Trends in rifampicin and isoniazid resistance in patients with presumptive TB.

BACKGROUND: Early diagnosis of drug-resistant TB (DR-TB) is crucial in preventing the spread of the disease in the community. Introduction of upfront decentralised drug susceptibility testing to district-level as part of universal drug susceptibility testing (UDST) policy increased the feasibility of rapid and early testing for drug resistance closer to the patient and has resulted in reduced circumstances for transmission. The introduction of the first-line line-probe assay (FL-LPA), GenoType® MTBDRplus v2, has had an extensive impact on the management of multidrug-resistant TB (MDR-TB) in India.MATERIALS and METHODS: Sputum samples of patients with presumptive TB and DR-TB from selected districts of Tamil Nadu received through National TB Elimination Programme (NTEP) were subjected to FL-LPA as per programme guidelines. In this study, we present trends in genotypic resistance to isoniazid (INH) and rifampicin (RIF) during the 4 years (2016-2019) among these patients. Band patterns were analysed as per the updated GLI (Global Laboratory Initiative) LPA interpretation and reporting guidelines.RESULTS: A total of 26,349 samples were received during the study period. Smear-positive samples (n = 20231) were directly subjected to FL-LPA; smear-negative samples were cultured in liquid media and M. tuberculosis-positive cultures were tested using FL-LPA. A total of 18,441 were MTB-positive on FL-LPA. INH monoresistance, RIF monoresistance and MDR-TB was observed in respectively 8.7%, 1.1% and 3.3% of the samples. There was a decreasing trend in all types of resistance observed particularly after 2017 (P < 0.001). MDR-TB showed a steady decrease from 5.6% to 1.8%. S531L (19.5%) and S315T (61.1%) were the most common mutations identified in the rpoB and katG genes, respectively. The percentage of inhA-c-15t promoter mutation, indicating low-level INH resistance, showed a consistent increase (P < 0.001).CONCLUSION: The impact of the UDST policy on the NTEP may have led to this decreasing trend in RIF and INH resistance observed in the study period. The increase in low-level INH resistance mutation inhA-c-15t may be associated with ethionamide/prothionamide resistance, and this should be taken into account when designing DR-TB regimen.

Alkylation of nitroaromatics with trialkyborane.

When p-dinitrobenzene is reacted with Et(3)B in t-BuOH or THF in the presence of t-BuOK, it yields p-nitroethylbenzene. In this report we examine the scope of this transformation by monitoring the effect of various parameters on the reaction. It has been found that the reaction is extremely sensitive to temperature and rather insensitive to the base-solvent combination used. It is also insensitive to the steric hindrance of the base: good yields were obtained using sodium 2,6-diisopropylphenoxide or when using NaH. Alkylation was obtained with a large variety of alkylboranes ranging from linear to polycyclic. Yields drop significantly if one of the nitro groups is replaced by another electron-withdrawing group. In all cases studied (CHO, PHCO, SO(2)Ph, and CN), it is the latter group which was preferentially displaced by the alkyl group. According to the suggested mechanism, the radical anion of the substrate combines with the alkyl radical released from the boranyl radical to form a Meisenheimer complex. The reaction takes place at the ring carbon bearing the highest spin density in accordance with ab initio calculations at the B3LYP/6-31+G level.

2-(exo-tricyclo[5.2.1.0(2,6)]deca-4,8-dien-3-endo-yl)acetaldehyde 2,4-dinitrophenylhydrazone.

The six-membered ring of the norbornene moiety in the title compound, C(18)H(18)N(4)O(4), is in a slightly distorted boat conformation, and the two five-membered rings within it adopt envelope conformations. The structure is stabilized by inter- and intramolecular N[bond]H...O hydrogen bonds.