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In a diverse country like India where most of the people are multilingual the use of the pure language is decreasing. Interpretation of such mixed language becomes easy for human but complex for machine. There are many machine learning models which are trained for pure language translation but there is a research gap in the field of code-mixed language translation. In order to bridge this gap, the paper presents a model which uses Hinglish as a standalone language to be translated into English. In this paper, we have discussed the algorithm, technique and limitation of our system.

Early diagnosis and treatment are associated with better outcomes in oncology. We reviewed the existing literature using the search terms "low dose computed tomography" and "lung cancer screening" for systematic reviews, metanalyses, and randomized as well as non-randomized clinical trials in PubMed from January 1, 1963 to April 30, 2022. The studies were heterogeneous and included people with different age groups, smoking histories, and other specific risk scores for lung cancer screening. Based on the available evidence, almost all the guidelines recommend screening for lung cancer by annual low dose CT (LDCT) in populations over 50 to 55 years of age, who are either current smokers or have left smoking less than 15 years back with more than 20 to 30 pack-years of smoking. "LDCT screening" can reduce lung cancer mortality if carried out judiciously in countries with adequate resources and infrastructure.

Introduction: Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in cytopathology, is able to assess the adequacy of onsite samples during TBNA. Material and methods: A pulmonologist was initially trained by a pathologist in examining cytology slides and assessing sample adequacy on TBNA smears. During TBNA, one slide from each needle pass was stained on-site using rapid Giemsa stain and was labelled as ROSE slide. The remaining slides were sent to the pathology laboratory for definitive cytological analysis. The ROSE slides were examined by a pulmonologist and a pathologist blinded to each other’s interpretation. Level of agreement between the pulmonologist and pathologist was assessed by estimating Cohen's kappa. Results: A total of 172 slides from 35 patients were prepared for ROSE and evaluated independently by pulmonologist and pathologist. For adequacy, the pulmonologist and pathologist agreed in 143 out of the 172 slides (83% agreement), κ 0.649 (p < 0.001). For diagnostic categories, the pulmonologist and the pathologist agreed in 143 out of the 172 slides (83% agreement); κ 0.696 (p < 0.001). The sensitivity, specificity and accuracy of ROSE performed by the pulmonologist with respect to that performed by the pathologist was 66.2%, 96.8% and 83.1% respectively. Conclusion: After a short period of training in cytopathology, a pulmonologist can assess for adequacy of TBNA ROSE slides in the bronchoscopy suite.

As no definitive therapy or vaccine is yet available for COVID-19, in a desperate attempt repurposed drugs are being explored as an option. A drug repurposing study identified Ciclesonide as a potential candidate. We reviewed the available evidence and clinical trials on the use of Ciclesonide in COVID-19. At present the evidence is limited to a report of three cases. However, five clinical trials are underway, and their results will help in elucidating the role of Ciclesonide in COVID-19.

Background Chest pain is one of the most common symptoms with which a patient presents to a doctor. Differentials include, but are not limited to, cardiac pulmonary, gastrointestinal, psychosomatic and musculoskeletal causes. In our case, ultrasound of the chest wall paved the way for the diagnosis of multiple myeloma, which occultly presented with chronic chest pain. Case summary Here we report a case of 50-year-old man with chronic chest pain without anemia or renal failure who was diagnosed with multiple myeloma, despite negative bence jones protein and M band electrophoresis. An ultrasound of the chest wall showed cortical irregularities along with a hypoechoic mass in the sternum and left 5th rib, which helped us in clinching the diagnosis. Conclusion Ultrasound of bone can often aid in reaching a diagnosis indirectly if not directly.

Introduction: Narrow band imaging (NBI) video bronchoscopy provides better visualisation of submucosal vascular patterns in malignant airway lesions compared to white light bronchoscopy. This analytical cross-sectional study was aimed to look for any relationship between these NBI vascular patterns and the histologic type of lung cancer. Material and methods: After screening 78 patients with suspected lung cancer, 53 subjects underwent video bronchoscopy. Thirty-two patients showing abnormal bronchial mucosa or endobronchial growth with any of the NBI vascular patterns on bronchoscopy were enrolled in the study. These abnormal areas were then biopsied and sent for histologic examination. Results: NBI bronchoscopy revealed a dilated tortuous vascular pattern in 54.8% of the patients, a non-specific pattern in 32%, a dotted pattern in 9.7% and an abrupt ending vessels pattern in 3.2% of the patients. We did not find any statistically significant relationship between a dilated tortuous pattern and squamous-cell carcinoma (p = 0.48), adenocarcinoma (p = 0.667) or small-cell carcinoma (p = 1); between a dotted pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 0.54) or small-cell carcinoma (p = 1), and between an abrupt ending capillary pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 1) or small-cell carcinoma (p =1). Conclusion: No relationship exists between NBI vascular patterns and the histology of lung cancer. Endobronchial lesions showing any vascular pattern on NBI needs to be adequately sampled for proper histologic and molecular studies in lung cancer patients.

A 24-year-old woman (Para 1, Living 1) with no previous comorbidities presented to the emergency room (ER) with complaints of acute onset dyspnoea with swelling of both legs for the past 12 h and cough with frothy sputum for the past 4 h. She denied any history of chest pain, back pain, fever, sore throat, runny nose or rash. She had undergone a caesarean section 24 h ago, which was uneventful, and she was stable postoperatively. Her medical and obstetric history were insignificant. The patient had had regular antenatal visits and her antenatal history was insignificant for any cardiac illness and/or preeclampsia. There was no history of any tocolytic administration or drug abuse., The aetiology of acute-onset dyspnoea in the post partum period is diverse. However, subtle clinical and radiological findings assist in early diagnosis and definitive management, thereby conferring better prognosis and survival. https://bit.ly/361b4qm

Interstitial lung diseases (ILDs) are a frequently occurring pulmonary manifestation in patients of connective tissue diseases (CTD). Detailed understanding of this subset of lung diseases is vital, hence the study was conducted to analyze the clinico-radiological characteristics of CTD-ILD. The present study was conducted between March 2017 to February 2018 at a tertiary care teaching hospital from western India. A total of 100 patients having respiratory symptoms suggestive of ILD, who were either diagnosed cases of CTD or had clinical manifestations of underlying CTD, were included in the study. 27% of patients belonged to age group 41-50 years and 78% were females. Chief respiratory complaints were dyspnea and cough. Clubbing was present in 29% patients. The most common CTDs were rheumatoid arthritis [RA] (26%), systemic sclerosis [SSC] (21%), mixed connective tissue disorder [MCTD] (19%) and Sjogren’s syndrome [SS] (16%). Restrictive defect on spirometry was seen in 58% cases and was most significant among patients with RA (65%) and SS (62%). Pulmonary arterial hypertension was seen in 40% cases and was most evident in MCTD (78%) and SSC patients (58%). Chest radiograph was normal in 47% of subjects. Most common radiological pattern on high resolution computed tomography (HRCT) thorax was non-specific interstitial pneumonia (42%) followed by usual interstitial pneumonia (21%). ILD is a common manifestation of CTD. Work-up for an underlying CTD should be offered to all ILD patients and vice versa.

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Aim: To study the serum levels of fibrinogen in patients with obstructive sleep apnea (OSA) and its correlation with apnea hypopnea index (AHI), oxygen desaturation index (ODI), minimal oxygen saturation & arousal index. Methods: It was a case control study in which 23 cases of OSA and 23 controls were enrolled. Morning fasting serum fibrinogen and d-dimer was measured in cases of OSA and controls. Those with liver disease, hypertension, diabetes mellitus, coronary artery disease, COPD, alcoholics and smokers were excluded from the study. Results: Serum fibrinogen levels among OSA patients (268.47 ± 53.11 mg/dl) were elevated as compared to their levels in controls (221.52 ± 65.84 mg/dl) (p Conclusions: The observation of elevated fibrinogen levels with the increasing severity of OSA and hypoxemic events makes OSA an independent risk factor for cardiovascular disorders.

A 55-year-old female complained of recurrent haemoptysis [...]

As no definitive therapy or vaccine is yet available for COVID-19, in a desperate attempt repurposed drugs are being explored as an option. A drug repurposing study identified Ciclesonide as a potential candidate. We reviewed the available evidence and clinical trials on the use of Ciclesonide in COVID-19. At present the evidence is limited to a report of three cases. However, five clinical trials are underway, and their results will help in elucidating the role of Ciclesonide in COVID-19.

Primary pulmonary lymphoma is a rare disease. The most frequent primary pulmonary lymphoma (PPL) is extranodal marginal zone B-cell lymphoma of MALT. About half of the patients are asymptomatic at diagnosis. We report a case of a 62-year-old male referred to us for preoperative assessment of surgery for Benign Prostatic Hyperplasia (BPH). He had no respiratory complaints but on evaluation was detected to have Pulmonary MALToma. Our case highlights the importance of tissue diagnosis.

Background Diagnosis and management of multidrug-resistant tuberculosis (MDR-TB) remains a global challenge and is associated with high morbidity and mortality. Burden of TB among symptomatic household contacts of MDR-TB is not extensively studied and screening of symptomatic contacts may provide a better opportunity for optimum management and effective TB control. Methods This prospective observational study was conducted in the department of Tuberculosis & Chest diseases, S.N. Medical College, Agra from February 2016 to January 2018. The study recruited 271 symptomatic household contacts of 87 index MDR-TB cases. Symptomatic contacts were screened for active disease and latent TB infection. Risk factors for the spread of disease were also looked for. Results Out of 271 symptomatic household contacts, 97 (35.79%) had active TB. Among 97 diseased, 62 (22.87%) had MDR-TB and 35 (12.91%) had drug-susceptible TB. 124 contacts (45%) had latent TB infection. Risk factors associated with occurrence of TB included age less than 18 years (OR = 7160, p = 0.1908, RR = 0.8082, p = 0.1887), male sex (OR = 2.3108, p = 0.0021, RR = 1.7444, p = 0.0034), Sibling as index case (OR = 0.6404, p = 0.0804, RR = 0.7520, p = 0.0806), lack of BCG vaccination (OR = 1.7763, p = 0.0271, RR = 1.4338, p = 0.0247) malnutrition (OR = 1.8980, p = 0.0138, RR = 1.5166, p = 0.0159) and lower socioeconomic status (OR = 3.2399, p Conclusion The high case detection rate by screening symptomatic household contacts shows MDR-TB is highly transmissible and household contacts are at a higher risk of developing active disease. It provides an opportunity for early diagnosis, adequate treatment, and interrupt the chain of transmission. Identifying risk factors help prevent the progression of latent TB infection to active disease.

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was

Lung cancer is posing an ever-increasing medical and social problem due to its increasing morbidity and mortality. Here we report a case of a young male who was being treated as tubercular pleural effusion but was ultimately diagnosed with non-small cell carcinoma. While considering the diagnosis of pleural effusion, in the context of country endemic for tuberculosis like India, it is not surprising that many clinicians rather prefer to consider pulmonary tuberculosis as the first differential, while keeping diagnosis of malignancy as the least likely differential diagnosis in the young patient.

Benign mediastinal teratomas often discovered while patients are still asymptomatic. Almost all arise in the anterosuperior mediastinal compartment. Most symptoms result from compression of adjacent structures. We report a case of a large teratoma arising from the anterior mediastinum that presented a confusing clinical picture of loculated pleural effusion which was successfully diagnosed and treated by surgical excision.

A 59-year-old married male, a known case of line probe assay-confirmed multidrug-resistant pulmonary tuberculosis was treated with kanamycin, levofloxacin, ethionamide, ethambutol, pyrazinamide and cycloserine for seven months [...]

A 62 year old male non-smoker diagnosed with pulmonary nocardiosis was initiated on Cotrimoxazole therapy at a dose of 20 mg/kg per day in three divided doses. He developed hyponatremia (serum sodium 105 mEq/L) on day 3 of therapy. The potential causes of hyponatremia were evaluated. After ruling out other causes, the cause was suspected to be Cotrimoxazole-induced syndrome of inappropriate anti-diuretic hormone secretion (SIADH). We subsequently re-initiated therapy with Cotrimoxazole and the hyponatremia (serum sodium 110 mEq/L) recurred. Upon discontinuation of therapy, serum sodium levels returned to normal. The patient was started on Amoxycillin-Clavulanic Acid as an alternative therapy for pulmonary nocardiosis which resulted in resolution of the hyponatremia. Cotrimoxazole-induced SIADH is a rare occurrence. This case is representative of a patient with Cotrimoxazole-induced SIADH and the causal relationship was confirmed once resumption of therapy with the offending medi-cation resulted in hyponatremia. Clinicians should be aware of this rare adverse effect of Cotrimoxazole and should monitor serum electrolytes during therapy, especially in the elderly and in those receiving high doses.

A 31-year-old, married female was admitted with complaints of sudden-onset shortness of breath and dry cough since that morning. It was not associated with chest tightness, wheezing or pleuritic chest pain. There was no history of fever, running nose or haemoptysis. The patient had undergone lower-segment caesarean section 2 weeks previously and had reduced mobility since then. She was known to have hypothyroidism for the past 3 years, which was well controlled on thyroxine. On admission, the patient had a respiratory rate of 30 per min, pulse rate of 130 per min, blood pressure of 110/70 mmHg and oxygen saturation by finger pulse oximetry of 89% on room air. Arterial blood gases on ambient air revealed pH of 7.48, carbon dioxide tension of 30 mmHg, oxygen tension of 58 mmHg and bicarbonate of 22 mEq·L−1. Chest radiography did not reveal any significant abnormality. ECG revealed sinus tachycardia, right-axis deviation and T-wave inversion in leads V1–V4., Management of pulmonary embolism in post partum females is a challenge. Lower segment caesarean section in past 3 weeks is a contraindication to systemic thrombolysis. Heparin, fondaparinux and warfarin can be safely used in breast-feeding mothers. http://bit.ly/39Nr7qY

Parenteral anticoagulation is recommended for patients of intermediate - high early mortality risk pulmonary embolism. Rescue reperfusion is considered if signs of hemodynamic decompensation appear. Recent surgery is a contraindication to thrombolysis. Percutaneous catheter directed thrombolysis and surgical embolectomy can be done in such patients. However, they are not readily available. We hereby report a case of rescue thrombolysis in a post lower segment caesarean section (LSCS) patient with pulmonary thromboembolism. We could successfully achieve thrombolysis in our patient with improvement in clinical and hemodynamic parameters and with no major bleeding from any site.

A 25-year-old male is admitted with complaints of dry cough for the past 5 years, and increased thirst, urinary frequency and output for the past 18 months. He also complains of shortness of breath on climbing a flight of stairs, and itchy lesions on the scalp and back for the past 2–3 months. There is no history of bone pain or abdominal pain. He has history of bilateral recurrent pneumothoraxes, twice on the right and once on the left side, in the past month. Pleurodesis with povidone iodine is performed on left side and the patient is transferred to your hospital with persistent right pneumothorax with air leak, with an intercostal drainage tube in situ. The patient is a never-smoker with no family history of pneumothorax. On general examination, he has small papules, 1–2 mm in diameter, with scaling over scalp and back. Onycholysis, onychoschisis and subungual splinter haemorrhages are present (figure 1)., The causes of cystic lung diseases are varied. Proper evaluation is required for appropriate management. http://bit.ly/37J7dvE

Malignant pleural effusions are one of the leading causes of exudative pleural effusions. We studied the clinical profile of patients presenting with malignant pleural effusion, their cytological and histopathological features and the efficacy of pleurodesis in preventing recurrence.100 patients who were positive for malignant cells in pleural fluid cytology or pleural biopsy were recruited. After history and clinical examination, Chest radiographs, Computed tomography of chest were performed. After diagnostic thoracocentesis and Pleural biopsy, Tube thoracostomy was done. Pleurodesis was performed in 40 patients.Most of the patients (65%) were in the age group of 61 to 70 years with a male to female ratio of 1.5:1. Most common presenting symptoms were breathlessness (86%) and cough (86%). All (100%) of the malignant pleural effusions were exudative. Pleural fluid cytology was positive in 86% while pleural biopsy was positive only in 44%. Pleural biopsy was positive only in 17% of patients with negative cytology. Adenocarcinoma (59%) was the most common type of cytological diagnosis. Pleurodesis was performed in 40 patients of which 30% had recurrence.In our tertiary health care centre, malignant pleural effusions presented as large pleural effusions. Most common presenting symptoms were breathlessness and cough. They were exudative, lymphocytic predominant with low ADA levels. Thoracocentesis and cytologic study should be the initial diagnostic approach to malignant pleural effusions. Adenocarcinoma of the lung was the most common cause of malignant pleural effusion. Pleurodesis with oxytetracycline was successful in majority of cases.

BACKGROUND: Drug resistant Tuberculosis is a major public health issue in India. Revised National Tuberculosis Programme (RNTCP) has launched Programmatic Management of Drug Resistant Tuberculosis (PMDT) in the year 2010 in Mumbai India which provides standardized treatment regimen for 24 months associated with various drug side-effects. AIMS & OBJECTIVES: To monitor the levels of TSH at end of Intensive phase (IP) (6-9) & Continuation phase (CP) (18-24) months. To study the effect of raised TSH on outcome. METHODOLOGY: Retrospective & Prospective (Descriptive Longitudinal). Blood was collected at the initiation of treatment; end of IP and at the end of treatment. TSH was measured using ultrasensitive sandwich chemiluminescent immunoassay. RESULTS: 4.2% cases had Serum TSH level ≥ 5.5 mcIU/ml at baseline. At IP to CP & End of treatment, proportion of cases with Serum TSH level ≥ 5.5 mcIU/ml showed a statistically significant rise (p=0.001) from baseline (4.2% to 30.3% at end of IP and 42.8% at end of CP). The study reveals that 64.3% cases treated with combination of PAS & Ethionamide had Hypothyroidism which was significantly more as compared to 28.2% cases treated with Ethionamide alone. Amongst 31 HIV-TB patients, baseline TSH was raised in 3 patients; 6 in IP and 5 in CP. Of the 124 patients with raised TSH, 75.8% were cured. CONCLUSIONS: 4.2% had subclinical hypothyroidism at baseline. There was serial increase in TSH from baseline at end of intensive phase and further at the end of treatment. The increase in TSH was more common with combination of Ethionamide and PAS than with Ethionamide alone. There was no change in the outcome of culture conversion in those with drug induced hypothyroidism.

Objective A thirty five year-old male presented with cough, fever and anorexia since two months and sudden increase in shortness of breath three days back. Chest radiograph showed bilateral miliary mottling with bilateral pneumothorax. Patient was managed with bilateral intercostal drainage tube and anti-tubercular treatment. However patient did not adhere to advised regular follow-up and died six months after starting anti-tubercular treatment.

Extraosseous ewings sarcoma is an extremely rare neuroectodermal tumour. We report the case of a 30-year-old female who presented with right sided pulmonary mass. Radiology, histopathology and immunohistochemistry confirmed the diagnosis of primary pulmonary Ewings sarcoma. This case highlights the fact that Ewings sarcoma should be considered in differential diagnosis of patients presenting with pulmonary mass.