oxy-9-phenyl-2-tosyl-2,3,3a,4,9,9a-hexa­hydro-1H-pyrrolo[3,4-b]quinoline

In the title compound, C32H32N2O3S, the pyrrolidine ring adopts an envelope conformation with the methine C atom nearest to the phenyl ring as the flap atom. The tetra­hydro­pyridine ring has a half-chair conformation. The two rings are trans-fused. The phenyl ring bound to the tetra­hydro­pyridine is oriented almost perpendicular [dihedral angle = 86.35 (10)°] to the fused benzene ring. The dihedral angle between the benzyl­phenyl ring and the sulfonyl-bound phenyl ring is 69.43 (10)°. A very weak N—H⋯π inter­action is observed in the mol­ecular structure. In the crystal, mol­ecules translated one unit along the b axis are linked into C(10) chains by C—H⋯O hydrogen bonds; adjacent chains are linked via C—H⋯π inter­actions, forming a two-dimensional network parallel to the bc plane