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Introduction: Tuberculosis (TB) is an important cause of morbidity and mortality among people living with HIV (PLHIV). Current WHO-recommended strategies for diagnosing TB among hospitalized PLHIV rely on symptom screening and disease severity to assess eligibility for urine lipoarabinomannan lateral flow (LF-LAM) and molecular testing. Despite these recommendations, autopsy studies show a large burden of undiagnosed TB among admitted PLHIV. The EXULTANT trial aims to assess the impact of an expanded screening strategy using three specimens (sputum, stool, and urine) for TB diagnosis among PLHIV admitted to hospitals in two high HIV and TB burden African countries. Methods: This is a multicenter, pragmatic, individually randomized controlled trial conducted across eleven hospitals in Tanzania and Mozambique. Participants in the intervention arm will be tested with Xpert MTB/RIF Ultra® from expectorated sputum, stool, and urine samples, with additional urine LF-LAM testing in the first 24 h after hospital admission, irrespective of the presence of the symptoms. The control arm will implement the WHO standard of care recommendations. Hospitalized adults (≥ 18 years) with a confirmed HIV-diagnosis, irrespective of antiretroviral (ART) therapy status or presence of TB symptoms will be assessed for eligibility at admission. Patients with a pre-existing TB diagnosis, those receiving anti-tuberculosis therapy or tuberculosis preventive treatment in the 6 months prior to enrolment, and those transferred from other hospitals will not be eligible. Also, participants admitted for traumatic reasons such as acute abdomen, maternal conditions, scheduled surgery, having a positive SARS-CoV2 test will be ineligible. The primary endpoint is the proportion of participants with microbiologically confirmed TB starting treatment within 3 days of enrolment. Discussion: The EXULTANT trial investigates rapid implementation after admission of a new diagnostic algorithm using Xpert MTB/RIF Ultra® in several non-invasive specimens, in addition to LF-LAM, in hospitalized PLHIV regardless of TB symptoms. This enhanced strategy is anticipated to detect frequently missed TB cases in this population and is being evaluated as an implementable and scalable intervention. Trial registration: Trial reference number: NCT04568967 (ClinicalTrials.gov) registered on 2020–09-29. [ABSTRACT FROM AUTHOR]

This clinical case presents an unusual case of Lemierre's syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist's opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre's syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region. [ABSTRACT FROM AUTHOR]

Patients with Mycobacterium avium complex pulmonary disease (MAC-PD) often suffer from chronic symptoms such as sputum production, which reduces quality of life. Oscillatory positive expiratory pressure (OPEP) devices are used in physiotherapy to promote the clearance of respiratory secretions. We report two cases of improved lung function and improved scores on the Leicester Cough Questionnaire (LCQ) and the Breathlessness, Cough and Sputum Scale (BCSS) after the use of OPEP in patients with MAC-PD where treatment with guideline-based therapy, including amikacin liposome inhalation suspension, had proved ineffective for symptoms. Use of OPEP might maximize the efficacy of therapy and thereby improves outcomes in patients with MAC-PD. It is important to use both guideline-based therapy and OPEP, especially in patients whose health-related quality of life is affected by sputum symptoms. Further prospective studies are warranted to assess the benefit of adding OPEP to guidelines concerning therapy for patients with MAC-PD and sputum symptoms. [ABSTRACT FROM AUTHOR]

Background: In 2022, fewer than half of persons with tuberculosis (TB) had access to molecular diagnostic tests for TB due to their high costs. Studies have found that the use of artificial intelligence (AI) software for chest X-ray (CXR) interpretation and sputum specimen pooling can each reduce the cost of testing. We modeled the combination of both strategies to estimate potential savings in consumables that could be used to expand access to molecular diagnostics. Methods: We obtained Xpert testing and positivity data segmented into deciles by AI probability scores for TB from the community- and healthcare facility-based active case finding conducted in Bangladesh, Nigeria, Viet Nam, and Zambia. AI scores in the model were based on CAD4TB version 7 (Zambia) and qXR (all other countries). We modeled four ordinal screening and testing approaches involving AI-aided CXR interpretation to indicate individual and pooled testing. Setting a false negative rate of 5%, for each approach we calculated additional and cumulative savings over the baseline of universal Xpert testing, as well as the theoretical expansion in diagnostic coverage. Results: In each country, the optimal screening and testing approach was to use AI to rule out testing in deciles with low AI scores and to guide pooled vs individual testing in persons with moderate and high AI scores, respectively. This approach yielded cumulative savings in Xpert tests over baseline ranging from 50.8% in Zambia to 57.5% in Nigeria and 61.5% in Bangladesh and Viet Nam. Using these savings, diagnostic coverage theoretically could be expanded by 34% to 160% across the different approaches and countries. Conclusions: Using AI software data generated during CXR interpretation to inform a differentiated pooled testing strategy may optimize TB diagnostic test use, and could extend molecular tests to more people who need them. The optimal AI thresholds and pooled testing strategy varied across countries, which suggests that bespoke screening and testing approaches may be needed for differing populations and settings. [ABSTRACT FROM AUTHOR]

Background: Most cases of chronic empyema are caused by acute thoracic empyema or tuberculous pleuritis. Open thoracotomy and decortication are traditional treatments for chronic empyema. However, some cases, such as those with thick calcifications around a large cavity, may be difficult to decorticate in a single surgery. We successfully treated a case of chronic empyema with a large cavity surrounded by a thick calcified membrane that was peeled off gradually each day through fenestration of the thoracic cavity with negative-pressure wound therapy (NPWT). Case presentation: The patient was a 47-year-old man who had undergone thoracic drainage for left post-pneumonia empyema at another hospital 10 years previously. He presented to our hospital with a fever of 39 °C, bloody sputum, and severe fatigue for 3 days. Computed tomography showed a 9-cm mass shadow in the left intralobar space and an adjacent 21 × 15 × 9-cm fluid-filled calcified unilocular cavity up to 5 mm in thickness. He underwent thoracic drainage for fluid, and empyema was suspected; the fluid was foul-smelling and purulent. The patient did not improve with antibiotics and intrathoracic lavage; therefore, thoracoscopic decortication was performed. The thoracic cavity had a thick calcified membrane filled with dark-red slurry resembling old blood. We attempted decortication; however, the calcified membrane was difficult to remove. Two drains were used for the pleural lavage. However, no improvement was observed with intrathoracic lavage and drainage; therefore, a fenestration was performed. The calcified membrane was peeled off each day for 3 months. Gradually, granulation increased and the inflammatory reaction improved. After NPWT, the empyema cavity gradually shrank to 8 cm × 6 cm × 2 cm. A latissimus dorsi flap closure was performed, and the patient was discharged. Conclusions: This is an informative report on the daily decortication of a highly calcified purulent membrane using NPWT in a patient with chronic empyema. The description of this method will aid in the management of patients with chronic empyema and thick calcified membranes. [ABSTRACT FROM AUTHOR]

Access to distal airway samples to assess respiratory diseases is not straightforward and requires invasive procedures such as bronchoscopy and bronchoalveolar lavage. The particles in exhaled air (PExA) device provides a non-invasive means of assessing small airways; it captures distal airway particles (PEx) sized around 0.5–7 μm and contains particles of respiratory tract lining fluid (RTLF) that originate during airway closure and opening. The PExA device can count particles and measure particle mass according to their size. The PEx particles can be analysed for metabolites on various analytical platforms to quantitatively measure targeted and untargeted lung specific markers of inflammation. As such, the measurement of distal airway components may help to evaluate acute and chronic inflammatory conditions such as asthma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, and more recently, acute viral infections such as COVID-19. PExA may provide an alternative to traditional methods of airway sampling, such as induced sputum, tracheal aspirate, or bronchoalveolar lavage. The measurement of specific biomarkers of airway inflammation obtained directly from the RTLF by PExA enables a more accurate and comprehensive understanding of pathophysiological changes at the molecular level in patients with acute and chronic lung diseases. [ABSTRACT FROM AUTHOR]

Sputum induction is widely used in clinical settings for collection of biological samples from the lower airways. However, in recent years sputum induction has been associated with serious adverse events and even death. This position statement was commissioned by the Thoracic Society of Australia and New Zealand to address major adverse events of two deaths associated with sputum induction that have occurred in Australia in 2021, and outlines best practice for the safe use of sputum induction. The statement resulted from systematic literature searches by a multi‐disciplinary group including respiratory physicians, nurses and physiotherapists (paediatric and adults focused). Consumers had input to an advanced draft of the position statement. The position statement covers indications for sputum induction, informed consent, scope of practice of personnel administering the procedure, infection control considerations, details about the sputum induction procedure, safety considerations and risk assessment in clinical settings. [ABSTRACT FROM AUTHOR]

Background: While the association between vitamin D and several inflammatory biomarkers in asthma patients has been extensively reported, it remains unclear whether supplementation modifies these biomarkers. This review aims to evaluate the impact of vitamin D supplementation on inflammatory biomarkers measured in vivo in individuals with asthma. Methods: We conducted a systematic review of randomized controlled trials (RCTs) published until November 2022 in six electronic databases evaluating the impact of vitamin D supplementation (any dose, form, administration route, frequency, or duration) compared to placebo in children or adults. The two co-primary outcomes were serum IgE and blood eosinophils reported at the endpoint. Secondary outcomes included other markers of type 2 inflammation (e.g., sputum eosinophils, fractional exhaled nitric oxide, etc.), anti-inflammatory biomarkers (e.g., interleukin (IL)-10, etc.), markers of non-type 2 inflammation (e.g., high-sensitivity C-reactive protein, etc.), and non-specific biomarkers (e.g., macrophages, etc.). Data were aggregated using fixed or random effect models. Results: Thirteen RCTs (5 in adults, 5 in pediatric patients, and 3 in mixed age groups) testing doses of vitamin D supplementation ranging from 800 to 400,000 IU over periods of 6 weeks to 12 months were included. Eight studies provided data on serum IgE and four on blood eosinophils. As secondary outcomes, three studies reported on sputum eosinophils, four on FeNO, five on serum IL-10, and two on airway IL-10. Compared to placebo, vitamin D supplementation had no significant effect on serum IgE (Mean difference [MD] [95% CI]: 0.06 [-0.13, 0.26] IU/mL), blood eosinophils (MD [95% CI]: - 0.02 [-0.11, 0.07] 103/mL), or FeNO (MD [95% CI]: -4.10 [-10.95, 2.75] ppb) at the endpoint. However, the vitamin D supplementation group showed higher serum IL-10 levels compared to placebo (MD [95% CI]: 18.85 [1.11, 36.59] pg/ml) at the endpoint. Although data could not be aggregated, narrative synthesis suggested no significant effect of supplementation on sputum eosinophils and IL-10 in both sputum and exhaled breath condensate, at the endpoint. Conclusion: Vitamin D supplementation in individuals with asthma was not associated with lower inflammatory biomarkers related to type 2 inflammation. However, it was significantly associated with higher serum IL-10 compared to placebo. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022365666. [ABSTRACT FROM AUTHOR]

Background: It has been recently recognized that pulmonary cyst may develop after pulmonary resection, causing various symptoms. Most previously reported cases were after upper lobectomy in patients with chronic obstructive lung disease (COPD). Case presentation: Case 1 was a man in his 70 s with interstitial pneumonia (IP). Right lower lobectomy was performed for metastatic lung tumor using video-assisted thoracoscopic surgery (VATS). On postoperative day (POD) 19, computed tomography (CT) revealed a large cyst at the upper interlobular surface of the middle lobe, with pneumoderma and pneumomediastinum. The cyst was incised, polyglycolic acid (PGA) sheet and fibrin glue were applied, and the cyst was sutured. The sutured line was covered again with PGA sheet and fibrin glue. Case 2 was a man in his 70 s with COPD. Right upper lobectomy for primary lung cancer was performed using VATS. On POD 17, CT revealed a large pulmonary cyst at the apex of S6 and massive air leakage was observed. The same surgical procedure as that used in case 1 was performed. Cases 3 and 4 were healthy donors for living-donor lung transplantation. Two months after the right lower lobectomy in Case 3 and 3 months after the left lower lobectomy in Case 4, the patients had respiratory symptoms such as dyspnea and hemosputum. CT revealed a large cyst on the diaphragmatic surface of the right middle lobe in Case 3 and on the posterior mediastinal surface of the left upper lobe in Case 4. Cyst incision, soft coagulation, and application of PGA sheet with fibrin glue were performed in both cases. CT performed 1 year after surgery showed no development of a pulmonary cyst or air space in these four cases. Conclusions: Pulmonary cysts newly formed after lobectomy can develop not only in COPD or IP but also in healthy lungs. Our findings suggest that incision of the cyst and application of fibrin glue and PGA sheet with or without suturing the cyst wall is effective for management. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of the study was to evaluate pulmonary sequestration (PS). We report on location, blood supply, histology, clinical manifestation, and surgical treatment of PS, as well as on postoperative course in patients with PS. BACKGROUND: PS is a rare congenital defect of the lower respiratory tract, it represents locus minoris resistentiae of the body. Occasionally, PS is diagnosed for the first time in adulthood. METHODS: We evaluated 7 cases of PS treated at the Centre of Thoracic Surgery in Vyšné Hágy, Slovakia, between years 2013 and 2020. RESULTS: Four of our seven patients were asymptomatic; the PS was found incidentally upon chest imaging. Three patients had recurrent bronchopneumonia related specifically to the intralobar type of sequestration. The most significant complication, observed in a singular patient, was a life-threatening episode of haemoptysis, requiring urgent surgical intervention. In the other 6 cases, the sequestra were surgically resected during the period when they were asymptomatic. and their sputum was confirmed negative upon microbiological examination. Anatomical resection of the affected pulmonary lobe by thoracotomy was the most common type of operation performed (4 cases, n = 7). There was no surgical mortality. CONCLUSION: To prevent complications, it is crucial to perform surgical treatment for pulmonary sequestration in patients who have sufficient functional capacity. [ABSTRACT FROM AUTHOR]

Introduction: Schistosomiasis is a significant public health concern, especially in Sub-Saharan Africa. Conventional microscopy is the standard diagnostic method in resource-limited settings, but with limitations, such as the need for expert microscopists. An automated digital microscope with artificial intelligence (Schistoscope), offers a potential solution. This field study aimed to validate the diagnostic performance of the Schistoscope for detecting and quantifying Schistosoma haematobium eggs in urine compared to conventional microscopy and to a composite reference standard (CRS) consisting of real-time PCR and the up-converting particle (UCP) lateral flow (LF) test for the detection of schistosome circulating anodic antigen (CAA). Methods: Based on a non-inferiority concept, the Schistoscope was evaluated in two parts: study A, consisting of 339 freshly collected urine samples and study B, consisting of 798 fresh urine samples that were also banked as slides for analysis with the Schistoscope. In both studies, the Schistoscope, conventional microscopy, real-time PCR and UCP-LF CAA were performed and samples with all the diagnostic test results were included in the analysis. All diagnostic procedures were performed in a laboratory located in a rural area of Gabon, endemic for S. haematobium. Results: In study A and B, the Schistoscope demonstrated a sensitivity of 83.1% and 96.3% compared to conventional microscopy, and 62.9% and 78.0% compared to the CRS. The sensitivity of conventional microscopy in study A and B compared to the CRS was 61.9% and 75.2%, respectively, comparable to the Schistoscope. The specificity of the Schistoscope in study A (78.8%) was significantly lower than that of conventional microscopy (96.4%) based on the CRS but comparable in study B (90.9% and 98.0%, respectively). Conclusion: Overall, the performance of the Schistoscope was non-inferior to conventional microscopy with a comparable sensitivity, although the specificity varied. The Schistoscope shows promising diagnostic accuracy, particularly for samples with moderate to higher infection intensities as well as for banked sample slides, highlighting the potential for retrospective analysis in resource-limited settings. Trial registration: NCT04505046 ClinicalTrials.gov. Author summary: Assessment of schistosomiasis control programs is a crucial step to understanding the success rate of these control programs. The Schistoscope: an AI-powered automated digital microscope could overcome the limitations of conventional microscopy in endemic resource limited settings as well as in settings lacking microscopy experts. In this study, we carried out an extensive validation of the Schistoscope's diagnostic performance for diagnosis of urogenital schistosomiasis compared to conventional microscopy as well as more accurate diagnostic tests such as real-time PCR and the up-converting particle (UCP) lateral flow (LF) test for the detection of circulating anodic antigen (CAA) on freshly collected urines. We also assessed the performance of the Schistoscope for the diagnosis of schistosomiasis on banked sample slides, using a simple and sustainable storage method, for approximately two years. Having a tool that can prospectively and retrospectively analyse samples in an easy and sustainable way could facilitate schistosomiasis control programs in settings with little or no access to microscopists. Overall, we found the Schistoscope to be as good as conventional microscopy for the diagnosis of schistosomiasis, and given its downstream advantages of digital health, it would serve as a valuable diagnostic/screening tool in resource limited endemic settings. [ABSTRACT FROM AUTHOR]

Background: Based on the theme of World Tuberculosis (TB) Day 2018—"Wanted Leaders for TB free world," various studies and country-level project have witnessed how training leaders on TB has helped enhance TB awareness in the community. This study was conducted to evaluate the effectiveness of Advocacy Communication and Social Mobilization (ACSM) intervention strategy through key community leaders, using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Materials and Methods: This study was undertaken by the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry, in the field practice area of Primary Health Centre (PHC), Thirubuvanai. The STOP TB, ENGAGE-TB, and National TB Elimination Program (NTEP) guidelines were used for interventions. Key community leaders (KCL) list (N = 117) was obtained from Mannadipet commune panchayat and PHC. The study was conducted in four phases: phase 1 (baseline): quantitative data: proportion of presumptive TB cases from notification register; phase 2 (intervention): training program for staff nurses, auxiliary nurse midwife (ANM), Accredited Social Health Activist (ASHA), and Anganwadi workers (group activity), participatory rural appraisal (PRA) activity for self-help group (SHG) leaders, and health education session for religious leaders and ex-panchayat leaders; phase 3: strengthening of ongoing activity: health education session and active case finding for TB; and phase 4: end line: outcome of the intervention, evaluated using the RE-AIM framework. Results: As an outcome of the intervention, there was a marginal increase (21 cases) in the proportion of presumptive TB cases when comparing before (2018) and after (2019) intervention. The proportion of presumptive TB cases identified and referred by KCL was 312. A total of 77 presumptive TB cases were identified through community-based active case finding (ACF). Two sputum samples (on the spot early morning) were collected and sent for Cartridge-based nucleic acid amplification testing (CBNAAT), of which three cases were positive. Conclusion: This study was community led and involved leaders from diverse backgrounds, optimizing the chance of success. For sustainability, we have initiated TB support group. [ABSTRACT FROM AUTHOR]

Achromobacter xylosoxidans is a common bacterium that rarely causes pneumonia. Determining whether A. xylosoxidans is the cause of lung infection in patients suspected of having chronic infectious lung disease is challenging because it can present with colonization. We report a case of a 56‐year‐old immunocompetent woman suspected of having non‐tuberculous mycobacteria (NTM) infection on imaging examination and monitored for 3 years. Sputum examinations revealed A. xylosoxidans several times, and it was determined to be a colonization. A. xylosoxidans was isolated from bronchial lavage fluid and aspirated sputum, but no evidence of NTM was observed. She was diagnosed with A. xylosoxidans infection and given ceftazidime for 2 weeks. Her symptoms and imaging findings improved rapidly after treatment, without recurrences. A. xylosoxidans rarely causes chronic lower respiratory tract infections similar to NTM in immunocompetent patients. A. xylosoxidans may be a target for treatment when detected in lower respiratory tract specimens. [ABSTRACT FROM AUTHOR]

Background: Sputum examination is the gold standard for the diagnosis of pulmonary tuberculosis. However, individuals particularly children, the aged, and immunocompromised may not expectorate sputum due to some underlying conditions. Moreover, sputum produces infectious aerosols which exposes both the patients and care giver. It is also difficult to standardize sputum specimen for Mycobacterium tuberculosis. Therefore, the present study considered alternative specimen for pulmonary tuberculosis. Aim: To identify Mycobacterium tuberculosis in tongue swab. Methods: This was a cross-sectional laboratory-based study carried out in July-December 2022 on 384 tuberculosis patients attending health facilities in Karu, North central Nigeria. Using a multistage sampling technique, participants were added one at a time until the required sample size was gotten and analyzed via GeneXpert MTB/RIF. Performance of the tongue swab was compared to the combined reference standard of sputum XPERT. Results: The tongue swab XPERT ultra had a sensitivity of 78%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 97.4% relative to a sputum XPERT ultra reference standard. There were positive associations between the socio-demographic variables (age group, sex, family size, family type, marital status, religion, educational status, and occupation) and Mycobacterium tuberculosis infection. However, only the participant's educational status (p=0.027) and occupation (p=0.05) had statistically significant difference. Conclusion: Tongue swab is an alternate specimen for sputum-based molecular diagnosis for Mycobacterium tuberculosis. The procedure is less invasive, easier, and non-aerosol producing efficient alternate approach for pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Background: In 2020, the WHO-approved Molbio Truenat platform and MTB assays to detect Mycobacterium tuberculosis complex (MTB) and resistance to rifampicin directly on sputum specimens. This primary health care center-based trial in Mozambique and Tanzania investigates the effect of Truenat platform/MTB assays (intervention arm) combined with rapid communication of results compared to standard of care on TB diagnosis and treatment initiation for microbiologically confirmed TB at 7 days from enrolment. Methods: The Tuberculosis Close the Gap, Increase Access, and Provide Adequate Therapy (TB-CAPT) CORE trial employs a pragmatic cluster randomized controlled design to evaluate the impact of a streamlined strategy for delivery of Truenat platform/MTB assays testing at primary health centers. Twenty-nine centers equipped with TB microscopy units were selected to participate in the trial. Among them, fifteen health centers were randomized to the intervention arm (which involves onsite molecular testing using Truenat platform/MTB assays, process process optimization to enable same-day TB diagnosis and treatment initiation, and feedback on Molbio platform performance) or the control arm (which follows routine care, including on-site sputum smear microscopy and the referral of sputum samples to off-site Xpert testing sites). The primary outcome of the study is the absolute number and proportion of participants with TB microbiological confirmation starting TB treatment within 7 days of their first visit. Secondary outcomes include time to bacteriological confirmation, health outcomes up to 60 days from first visit, as well as user preferences, direct cost, and productivity analyses. Ethics and dissemination: TB-CAPT CORE trial has been approved by regulatory and ethical committees in Mozambique and Tanzania, as well as by each partner organization. Consent is informed and voluntary, and confidentiality of participants is maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals. Trial Registration: US National Institutes of Health's ClinicalTrials.gov, NCT04568954. Registered 23 September 2020. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence-based computer-aided detection (AI–CAD) for tuberculosis (TB) has become commercially available and several studies have been conducted to evaluate the performance of AI–CAD for pulmonary tuberculosis (TB) in clinical settings. However, little is known about its applicability to community-based active case-finding (ACF) for TB. Methods: We analysed an anonymized data set obtained from a community-based ACF in Cambodia, targeting persons aged 55 years or over, persons with any TB symptoms, such as chronic cough, and persons at risk of TB, including household contacts. All of the participants in the ACF were screened by chest radiography (CXR) by Cambodian doctors, followed by Xpert test when they were eligible for sputum examination. Interpretation by an experienced chest physician and abnormality scoring by a newly developed AI–CAD were retrospectively conducted for the CXR images. With a reference of Xpert-positive TB or human interpretations, receiver operating characteristic (ROC) curves were drawn to evaluate the AI–CAD performance by area under the ROC curve (AUROC). In addition, its applicability to community-based ACFs in Cambodia was examined. Results: TB scores of the AI–CAD were significantly associated with the CXR classifications as indicated by the severity of TB disease, and its AUROC as the bacteriological reference was 0.86 (95% confidence interval 0.83–0.89). Using a threshold for triage purposes, the human reading and bacteriological examination needed fell to 21% and 15%, respectively, detecting 95% of Xpert-positive TB in ACF. For screening purposes, we could detect 98% of Xpert-positive TB cases. Conclusions: AI–CAD is applicable to community-based ACF in high TB burden settings, where experienced human readers for CXR images are scarce. The use of AI–CAD in developing countries has the potential to expand CXR screening in community-based ACFs, with a substantial decrease in the workload on human readers and laboratory labour. Further studies are needed to generalize the results to other countries by increasing the sample size and comparing the AI–CAD performance with that of more human readers. [ABSTRACT FROM AUTHOR]

Schistosomiasis is a parasitic disease caused by trematodes (body flukes), affecting millions worldwide. However, its pulmonary manifestations are rare. We report a rare case of a 51-year-old People Living with HIV male, managed in a tertiary care hospital in west India in May 2023, vegetable vendor who was admitted with complaints of dysphagia, odynophagia, fever and chest pain for 3 days, cough and breathlessness for 1 month. Chest x-ray and CT scan were suggestive of hypodense fluid collection with rim enhancement along right lateral and posterior aspect of thoracic esophagus. All routine investigations and urine cultures were sent, which turned to be inconclusive. Upper Gastrointestinal scopy was suggestive of pangastritis. Fiberoptic bronchoscopy was done with no structural abnormality or endobronchial mass. Bronchoalveolar lavage from right lower lobe was sent for CBNAAT, Gram and Ziehl Nelson staining and cultures, acid fast bacilli cultures and cytology which revealed parasitic infection with Schistosoma haematobium. The patient was treated with tablet praziquantel P/O 2400 mg in divided doses for 1 day followed up after two weeks when he experienced reduced symptoms. Sputum examination was repeated showed Schistosoma on wet mount and hence a repeat dose of tablet praziquantel 3000 mg in divided doses was given and was advised to follow up 2 weeks later, which showed resolution of right lower zone opacities. [ABSTRACT FROM AUTHOR]

A 29-year-old man from Comoros presented with rapidly progressive paraplegia and sexual dysfunction. Magnetic resonance imaging (MRI) showed a contrast-enhanced conus medullaris lesion. Differential diagnoses included tumors, abscesses, and inflammatory diseases. Neurosurgery was delayed to complete examinations. Cerebral MRI showed three abscesses. Body computed tomography scan showed supracentimetric polyadenopathies, pulmonary nodules, prostatic lesion, and enhanced seminal vesicle, with hypermetabolism on positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose scan. Histology of lymph node biopsy showed granulomatous infiltration without acid-fast bacilli, and positive polymerase chain reaction for Mycobacterium tuberculosis. Lymph node culture was positive after 2 months, urine culture after 3 weeks, but cerebrospinal fluid and sputum cultures were negative. A 1-year antituberculosis therapy was initiated, associated with corticosteroids because the patient developed tuberculosis-immune reconstitution syndrome, revealed by the recurrence of neurological symptoms. After 2 months the patient completely recovered and could run. MRI showed stability of the voluminous tuberculoma with decrease of medullary edema. Avoiding surgery in those cases may prevent iatrogenic neurological deterioration. [ABSTRACT FROM AUTHOR]

Objective. To explore the clinical application of a new type of protective sputum suction device (PSSD) in patients with tracheotomy or tracheal intubation and to evaluate the protective effect of PSSD against cross-infection between medical staffs and patients. Methods. A novel PSSD was designed which can assist closed sputum suction operation without disconnecting the ventilator. 32 patients with tracheotomy were included to study the protective effect and safety of this device. Patients' vital signs including heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation were recorded to compare the influence of open suction and closed suction (performed with this novel device). To verify the antisplash effect of this device on airway secretions, bacterial samples were collected from the hands of the suction operators and the environment near the endotracheal tube orifice before and after the two suction processes. In addition, the satisfaction of the two suction methods was compared through the questionnaire of suction staff. Finally, with the assistance of this device, an attempt was made to complete the bronchoscopy without weaning of ventilator. Results. Compared with open sputum suction, closed sputum suction has a smaller decrease in patients' blood oxygen saturation (P < 0.05), and no significant differences in other vital signs. Compared with open sputum suction, bacteria from the hands of suction staffs and the surrounding environment of the endotracheal tube were barely detected in closed suction. A questionnaire survey of sputum suction nurses suggested that the satisfaction with use and protective effect of the closed suction were better than open suction. In addition, bronchoscopy can be successfully completed with the assistance of this device, which is not possible for other breathing tubes. Conclusion. This closed sputum suction device has little effect on the oxygen saturation of patients but has excellent protective effects for medical staff against cross-infection. It has a unique advantage that can assist in completing the fiberoptic bronchoscopy with continuous ventilator-assisted breathing. [ABSTRACT FROM AUTHOR]

INTRODUCTION- Tuberculosis (TB) is a chronic granulomatous infection principally caused by Mycobacterium TB and less frequently by ingestion of Mycobacterium bovis infected unpasteurized cow’s milk or by other atypical mycobacteria. It presents a great social and economic problem and is one of the major factors responsible for the high morbidity and mortality in India. The incidence of tuberculous cervical lymphadenopathy now accounts for two third of the extra pulmonary tuberculous lymphadenopathy. Most of these are supposed to be tuberculous in origin because of greater incidence of pulmonary tuberculosis in our country. At the same time there are other causes of lymph-adenopathy which are usually misdiagnosed as tuberculosis. It has been a common problem for both to clinicians as well as pathologist from to diagnose tuberculosis. Methos and materials- The present work is carried out in 100 clinically suspected cases of tuberculous cervical lymphadenitis attending E.N.T., Surgery, Paediatrics and Medicine Department of central India institute as an outdoor/indoor patient during the period of one year. Patients with enlarged cervical lymph nodes with a history suggestive of tuberculosis were included after taking an informed consent. Results- Study was done on 100 clinically suspected cases of tuberculous cervical lymphadenitis, Tuberculosis was diagnosed in 57% cases by FNAC, smear and culture together, the maximum incidence of tuberculosis was observed in second and third decades, Females were more affected (64%) than males with the ratio of 1:2.3. By FNAC 42% accuracy was obtained, 30% cases were AFB smear positive in our study this rate of incidence is nearer to other authors. In our culture study, 57 cases were diagnosed as tuberculous and 4 cases as non-tuberculous cervical lymphadenitis. Culture positive was higher in granulomatous necrotic lesions. Sensitivity, specificity and predictive values of culture study were significantly higher than FNAC and smear. These methods of investigation need considerable experience and confidence of a pathologist who perform the procedure for a better result. When culture was taken as Gold Standard, cytology was found to be more sensitive than smear. Conclusions – from this study we concluded that Both FNAC and smear are quick, simple, less traumatic and cost-effective methods and used as a routine investigating procedure in OPD of urban and semi-urban hospitals. Simplicity of these techniques (FNAC & Smear) combined with early availability of results and good diagnostic accuracy warrants their clinical application. Missed cytological diagnosis and isolation of non-tuberculous mycobacteria justify culture studies on all suspected tuberculous lymphadenitis cases. [ABSTRACT FROM AUTHOR]

Objective.To evaluate the application value of the fluorescence PCR probe melting curve (MeltPro) technique in the detection of isoniazid drug- resistance of Mycobacterium tuberculosis (MTB) in sputum samples. Methods.In this study, we collected sputum samples of PTB that were identified as MTB by GeneXpert MTB/RIF method(MTB positive) from 2021 to 2022. These sputum samples were detected including smear, Myco- bacterium culture, GenoType MTBDRplus,and isoniazid drug-resistance test by MeltPro technique. We did the proportional drug sensitivity test (DST) of isoniazid for culturing positive strains, analyzed the influence of the amount of bacteria in sputum samples on the results of MeltPro technique, compared the difference in the detection rate of isoniazid resistance by proportional DST, GenoType MTBDRplus, and MeltPro technique, The proportional DST results of isoniazid were used as a standard to evaluate the isoniazid drug-resistance detection efficiency of MeltPro technique and GenoType MTBDRplus. Results.157 qualified MTB positive sputum samples were collected, after Mycobacterium culture, we got 130 strains. The rate of success for isoniazid in sputum samples detected by MeltPro technique was84.1%(132/157). Among different grades of sputum smear results, there is a difference in the successful rate of MeltPro technique (H = 24.169,P = 0.000), increased with the grade of sputum smear results, the successful rate was increased from64.8% (32/54,the negative sputum)to 100.0%(17/176/6,the positive sputum grade 3+4+), the successful rate also increased with the increase of MTB grade detected by GeneXpert MTB/RIF, from54.8%(17/31,the very low sputum) to 96.4%(27/28,the high sputum)and the difference between each grade was statistically significant (H = 27.763,P = 0.000). The detection rate of isoniazid resistance using MeltPro technique, GenoType MTBDRplus and proportional DST were 22.0%(29/132),15.3%(19/124),14.6%(19/130), respectively. There was no statistically significant difference between the three methods (χ2 = 2.997,P = 0.223). Based on the results of proportional DST, the sensitivity, specificity, positive predictive value and negative predic- tive value of MeltPro technique in the detection of isoniazid were 84.6%(11/13)91.2%(93/102)55%(11/20) 97.9%(93/95), respectively, Kappa is 0.614. The sensitivity, specificity, positive predictive value and negative predictive value of GenoType MTBDRplus in the detection of isoniazid were 55.6%(10/18)92.3%(84/91), 58.8% (10/17), 91.3%(84/92),respectively, Kappa is 0.490. Conclusion.The MeltPro technique has high sensitivity and specificity in detecting MTB isoniazid resistance in sputum samples of pulmonary tuberculosis patients, and can quickly and accurately screen for isoniazid resistance in patients, To improve the success rate of testing, it is necessary to pay attention to the selection of sputum samples when promoting the application in grassroots laboratories. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the outcomes of patients who received early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy due to esophageal cancer. Methods: A prospective randomized clinical trial was performed between March 2020 and June 2022. Patients who were scheduled for thoracoscopic and laparoscopic esophagectomy due to esophageal cancer were enrolled. Then, these patients were assigned to the control group (traditional postoperative care) and study group (traditional postoperative care with early bronchoscopic sputum aspiration and lavage). The outcomes, which included the length of hospital stay and medical expenses, and postoperative complications, which included pulmonary infection, atelectasis, respiratory dysfunction and anastomotic leakage, were compared between these two groups. Results: A total of 106 patients were enrolled for the present study, and 53 patients were assigned for the control and study groups. There were no statistically significant differences in gender, age, and location of the esophageal cancer between the two groups. Furthermore, the length of hospital stay was statistically significantly shorter and the medical expenses were lower during hospitalization in the study group, when compared to the control group (12.3 ± 1.2 vs. 18.8 ± 1.3 days, 5.5 ± 0.9 vs. 7.2 ± 1.2 Chinese Yuan, respectively; all, P < 0.05). Moreover, there were statistically significantly fewer incidences of overall complications in study group, when compared to the control group (20.7% vs.45.2%, P < 0.05). Conclusions: For patients with esophageal cancer, early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy can shorten the length of hospital stay, and lower the medical expense and incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization advised bedaquiline for the treatment of extensively drug-resistant (XDR), pre-XDR and multidrug-resistant (MDR) tuberculosis (TB). Bedaquiline is now recommended for usage for at least six months throughout therapy, it is used to treat drug-resistant tuberculosis when other treatment modalities cannot be used. This drug shows good result in clinically relevant patient associated with drug resistant tuberculosis. Objective: Present study was aim to analyse effectiveness of bedaquiline treatment in patients with MDR, pre-XDR and XDR tuberculosis. We also aim to analyse the early culture conversion rate after starting bedaquiline treatment. Methods: Total 248 patients of which representing 160 patients with MDR and 88 patients with pre-XDR were included in the study. Sociodemographic data, outcome, HIV status, drug sensitivity, diagnosis and culture conversion rate were analysed. Results: There were 58.5% male and 41.5% female patients with mean age of 34.23 ± 15.42 years. Among total patients, 68.14% patients were cured whereas mortality observed in 21.4% patients. Total 46.4% patients exhibit resistance against isoniazid, 100% patients exhibit resistance against rifampicin and 43.5% patients exhibit resistance against fluoroquinolones. We found a significant linear declining trend in the positivity rate of sputum culture over a period of 24 months follow up which started declining from 3rd month & a significant drop after 8 months of treatment. Conclusion: Findings of present study are in consistent with the recommendations as per PMDT GUIDELINES 2021(Programmatic Management of Drug resistant Tuberculosis in India.)for the bedaquiline based drug resistant tuberculosis, which suggest a treatment of bedaquiline for6 months or longer showing the positive effect in sputum culture conversion & favourable effect on success rate as shown by pmdt guidelines. [ABSTRACT FROM AUTHOR]

Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception. Objective To increase awareness about the different clinical presentations of otorhinolaryngological, head and neck tuberculosis, the techniques employed to diagnose it, and to assess the response to the treatment. Methods We conducted a prospective study of 114 patients who presented primarily with otorhinolaryngological, head and neck tuberculosis. Routine blood investigations, chest radiographs, the tuberculin test, and sputum examination for the presence of acid-fast bacilli were performed in all cases. Site-specific investigations were performed in relevant cases only. The patients were treated according to the antitubercular treatment (ATT) regimen recommended by the Indian Ministry of Health and Family Welfare's National Tuberculosis Elimination Program (NTEP), and they were followed up clinically two and six months after starting the ATT. Results Tubercular cervical lymphadenopathy was the most common clinical presentation (85.96%), followed by deep neck abscess (5.27%). Fine-needle aspiration cytology proved to be a reliable tool for the diagnosis of tubercular lymphadenopathy. Improvement at the end of 2 and 6 months of the ATT was observed in 90.35% and 96.50% of the cases respectively. Conclusion The diagnosis of otorhinolaryngological, head and neck tuberculosis requires a high index of clinical suspicion, and the ATT proved to be very effective in reducing the severity of the disease. [ABSTRACT FROM AUTHOR]

Background: Pulmonary tuberculosis (PTB) diagnosis relies on sputum examination, a challenge in sputum-scarce patients. Alternative non-invasive sampling methods such as face mask sampling (FMS) have been proposed. Objective: To evaluate the value of FMS for PTB diagnosis by assessing its agreement with sputum samples processed by GeneXpert MTB/RIF (Ultra)(Xpert) testing, and describe FMS sensitivity and specificity. Methods: This was a prospective study conducted at the Carrière TB clinic in Guinea. Presumptive TB patients willing to participate were asked to wear a surgical mask containing a polyvinyl alcohol (PVA) strip for thirty minutes. Subsequently, two spot sputum samples were collected, of which one was processed by microscopy on site and the other by Xpert in Guinea's National Reference Laboratory of Mycobacteriology (LNRM). The first 30 FMS were processed at the Supranational Reference Laboratory in Antwerp, Belgium, and the following 118 FMS in the LNRM. Results: One hundred fifty patients participated, of whom 148 had valid results for both mask and sputum. Sputum smear microscopy was positive for 47 (31.8%) patients while sputum-Xpert detected MTB in 54 (36.5%) patients. Among the 54 patients testing sputum-Xpert positive, 26 (48.1%) yielded a positive FMS-Xpert result, while four sputum-Xpert negative patients tested positive for FMS and 90 patients were Xpert-negative for both sputum and mask samples, suggesting a moderate level of agreement (k-value of 0.47). The overall mask sensitivity was 48.1%, with 95.7% specificity. Conclusion: In our setting, Xpert testing on FMS did not yield a high level of agreement to sputum sample. [ABSTRACT FROM AUTHOR]

Epstein-Barr virus (EBV) frequently is measured at high levels in COPD using sputum quantitative polymerase chain reaction, whereas airway immunohistochemistry analysis has shown EBV detection to be common in severe disease. Is valaciclovir safe and effective for EBV suppression in COPD? The Epstein-Barr Virus Suppression in COPD (EViSCO) trial was a randomized double-blind placebo-controlled trial conducted at the Mater Hospital Belfast, Northern Ireland. Eligible patients had stable moderate-to-severe COPD and sputum EBV (measured using quantitative polymerase chain reaction) and were assigned randomly (1:1) to valaciclovir (1 g tid) or matching placebo for 8 weeks. The primary efficacy outcome was sputum EBV suppression (defined as ≥ 90% sputum viral load reduction) at week 8. The primary safety outcome was the incidence of serious adverse reactions. Secondary outcome measures were FEV 1 and drug tolerability. Exploratory outcomes included changes in quality of life, sputum cell counts, and cytokines. From November 2, 2018, through March 12, 2020, 84 patients were assigned randomly (n = 43 to valaciclovir). Eighty-one patients completed trial follow-up and were included in the intention-to-treat analysis of the primary outcome. A greater number of participants in the valaciclovir group achieved EBV suppression (n = 36 [87.8%] vs n = 17 [42.5%]; P <.001). Valaciclovir was associated with a significant reduction in sputum EBV titer compared with placebo (–90,404 copies/mL [interquartile range, –298,000 to –15,200 copies/mL] vs –3,940 copies/mL [interquartile range, –114,400 to 50,150 copies/mL]; P =.002). A statistically nonsignificant 24-mL numerical FEV 1 increase was shown in the valaciclovir group (difference, –44 mL [95% CI, –150 to 62 mL]; P =.41). However, a reduction in sputum white cell count was noted in the valaciclovir group compared with the placebo group (difference, 2.89 [95% CI, 1.5 × 106-7.4 × 106]; P =.003). Valaciclovir is safe and effective for EBV suppression in COPD and may attenuate the sputum inflammatory cell infiltrate. The findings from the current study provide support for a larger trial to evaluate long-term clinical outcomes. ClinicalTrials.gov; No.: NCT03699904; URL: www.clinicaltrials.gov [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Multiphasic screening with GeneXpert MTB/RIF and PHQ-9 is a solution for achieving successful conversion of intensive phase sputum examination. Purpose: To determine the effectiveness and feasibility of multiphasic screening for clinical symptoms and mental health in patients using the Tuberculosis Directly Observed Therapy (TB-DOTS) strategy. Methods: This study used a survey approach with a one-sample multiple testing screening method on the case finding and mental health of patients with TB. This screening was carried out in two stages: Stage I, suspected TB screening, and Stage II, mental health screening of TB patients undergoing intensive treatment (two months). Samples were taken from 160 TB suspects who came to health centers in Jambi City from August 1 to October 1, 2022, using proportionate stratified random sampling. Data were analyzed using statistical software to determine the accuracy and feasibility of screening. Results: Sputum conversion (Smear [-]) was 97.78% and the prevalence of mental health problems in patients was 22.22%. Stage I screening (suspected TB [GeneXpert MTB/RIF]): cough >2 weeks sensitivity, 94.84%; PPV, 97.35%; and accuracy, 92.50%. Stage II screening (patient mental health [PHQ-9]) with a validity of 9 items in the range of 0.17-0.66; ICC (interclass correlation coefficient [ICC], 0.60-0.83; Cronbach's α coefficient, 0.88). Multiphasic yield screening is recommended to achieve a better treatment success rate. Conclusion: Early detection of cases and mental health problems of TB patients in the early phase of treatment is a solution for developing a TB-DOTS strategy at first-level health facilities. [ABSTRACT FROM AUTHOR]

Background: Thirty-five laboratory-confirmed legionellosis cases were reported to the Simcoe Muskoka District Health Unit (Ontario, Canada) between September 27, 2022, and October 15, 2022, resulting in one death and 29 hospitalizations. This article describes the Legionella outbreak and highlights activities for managing the outbreak, including various environmental and infrastructural controls associated with the public health response and some of the unique challenges and potential solutions to mitigate future outbreaks. Methods: All cases of legionellosis were reported to and investigated by the local provincial health unit. Within a 6 km radius around the community, 27 cooling towers (CTs) were identified as potential sources of Legionella. Environmental samples were collected from 19 CTs and a long-term care home. Outcome: Of the 35 cases, 29 (83%) were hospitalized (including three long-term care residents) with two requiring intubation/ventilation. Of the five sputa (clinical isolates) collected from confirmed cases, four tested positive for Legionella pneumophila (one was positive for L. pneumophila serogroup 1—with the same sequence type as one of the CT isolates). Education and recommendations were provided by the local provincial health unit to operators to improve CT operation. Conclusion: Detection and management of community legionellosis outbreaks associated with CTs involve resources and time to properly identify and control risks. Measures for community risk mitigation included coordinating with provincial and community partners, developing methods to rapidly identify CTs as a likely source of infection and applying operational/ maintenance/testing standards for CTs to control bacterial growth and minimize the dispersion of contaminated aerosols. [ABSTRACT FROM AUTHOR]

Rationale: CFTR (cystic fibrosis transmembrane conductance regulator) dysfunction is associated with mucus accumulation and worsening chronic obstructive pulmonary disease (COPD) symptoms. Objectives: The aim of this phase IIb dose-finding study was to compare a CFTR potentiator, icenticaftor (QBW251), with placebo in patients with COPD and chronic bronchitis. Methods: Patients with COPD on triple therapy for at least three months were randomized to six treatment arms (icenticaftor 450, 300, 150, 75, or 25mg or placebo twice daily [b.i.d.]) in a 24-week, multicenter, parallel-group, double-blind study. The primary endpoint was change from baseline in trough FEV1 after 12weeks. Secondary endpoints included change from baseline in trough FEV1 and Evaluating Respiratory Symptoms in COPD (E-RS) total and cough and sputum scores after 24weeks. Multiple comparison procedure-modeling was conducted to characterize dose-response relationship. Rescue medication use, exacerbations, and change in serum fibrinogen concentration after 24weeks were assessed in exploratory and post hoc analyses, respectively. Measurements and Main Results: Nine hundred seventy-four patients were randomized. After 12weeks of icenticaftor treatment, no dose-response relationship for change from baseline in trough FEV1 was observed; however, it was observed for E-RS cough and sputum score. A dose-response relationship was observed after 24weeks for trough FEV1, E-RS cough and sputum and total scores, rescue medication use, and fibrinogen. A dose of 300mg b.i.d. was consistently the most effective. Improvements for 300mg b.i.d. versus placebo were also seen in pairwise comparisons of these endpoints. All treatments were well tolerated. Conclusions: The primary endpoint was negative, as icenticaftor did not improve trough FEV1 over 12weeks. Although the findings must be interpreted with caution, icenticaftor improved trough FEV1; reduced cough, sputum, and rescue medication use; and lowered fibrinogen concentrations at 24weeks. [ABSTRACT FROM AUTHOR]

A 53-year-old woman with no significant past medical history came to her local ED after a witnessed generalized tonic-clonic seizure. CT scan imaging of the head revealed a left frontal lobe hypodensity concerning for a mass with surrounding edema. In the previous month, she had undergone ambulatory evaluation for a subacute cough that had more recently become productive of bloody sputum. Outpatient chest radiography had demonstrated a new right lung opacity, shown on subsequent CT scan imaging to be a right upper lobe (RUL) consolidation. She was prescribed a course of doxycycline, after which sputum expectoration improved but a nonproductive cough remained. Repeat thoracic imaging was pending at the time the seizure occurred. The patient had no history of chronic lung disease or recurrent infections. There were no constitutional symptoms. She did not take any home medications on a regular basis. She was a lifetime nontobacco user. She denied use of alcohol and illicit drugs. She had previously worked in a medical office but was now spending most of her time helping her husband take care of their house and property in Kingston, New York, a town of about 23,000 people in the Hudson River Valley. She was born in the United States and had not traveled recently. She had no pets. There was no history of recent dental procedures. She was transferred to our institution for neurosurgical evaluation. [ABSTRACT FROM AUTHOR]

(D) Table showing the microbial detection number and rate in samples of oral rinse specimen (OR) and bronchoalveolar lavage specimen (BAL), as well as different BAL subgroups, including left lingular segment lung lobe specimen (L), right middle lung lobe specimen (R), healthy lung lobe specimen (H) and nodular lung lobe specimen (N), collected from general anaesthesia and local anaesthesia groups of subjects. gl Bacteriome was detected in all OR samples (100%) from both anaesthesia groups. Although general anaesthesia slightly enhanced mouth-lung microbial communication, likely through increased aspiration, similar mouth-lung microbial diversity and composition were observed under general and local anaesthesia strategies. Dear Editor, Bronchoscopy has become a well-established strategy for the diagnosis and treatment of lung diseases and is commonly used in pathological assessment and biopsy. [Extracted from the article]

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Background: Smear microscopy has remained the initial diagnostic test for presumptive tuberculosis (TB) patients in health facilities without the World Health Organization (WHO) recommended rapid diagnostic tools. In the Uganda TB laboratory network, the technique remains the only tool to monitor response to treatment among drug susceptible TB patients, with the country currently having over 1,600 microscopy TB testing units. It has been evidenced that acid-fast bacilli (AFB) microscopy's yield highly depends on the staining technique and reading ability of the laboratory personnel. For the quality of TB testing in the country, the TB control program set up a Randomized Blinded Rechecking (RBRC) program in 2008 to monitor the testing performance of laboratories to continuously improve the reliability and efficiency of results. This is the first study to determine the effectiveness and impact of the RBRC program on the performance of the participating laboratories in Uganda. Methods: This was a retrospective cross-sectional study based on a record review of the RBRC's annual results compilations between January 2008 and December 2017. Results: Between January 2008 and December 2017, a total of 265,523 smears were re-checked during the RBRC program. The number of enrolled laboratories in the RBRC program rose from 660 to 2008 to 1,406 in 2017. The RBRC program resulted in a statistically significant reduction in microscopy errors, with false positives decreasing from 12.8% to 2008 to 7.6% in 2017, false positive errors decreasing from 10 to 6.3%, false negative errors decreasing from 2.9 to 0.7%, quantification errors decreasing from 6.0 to 1.8%, and the overall sensitivity of smear microscopy compared to the controllers increased with statistical significance from 93 to 97%. Conclusion: The study reveals an overall significant error reduction and an improved sensitivity of smear microscopy upon continuous implementation of the RBRC program in an AFB microscopy TB laboratory network. Implementation of a RBRC program is crucial and essential to maintaining a reliable TB laboratory service that can facilitate accurate diagnosis and offset the disadvantages of using smear microscopy. [ABSTRACT FROM AUTHOR]

Background: To improve tuberculosis (TB) diagnosis, the World Health Organisation (WHO) has called for a non-sputum based triage test to focus TB testing on people with a high likelihood of having active pulmonary tuberculosis (TB). Various host or pathogen biomarker-based testing devices are in design stage and require validity assessment. Host biomarkers have shown promise to accurately rule out active TB, but further research is required to determine generalisability. The TriageTB diagnostic test study aims to assess the accuracy of diagnostic test candidates, as well as field-test, finalise the design and biomarker signature, and validate a point-of-care multi-biomarker test (MBT). Methods: This observational diagnostic study will evaluate sensitivity and specificity of biomarker-based diagnostic candidates including the MBT and Xpert® TB Fingerstick cartridge compared with a gold-standard composite TB outcome classification defined by symptoms, sputum GeneXpert® Ultra, smear and culture, radiological features, response to TB therapy and presence of an alternative diagnosis. The study will be conducted in research sites in South Africa, Uganda, The Gambia and Vietnam which all have high TB prevalence. The two-phase design allows for finalisation of the MBT in Phase 1 in which candidate host proteins will be evaluated on stored serum from Asia, South Africa and South America and on fingerstick blood from 50 newly recruited participants per site. The MBT test will then be locked down and validated in Phase 2 on 250 participants per site. Discussion: By targeting confirmatory TB testing to those with a positive triage test, 75% of negative GXPU may be avoided, thereby reducing diagnostic costs and patient losses during the care cascade. This study builds on previous biomarker research and aims to identify a point-of-care test meeting or exceeding the minimum World Health Organisation target product profile of a 90% sensitivity and 70% specificity. Streamlining TB testing by identifying individuals with a high likelihood of TB should improve TB resources use and, in so doing, improve TB care. Trial registration: NCT04232618 (clinicaltrials.gov) Date of registration: 16 January 2020. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. Methods: A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow‐up ranged from 18 to 66 months. Results: Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow‐up period. Systemic‐pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non‐recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self‐limiting. Conclusions: BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic‐pulmonary shunts and clinical failure are the risk factors for recurrence. [ABSTRACT FROM AUTHOR]

The authors report a clinical case of a 15-year-old female patient with a giant pulmonary hydatid cyst that was diagnosed only after rupture and successfully operated. The patient suffered a minor trauma during gym class, and a short time after the trauma she vomited profusely with a large amount of colorless fluid. Subsequently, her condition worsened, with fatigue, severe pain in the right hemithorax, severe cough with poor sputum, dyspnea and unspoken hemoptysis, so she was admitted to the hospital. After admission, a CT scan confirmed the diagnosis of pulmonary hydatid cyst complicated by endobronchial rupture with subtotal involvement of the right lower lobe. The patient underwent surgery by right lateroposterior thoracotomy. After removal of the parasitic larvocyst, the remaining postechinococcectomy cavity was padded. In the postoperative period, partial insufficiency of the padding sutures was observed, which was treated conservatively. The authors conclude that echinococcectomy with silver nitrate treatment of the residual cavity and filling with superimposed bursae in giant pulmonary hydatid cyst complicated by endobronchial rupture is an effective technical procedure that allows to reduce postoperative morbidity and hospitalization time in this serious complication. [ABSTRACT FROM AUTHOR]

Background: 1.To determine the efficacy of shorter oral BDQ regimen in patients of MDR-TB/RRTB in terms of treatment outcome. 2. To determine the prevalence of MDR-TB/RR-TB based on age and gender 3. To study the resistance patterns and its association with comorbidities. Material And Methods: This is a retrospective study of 50 patients conducted from August 2021 to December 2022. Patient data sputum AFB and CBNAAT, sputum culture conversion, comorbidities, resistance pattern, age and gender based prevalence and site of infection was collected from District Tuberculosis Centre, Bhavnagar. Result: Total 50 patients of pulmonary tuberculosis were included of which there were 66% males, 34% females with maximum being in age group of 21-40 years. Of total patients included, 58% were cured, 14% lost to follow up, 8% expired and 20 % are on treatment. Results were indicative of 73% cure rate. Of this 4% patients were HIV positive, 12% were diabetic. In terms of resistance, 52% had RIF+ KAT G resistance, 46% had Rif resistance and 2% had Rif + Inh A resistance. Conclusion: Introduction of Shorter oral BDQ regimen has significantly improved compliance as it reduced duration by almost half which ultimately lead to improvement in treatment success rate. [ABSTRACT FROM AUTHOR]

Background: In 2021, one third of the notified TB patients in the country were contributed by the private sector. But evidence supports nearly 50% of TB patients first seek care from a private practitioner (PP). Aims/objectives: The study was carried out to understand the TB care practices among the private practitioners based on Standards of TB Care in India (STCI) in Davangere city. Methodology: Cross-sectional study was conducted among the 365 qualified, registered private practitioners of Davangere city who have treated at least one presumptive TB case in the past year. Study was conducted from Jan 2017 to June 2018 Results: PPs considered weight loss (80.5%) and hemoptysis (70.1%), followed by cough and fever as a major symptom to screen for TB. 87.4% of them used Chest Xray as diagnostic tool, followed by Mantoux test and Sputum smear examination 83% of TB cases diagnosed were notified but the public health actions like contact tracing, preventive measures among the household contacts were compromised. Conclusion: This study identifies the need to sensitize PPs about the services available in the government sector and the updates in the TB program, which could help in meaningful partnership towards efforts of TB elimination in the country. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) presents a substantial health risk to autopsy staff, given its three to five times higher incidence of TB compared to clinical staff. This risk is notably accentuated in South Korea, which reported the highest TB incidence rate and the third highest TB mortality rate among OECD member countries in 2020. The standard TB diagnostic method, histopathological examination of sputum or tissue for acid-fast bacilli (AFB) using Ziehl–Neelsen staining, demands microscopic examination of slides at 1000× magnification, which is labor-intensive and time-consuming. This article proposes a computer-aided diagnosis (CAD) system designed to enhance the efficiency of TB diagnosis at magnification less than 1000×. By training nine neural networks with images taken from 30 training slides and 10 evaluation slides at 400× magnification, we evaluated their ability to detect M. tuberculosis. The N model achieved the highest accuracy, with 99.77% per patch and 90% per slide. We discovered that the model could aid pathologists in preliminary TB screening, thereby reducing diagnostic time. We anticipate that this research will contribute to minimizing autopsy staff's infection risk and rapidly determining the cause of death. [ABSTRACT FROM AUTHOR]

• Faropenem has been proven useful in replacing ethambutol in the standard regimen. • Faropenem regimen showed a similar treatment success rate to the standard regimen. • Faropenem regimen is well tolerated and has fewer adverse events. • Oral β-lactam antibiotic can be a promising antituberculosis candidate. Faropenem has antituberculosis activity in vitro but its utility in treating patients with tuberculosis (TB) is unclear. We conducted an open-label, randomized trial in China, involving newly diagnosed, drug-susceptible pulmonary TB. The control group was treated with the standard 6-month regimen. The experimental group replaced ethambutol with faropenem for 2 months. The primary outcome was the treatment success rate after 6 months of treatment. Noninferiority was confirmed if the lower limit of a 95% one-sided confidence interval (CI) of the difference was greater than −10%. A total of 227 patients eligible for the study were enrolled in the trial group and the control group in a ratio of 1:1. Baseline characteristics of participants were similar in both groups. In the modified intention-to-treat population, 88.18% of patients in the faropenem group achieved treatment success, and 85.98% of those in the control group were successfully treated, with a difference of 2.2% (95% CI, −6.73-11.13). In the per-protocol population, treatment success was 96.04% in the faropenem group and 95.83% in the control group, with a difference of 2.1% (95% CI, −5.31-5.72). The faropenem group showed noninferiority to the control group in the 6-month treatment success rates. The faropenem group had significantly fewer adverse events (P <0.01). Our study proved that oral faropenem regimen can be used for the treatment of TB, with fewer adverse events. (Chinese Clinical Trial Registry, ChiCTR1800015959). [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Lung Disease (COPD) is an incurable, gradually worsening respiratory condition characterised by airflow limitation and blockage that cannot be completely reversed. Productive cough caused due to mucus hypersecretion is a common symptom of COPD. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. Therefore, Oscillating Positive Expiratory Pressure (OPEP) devices are designed to aid in sputum clearing in COPD patients. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Need of the Study: Chronic Obstructive Pulmonary Disease (COPD) makes it challenging for air to flow freely into and out of the lungs. Shortness of breath, cough, and mucus in the lungs are all possible symptoms. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. To help clear away excess sputum, numerous airway clearance devices can be used. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Aim: To compare the effect of Aerobika vs. Acaplla device on sputum volume and lung function in COPD patients. Materials and Methods: A comparative study will be performed in respiratory medicine OPD of Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha. Ethical approval was received from the Ethical Review Committee of Datta Meghe Institute of Medical Sciences, Deemed to be University. In this study 30 patients diagnosed with COPD will be categorised into two groups one group will receive aerobika device with conventional physiotherapy and another group will receive acapella device with conventional physiotherapy twice a day. Treatment will be given five days for one week. The assessment will be done on day one of the treatment and at the end of treatment which is first week. Sputum volume and lung function will be assessed by sputum collector and Pulmonary Function Test (PFT), respectively. The statistical analysis will be done using chisquare test. The parameters will be compared between both the groups for sputum volume and lung function over a period of one week. Data will be analysed in a statistical software SPSS 27.0.V. [ABSTRACT FROM AUTHOR]

Background: India, like many other developing nations has seen a steady decline in pulmonary tuberculosis over the past decades due to successful implementation of RNTCP-DOTS programme nationwide and improvement in social & economic condition of the general population. It is now seen that extra-pulmonary presentations form a major proportion of new cases. A majority of them present as head and neck tuberculosis (TB) - tubercular cervical lymphadenopathy. In spite of advent of newer diagnostic tools like nuclear ploidy, genetic analysis, nuclear scan and so on, Ultrasonography (USG) being the simplest, quickest and noninvasive diagnostic modality with high sensitivity has gained a very significant place in clenching early diagnosis of neck nodes. Aims & Objectives To calculate the Sensitivity, Specificity & Predictive Accuracy of USG in diagnosis of Extra Pulmonary Tuberculosis (EPTB) when presenting as cervical lymphadenopathy. Material &Methods A prospective, cross sectional study was conducted for 12 months in a Medical College and Hospital among the patients attending the ENT, Surgery, Paediatrics and Medicine OPD & IPD with cervical lymphadenopathy. After estimating the sample size,172 patients were included in this study. After obtaining approval from the IEC and informed consent of the participants, they were selected according to the inclusion and exclusion criteria. Result The Sensitivity and Specificity of USG in reference to TB cervical lymphadenopathy were 91.43% and 84.38% respectively with a positive predictive value of 96.24% and negative predictive value of 69.23%. 15.63% were false positive and false negative were 08.57%. Conclusion USG is an effective, noninvasive, inexpensive and safe tool with a high Sensitivity which can become an important and integral screening modality in the diagnosis of Extra Pulmonary Tuberculosis. [ABSTRACT FROM AUTHOR]

Introduction: Enterobacteriaceae that produce extended-spectrum beta-lactamase (ESBL) are quickly spreading, posing a threat to world healthcare. Methodology: 138 gram-negative bacteria were collected from different samples (stool, urine, wound, blood, tracheal aspirate, catheter tip, vaginal swab, sputum, and tracheal aspirate) from hospitalized patients. Samples were subcultured and identified in accordance with their biochemical reactions and culture characteristics. Against all the isolated Enterobacteriaceae, an antimicrobial susceptibility test was performed. VITEK®2 system, phenotypic confirmation, and Double-Disk Synergy Test (DDST) had been utilized to identify the ESBLs. Results: Of the 138 samples studied, the prevalence of ESBL-producing infections among the clinical samples of the present study was 26.8 % (n = 37). E. coli was the commonest ESBL producer at 51.4% (n = 19) followed by K. pneumoniae at 27% (n = 10). The potential risk factors for the ESBL development that produces bacteria were as follows, patients with the presence of indwelling devices, previous history of hospital admission, and usage of antibiotics. ESBL is statistically (p = 0.05) higher among the patients with indwelling devices, ICU admission, who had a previous hospital admission in the last 6 months as well as who was given antibiotics (quinolones and/or cephalosporins) in the last 6 months. One hundred thirty-two (95.7%) of ESBL isolates were resistant to amoxicillin, while the lowest resistance was for fosfomycin (15.2%). Conclusions: ESBL-producing Enterobacteriaceae are highly prevalent in Turaif General Hospital setting with some potential risk factors. A strict policy to be made available on the usage of antimicrobials in hospitals and clinics should be established. [ABSTRACT FROM AUTHOR]

Background: The burden of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. Amidst the poor treatment success of antibiotic therapy, adjunctive surgery is gaining attention; however, discrepancies in reported outcomes exist.Research Question: What are the treatment outcomes and complications of patients with NTM-PD undergoing adjunctive surgery?Study Design and Methods: The MEDLINE, Embase, and Cochrane databases were searched for eligible studies before January 2022. Studies reporting the outcomes of adjunctive surgery in adult patients who satisfied the diagnostic criteria for NTM-PD were included. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by two independent observers. Estimates of proportion were pooled using a random-effects model. Sputum mycobacterial culture negative conversion, recurrence, complications, and in-hospital mortality after surgery were primary outcomes that had been set before data collection began. Heterogeneity was evaluated by using the I2 statistic, and publication bias was assessed by using funnel plots and the Egger test.Results: Fifteen of the 2,739 screened studies, with 1,071 patients, were assessed. The weighted proportion of postoperative sputum culture negative conversion was 93% (95% CI, 87%-97%), and recurrence was 9% (95% CI, 6%-14%) for a median follow-up of 34 months. The proportion of patients who experienced postoperative complications was 17% (95% CI, 13%-23%), and in-hospital mortality was 0% (95% CI, 0%-2%). Studies that performed multilobar lung resection in > 30% of the study population showed comparable rates of complications with studies that did not.Interpretation: Adjunctive surgery is an effective therapeutic option with acceptable rates of complications for selected patients with NTM-PD.Trial Registry: PROSPERO; No.: CRD42022310663; URL: https://www.crd.york.ac.uk/prospero/. [ABSTRACT FROM AUTHOR]

Background: Pleural effusions contribute to a significant proportion of cases coming to pulmonary medicine OPD or casualty. Pleural effusion constitutes an important differential diagnosis of any abnormal chest radiograph. Homogenous opacities on chest radiograph with or without parenchymal infiltrates, mass lesions represent pleural fluid. Objectives 1. To study the role of biochemical analysis in cases with exudative pleural effusion. 2. To study the role of cytology in exudative pleural effusions. 3. To study the role of ADA in exudative pleural effusion cases. 4. To study the role of CBNAAT in exudative pleural effusion cases. Material and Methods Study Design: Prospective hospital based observational study. Study Area: The study was carried out in the Department of Pulmonary Medicine, Government Medical College & Government General Hospital, Kadapa, Andhra Pradesh. Study Period: June 2022 to November 2022. Study population: The study was carried out in 100 consecutive patients with exudative pleural effusions. Sample Size: Study consisted of 100 subjects. Sampling Method: Simple random Sampling Technique. Study tools and Data collection procedure: A complete clinical, general and physical examination was done on all patients. A chest radiograph Postero-anterior view was taken and effusion amount was estimated. Effusion occupying 1/3rd of volume - mild effusion. Effusion occupying more than 1/3rd and less than 2/3rd of volume -moderate effusion Effusion occupying more than 2/3rd of volume - massive effusion Patient is subjected to other investigations like CBP, RFT, LFT, serum electrolytes, total leukocyte count (TLC), differential count (DC), viral markers, RBS, Serum proteins, sputum CBNAAT, pleural fluid CBNAAT, pleural fluid ADA, pleural fluid cytology, biochemical analysis and cell block for malignant cells. An informed consent was taken from patients in their native language regarding thoracocentesis. Results: There were 52 tubercular effusion cases in our study. Among them, 6 cases had raised ADA above 40 and pleural fluid CBNAAT detection for mycobacterium. 40 of them had ADA above cut off value but mycobacterium was not detected. Mycobacterium was detected among 3cases who had borderline raised ADA but less than 40 IU/L. Conclusion: Pleural effusions are more commonly encountered in pulmonary and medical practices in our country. The most common is tubercular effusions as shown in our study. All cases should undergo ultrasonography of chest along with routine chest x-ray. Fluid has to be aspirated under sonography guidance. [ABSTRACT FROM AUTHOR]

The article focuses on the study approved by the appropriate institutional review board and all patients who gave written informed consent to participate. Topics include considered once recruited, patients underwent clinical, radiological, and functional evaluation and demographic and clinical data were collated as summarized.

Introduction: The Kingdom of Lesotho has one of the highest burdens of tuberculosis (TB) in the world. A national TB prevalence survey was conducted to estimate the prevalence of bacteriologically confirmed pulmonary TB disease among those ≥15 years of age in 2019. Method: A multistage cluster-based cross-sectional survey where residents ≥15 years in 54 clusters sampled from across the country were eligible to participate. Survey participants were screened using a symptom screen questionnaire and digital chest X-ray (CXR). Respondents who acknowledged cough of any duration, fever, weight loss, night sweats and/or had any CXR abnormality in the lungs were asked to provide two spot sputum specimens. All sputum testing was conducted at the National TB Reference Laboratory (NTRL), where samples underwent Xpert MTB/RIF Ultra (1st sample) and MGIT culture (2nd sample). HIV counselling and testing was offered to all survey participants. TB cases were those with Mycobacterium tuberculosis complex-positive samples with culture; and where culture was not positive, Xpert MTB/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no current or prior history of TB. Result: A total of 39,902 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to participate; 21,719 (80.9%) participated in the survey of which 8,599 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey participants underwent symptom screening and a total of 21,344 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only, 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and 311 (4.1%) submitted one sample only. From the 21,719 survey participants, HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were documented as HIV-positive. The survey identified 132 participants with bacteriologically confirmed pulmonary TB thus providing an estimated prevalence of 581 per 100,000 population (95% CI 466–696) for those ≥15 years in 2019. Using the survey results, TB incidence was re-estimated to be 654 per 100,000 (95% CI 406–959), which was comparable to the 2018 TB incidence rate of 611 per 100,000 (95% CI 395–872) reported by the World Health Organization (WHO). The highest TB burden was found in those ≥55 years and among men. The ratio of prevalence to case notification was estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%) participants. Out of the 1,825 participants who reported a cough, 50% of these participants, mostly men, did not seek care. Those who sought care predominantly went to the public health facilities. Conclusion: The TB prevalence survey results confirmed that burden of TB and TB/HIV coinfection remains very high in Lesotho. Given that TB prevalence remains high, and there is a significant proportion of participants with confirmed TB that did not report TB suggestive symptoms. The National TB Programme will need to update its TB screening and treatment algorithms to achieve the End TB targets. A major focus will need to be placed on finding the "missing cases" i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission. [ABSTRACT FROM AUTHOR]

Post-stroke pneumonia (PSP) has an impact on acute ischemic stroke (AIS). Although predictive scores for PSP have been developed, it is occasionally difficult to predict. Clarifying how PSP was treated after its onset in clinical practice is important. Admitted patients with AIS over a 2-year period were retrospectively reviewed. Of 281 patients with AIS, 24 (8.5%) developed PSP. The integer-based pneumonia risk score was higher in patients with PSP. The onset of PSP was frequently seen up to the 4th day of hospitalization. Of patients with PSP, sputum examination yielded Geckler 4 or 5 in only 8.3%. Angiotensin-converting enzyme inhibitor (ACE-I) was more frequently administered to patients with PSP; however, all these cases were started with ACE-I following PSP onset. Nasogastric tubes (NGTs) were inserted in 16 of the patients with PSP, of whom 11 were inserted following PSP onset. Multivariate analysis showed that PSP onset was a poor prognostic factor independent of the female sex, urinary tract infection, and National Institutes of Health Stroke Scale. PSP treatment would benefit from the administration of antimicrobials and ACE-I, as well as NGT insertion. To select effective agents for PSP and evaluate the indications for NGT insertion, further case studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: Post-Tuberculosis (TB), complications may involve the lungs, mediastinum, pleura, chest wall, or any combination of these structures. It can also affect the caliber of the airways which might lead to the increase in their resistance and decrease in the airflow, severely impairing the quality of life. Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of post TB complications are currently available. Aim: To study the clinical symptoms, radiological involvement and the Spirometry pattern of previously treated TB patients. Materials and Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Shri MP Shah Government Medical College and Guru Govind Singh Government Hospital, Jamnagar, from July 2018 to December 2019. Total 102 patients with history of TB and currently sputum negative were enrolled in the study. All patients underwent clinical examination, microbiological examination, chest radiograph, and spirometry. Data was collected from case record form and entered into MS excel 2016. Data analysis was done in Statistical Package of Social Science (SPSS) Software version 26. Results: Out of the 102 patients, there were 66 (64.70%) males and 36 (35.29%) females. Of the study population, 13 (12.74%) was asymptomatic, 7 (6.86%) had dyspnea, 17 (16.66%) had cough and 65 (63.72%) had both cough and dyspnea. Spirometry analysis revealed that 26 (25.49%) were normal, 6 (5.88%) had restrictive pattern, 69 (67.64%) had obstructive pattern and 1 (0.98%) had mixed pattern. Chest radiograph revealed unilateral chest involvement in 78 patients (76.47%) and 24 patients (23.52%) had bilateral chest involvement. Conclusion: There is high prevalence of post-TB pulmonary disability causing clinical symptoms, radiological involvement and spirometry changes and thus should be assessed early to prevent further complications. [ABSTRACT FROM AUTHOR]