BACKGROUND:The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images.METHODS:777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin.RESULTS:CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42.LIMITATIONS:Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I.CONCLUSION:CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.

A number of field tests were carried out at the Chandra Shekhar Azad University of Agriculture and Technology's Soil Conservation and Water Management Farm in Kanpur, Uttar Pradesh, during the successive rabi seasons of 2020–21 and 2021–22. The gangatic alluvial soil in the study area had a pH of 7.6, which was indicative of its light texture and moderate soil fertility. The study included three different treatments that included preparatory tillage techniques: T1 treatment was one cross plowing with a cultivator; T2 treatment was one disc harrow plowing followed by another cross plowing with a cultivator; and T3 treatment was one disc harrow plowing plus one rotavator pass. The experiment also looked into three different nutrient management strategies: N1, which involved applying 100% of the Recommended Dose of Fertilizers (RDF)—60 kg of N, 30 kg of P2O5, and 30 kg of K2O—through chemical fertilizers; N2, which involved applying 75% of the RDF through chemical fertilizers along with 25% of Farm Yard Manure (FYM); and N3, which applied 50% of the RDF through chemical fertilizers along with 50% of FYM. In addition to applying 50% RDF through chemical fertilizers combined with 50% FYM, the results of the two-year experiment showed that planting barley crops in plots that received one disc harrow plowing and one rotavator pass yielded the maximum values across growth factors, yield attributes (such as grain yield q ha-1, straw yield q ha-1, biological yield q/ha, as well as harvest index), net return, gross return, and the barley benefit-to-cost ratio. This was noted in both years in a consistent manner. The next best results were seen with preparatory tillage, which involved using a cultivator to plough a single cross and applying chemical fertilizers to achieve 100% RDF (N1: 60 kg N ha-1 + 30 kg P2O5ha-1 + 30 kg K2Oha-1).

The extraocular muscles (EOMs) are implicated in a variety of local and systemic diseases. Often, the pattern of disease on imaging, along with the clinical presentation, can lead the ophthalmologist and radiologist toward a specific diagnosis. This article provides a comprehensive pictorial review of common pathologies affecting EOM, with an emphasis on the unique imaging characteristics that help in clinching the diagnosis.

Listeria monocytogenes, a gram-positive bacillus and an intracellular pathogen, is an uncommon cause of illness in the general population. During pregnancy, a perinatal infection can lead to serious complications such as abortion, stillbirth, neonatal sepsis, and meningitis. We present two cases of neonatal meningitis caused by Christie, Atkins, Munch-Peterson (CAMP)-negative Listeria monocytogenes. In the first case, a seven-day-old female term neonate delivered vaginally, presented with high-grade fever and refusal to feed. In view of the suspected late-onset sepsis, a septic workup, including cerebrospinal fluid analysis, was conducted. CSF culture reports obtained showed a growth consistent with Listeria monocytogenes, which was CAMP test negative and susceptible to the penicillin group of drugs, cotrimoxazole, erythromycin, and meropenem. The isolate was identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and confirmed by 16S rRNA sequencing. The blood culture was sterile. At 48 hours of admission, the neonate clinically deteriorated with fluctuation in oxygen saturation below 95% at room air. Thus, she was electively intubated and connected to the mechanical ventilator with appropriate settings. The antibiotics were upgraded to meropenem from the empirical antibiotic therapy. The neonate showed clinical improvement within the next 24 hours of initiating antibiotics according to culture susceptibility and was gradually weaned from the mechanical ventilator to continuous positive airway pressure (CPAP). After 24 hours, she was able to maintain normal saturation at room air. In the second case, an 11-day-old low birth weight neonate, small for gestational age, was presented to the NICU with complaints of loose stools, fever, and refusal to feed for the past two days. In view of the suspected sepsis, relevant investigations were carried out while initiating empirical antibiotics IV piperacillin-tazobactam and IV amikacin for the neonate. Meanwhile, there was a dip in oxygen saturation noted on room air for the neonate and he/she was mechanically ventilated. The CSF culture grew Listeria monocytogenes, which was identified using MALDI-TOF MS and confirmed by 16S rRNA sequencing. The isolate tested negative for the CAMP test and was susceptible to ampicillin, penicillin, cotrimoxazole, erythromycin, and meropenem. The blood culture was sterile. The antibiotics were upgraded to meropenem from the empirical antibiotic therapy, the patient's condition improved, and the baby was eventually discharged.

Orbital Aspergillosis is a rare life-threatening fungal infection that is often misdiagnosed due to its nonspecific clinical and radiological appearance. In this case report, we present a case of disseminated aspergillus infection initially presenting as right inferior rectus palsy.

AIM:This study aimed to determine the prevalence of microbiologically confirmed female genital tuberculosis (FGTB) infection in patients attending a tertiary care hospital in North India. MATERIALS AND METHODS:A total of 623 endometrial biopsy samples were processed in the mycobacteriology laboratory from the outpatient and inpatient gynecology departments between May 2022 and February 2024. Ziehl-Neelsen (ZN) smear was performed on all samples. Each sample was subsequently subjected to cartridge-based nucleic acid amplification test (CBNAAT) Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) Ultra (Cepheid, Sunnyvale, California), and LJ culture irrespective of the ZN smear result and demographic details of the patients were recorded simultaneously. RESULTS:Of the 623 endometrial biopsy samples tested, 17 (2.73%) samples were positive for MTB by CBNAAT Ultra. The disease was most commonly observed in the reproductive age group between 21 and 35 years. ZN smear and culture were negative for all the samples received for endometrial TB. Of these 17 positive samples, one (5.9 %) was MTB detected (medium), four (23.5 %) (low), two (11.8 %) (very low), and 10 (58.8 %) (trace). RIF resistance was detected in one (5.9 %) of these 17 samples. However, the 10 samples that were detected as MTB trace and RIF indeterminate ideally need to be processed further by culture or by line probe assay to determine the drug resistance. CONCLUSION:Genital TB is characterized by a low bacterial load. Therefore, a highly sensitive and specific molecular test is essential for confirming the diagnosis microbiologically. Our study found that Xpert MTB/RIF Ultra is particularly valuable because it detected 58.8% of cases as "TRACE," which might be missed by other testing methods. Early diagnosis using this test can significantly impact patient management, especially in cases related to infertility. This study effectively highlights the role of GeneXpert Ultra in documenting extra-pulmonary TB, including genital TB.

Nocardia is a type of bacteria that can cause infections in both immunocompromised and immunocompetent hosts. It is an obligate aerobe and is commonly found in the environment. Pulmonary nocardiosis may present as pneumonia, endobronchial inflammatory masses, lung abscess, and cavitary disease with contiguous extension, leading to effusion and empyema. We present a case of pulmonary nocardiosis in a 75 -year -old male patient with type 2 diabetes mellitus. The patient presented with bilateral pneumonia and hypoxia with an oxygen saturation of 85%. Sputum samples were sent to the microbiology laboratory for testing. Acid-fast staining with 1% H2SO4 showed acid-fast branching filamentous rods, but Nocardia could not be isolated in culture. The sample was subjected to 16S rRNA gene sequencing, which identified the pathogen as Nocardia wallacei. The culture of the sputum did not grow any pathogenic organisms, and the blood culture was sterile. Unfortunately, the patient left the hospital against medical advice as he was advised for intubation. The patient could not survive and died the next day after leaving the hospital. N. wallacei can be fatal and cause disseminated infection in both immunosuppressed and immunocompetent patients. Only eight case reports of N. wallacei have been reported in the literature from various parts of the world. Our case is the first case report of N. wallacei from India.

Tuberculosis (TB) is a chronic condition that weakens the immune system, causes structural changes in the lungs, and can lead to infections by other bacterial pathogens. Very few studies have been done to understand the magnitude of co-infection with other bacterial pathogens, so this study was conducted to understand the co-infection pattern and burden. A total of 174 microbiologically confirmed pulmonary TB patients' samples, identified by cartridge-based nucleic acid amplification test, were further tested for other bacterial pathogens by culture over a period of five months from May 2023 to September 2023. The isolates' identification and drug susceptibility were performed using the VITEK 2 system (bioM & eacute;rieux, Marcy-l'& Eacute;toile, France). Of the 174 pulmonary samples tested, 19 samples grew a significant amount of other bacterial pathogens, making the prevalence 10.91% (19/174). Among the pulmonary samples tested, 54.59% were sputum, 38.5% were bronchoalveolar lavage, and 6.89% were endotracheal aspirate. Additionally, 70.11% of the patients tested were in the age group of 19-60 years. Of the patients who had co-infection, 94.73% (18/19) were male. The most common bacterial infection was caused by Pseudomonas aeruginosa, , which was identified in 36.84% of the co-infection cases (7/19). This was followed by Acinetobacter baumannii in 31.57% (6/19), Klebsiella pneumoniae in 26.31% (5/19), and Stenotrophomonas maltophilia in 5.28% (1/19). Acinetobacter baumannii and Klebsiella pneumoniae showed high drug resistance, ranging from 60% to 100% against various groups of drugs tested. None of the patient samples with co-infection showed rifampicin resistance. Among all the samples with co-infection, the majority (42.10%, or 8/19) had a high load of Mycobacterium tuberculosis complex detected by CBNAAT Ultra (Cepheid, Sunnyvale, California). Pseudomonas aeruginosa, , Acinetobacter baumannii, , and Klebsiella pneumoniae are unusual pathogens causing infection in community patients and are known to cause illness in hospitalized patients. These organisms' resistance was also similar to the resistance shown by hospital-acquired infections. This indicates that bacterial co-infection in pulmonary TB patients will be similar to the pattern of hospital-acquired infections. The high prevalence of bacterial co-infections (10.91%) in patients with pulmonary TB poses a significant challenge as these bacterial pathogens are not susceptible to anti-tubercular drugs. Therefore, comprehensive screening for other bacterial infections in all pulmonary TB patients is crucial for effective treatment and outcomes.

Immunoglobulin G4-related disease of the ocular adnexa is a systemic fibroinflammatory process of unknown etiology characterized by tissue infiltration by Immunoglobulin G4 plasma cells. In this case report, we present a case of Immunoglobulin G4-related disease involving extraocular muscles and lacrimal gland in a young female with initial and follow-up magnetic resonance imaging findings.

Testicular or epididymal tuberculosis is a rare form of extrapulmonary tuberculosis. Extrapulmonary tuberculosis of any form is very difficult to diagnose by microscopy because it is usually paucibacillary. Therefore, molecular methods play a major role in the diagnosis of extrapulmonary tuberculosis. We present a rare case of unilateral testicular tuberculosis in a 23-year-old immunocompetent patient with no history of contact with a known tuberculosis case. He presented to us with swelling on his testis for one month and a discharging sinus in the left testis for 15 days, along with an intermittent fever for a week. A pus swab from the discharging sinus of the testis was sent to microbiology, where a cartridge-based nucleic acid amplification test (CBNAAT) was done, which detected Mycobacterium tuberculosis complex (MTBC), but resistance to rifampicin was not detected. A line probe assay was also done on the sample for first-line drugs, and no resistance was detected for rifampicin or isoniazid. The patient was started on first-line drugs in the intensive phase, and after the completion of two months of treatment, the patient’s discharge stopped and he showed clinical improvement. Being a young patient, if he had not been diagnosed and treated as early as possible, it could have led to infertility. This again emphasizes the importance of molecular methods for the diagnosis of extrapulmonary tuberculosis.

A two-year field experiment conducted at Rama University's farm in Kanpur, Uttar Pradesh during the kharif seasons of 2022 and 2023 aimed to assess the impact of different nutrient management strategies on nutrient uptake. Phosphorus, a crucial nutrient, is deficient in insoluble forms, causing low yields in mungbean. Biofertilizers offer a cost-effective, eco-friendly, and renewable alternative to chemical fertilizers. Inoculating pulse seeds with phosphorus-solubilizing agents boosts phosphorus availability for plant growth, enhancing mungbean productivity in the Central alluvial region of Uttar Pradesh. The study incorporated four varieties—PDM-139, IPM 2-3, Meha, and IPM 2-14—alongside varying levels of nutrient management practices. These practices involved N0 (Control), N1, N2, and N3, each with distinct combinations of nitrogen, phosphorus, zinc sulfate, seed treatment with rhizobium culture, and phosphate-solubilizing bacteria (PSB). The experiment followed a factorial randomized block design with three replications. Findings indicated that the application of 20 kg N + 40 kg P2O5 + 25 kg ZnSO4.H2O ha-1, coupled with seed treatment involving rhizobium culture and PSB at 2.5 kg ha-1 in soil, significantly enhanced nutrient uptake in the Central alluvial tract of Uttar Pradesh.

Nocardiosis is known as an opportunistic infection in immunocompromised hosts. We present to you a case of pleural nocardiosis in a 38-year-old male patient who was a chronic smoker and presented with a left-sided pleural effusion. He was a known case of thrombocytopenia due to immune thrombocytopenia (ITP) and was on steroid therapy. On admission, he was found to be positive for HIV. Pleural fluid was sent to microbiology, where acid-fast staining with 1% sulfuric acid (H2SO4) showed acid-fast branching filamentous rods and cultures grew Nocardia, which was resistant to ampicillin, ceftriaxone, imipenem, cotrimoxazole, erythromycin, tetracycline, and susceptible to amikacin, linezolid, and levofloxacin. The isolate was identified as Nocardia otitidiscaviarum using 16S rRNA gene sequencing. Culture from the chest wall drain grew Escherichia coli and Stenotrophomonas maltophilia. Subsequently, the patient developed sepsis, and paired blood cultures grew Candida guilliermondii. Unfortunately, the patient could not survive despite aggressive efforts and died after 40 days of admission.

Abstract Background Despite significant advances in computer‐aided diagnostics, onychomycosis, a widespread fungal nail infection, lacks an automated approach for objective analysis and classification. Objectives Our study aimed to develop and validate automated machine learning models to accurately detect and classify onychomycosis‐affected areas in toenails. Methods The images in this study were captured using the Scarletred® Vision mobile App and SkinPatch, a CE certified medical device system working seamlessly together to deliver auto‐color calibrated, high‐resolution clinical images. Considering a total of 1687 images from 440 subjects, the research explores various degrees of onychomycosis and evaluates the infection extent in the toenails detected. We developed an advanced machine learning algorithm for precise segmentation and classification of onychomycosis‐affected toenails, utilizing expert annotations and advanced post‐processing techniques. Additionally, an analysis of nail growth was performed, and a comparison graph with the percentage of infection was estimated. Results Using advanced machine learning algorithms, we successfully detected toenails, enabling detailed analysis of intricate structures within the images. We achieved a final validation loss of 0.0236 and an F1 score of 0.8566 for accurate toenail detection, while the Random Forest algorithm demonstrated 81% accuracy in classifying and distinguishing between infected and healthy toenail areas. Our applied superpixel method furthermore improved the algorithm's precision in identifying the infected regions. Conclusions Our AI‐powered image analysis method, initially focused on the big toe's toenail, shows great promise for broader validation on comprehensive datasets, enabling more detailed assessments of onychomycosis severity and disease dynamics. The potential impact of limited patient diversity, particularly with darker skin tones, needs further assessment. Proven to measure nail growth and assess treatment effectiveness over time, our developed AI is the first of its kind to demonstrate this capability, representing a significant advancement as a novel decision support tool for clinical research and routine medical practice.

A 47-year-old male, a known case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath. A provisional diagnosis of ethanol-related compensated chronic liver disease (CLD) with portal hypertension and splenomegaly, gross ascites with bilateral hepatic hydrothorax was made. The left-sided pleural effusion subsided after three pleural taps, but the right-sided effusion kept refilling even after four to five days of repeated therapeutic taps, so a pigtail catheter was left in situ. The pleural fluid was sent for culture which did not grow any pathogenic organisms. Cartridge-based nucleic acid amplification tests where Mycobacterium tuberculosis complex (MTBC) was not detected, Ziehl-Neelsen staining was done in which acid-fast bacilli were not seen, and cytology was done where no malignant cells were seen. The patient was discharged with the pigtail in situ on the right side and, after 20 days, the patient again presented with shortness of breath, and imaging revealed moderate right-side pleural effusion. Draining of pleural fluid was done and sent for investigation which again revealed no infective etiology. The patient was admitted to the hospital for one month as the right-sided effusion did not resolve. Suddenly, the patient developed shortness of breath, and a chest X-ray was done, which showed pigtail blockage; pigtail flushing was done, and the bag was drained. The patient was empirically started on IV meropenem 500 mg TID, IV teicoplanin 400 mg BD, and inj polymyxin B 500,000 IU IV BD. The pleural fluid was sent continuously for investigation for the first two months which again did not reveal any infective etiology. After two months of pigtail in situ, the pleural fluid was sent for CBNAAT where MTBC was not detected, and ZN stain showed smooth acid-fast bacilli. The sample was cultured, and it grew acid-fast bacilli in 72 hours on blood agar, MacConkey agar, and Lowenstein-Jensen media. A line probe assay done from the isolate revealed it to be Mycobacterium abscessus subsp. abscessus which was resistant to macrolides and sensitive to aminoglycosides. Mycobacterium abscessus subsp. abscessus was isolated from repeated cultures of pleural fluid, and the patient was advised on a combination treatment of amikacin, tigecycline, and imipenem. The patient was discharged with the indwelling pigtail with the advised treatment; unfortunately, we lost patient follow-up as the patient never returned to us.

We report a rare case of splenic tuberculosis (TB) in a male patient with a competent immune system who had no previous record of pulmonary TB. A 56-year-old male patient came to our outpatient department complaining of upper abdominal pain with a few episodes of vomiting for three days. He had alcoholism, smoked for 15 years, and had no past history of diabetes mellitus, hypertension, TB, or HIV. An abdominal ultrasound and CT scan at admission showed pancreatitis with a splenic abscess. After five days of admission, the patient's vitals deteriorated, and he had severe abdominal pain. CT scan suggested a splenic abscess rupture with hemoperitoneum. An emergency exploratory laparotomy was performed, and a splenectomy was done due to the splenic abscess rupture. A cartridge-based nucleic acid amplification test from splenic intracapsular fluid detected a trace Mycobacterium tuberculosis complex. The patient was discharged after starting first-line antitubercular treatment for six months. After three months of follow-up, the patient was doing well with no complaints.

The present paper deals with the taxonomy of all the Indian Lista. Previously, four species of Lista were reported from India. Herein, two additional species, Lista monticola Yamanaka, 2000 and Lista furciillatusa Wang, Chen and Wu, 2019 are reported for the first time from India. Adults and their genitalia structures are illustrated. A key to the Indian species and a checklist of the global Lista species are provided.