We made head-to-head comparison between Truenat® MTB Plus (TruPlus) vs. GeneXpert® MTB/RIF (Xpert) for tuberculosis (TB) diagnosis. TruPlus exhibited somewhat higher sensitivity (88.9% vs. 83.3%) than Xpert with pulmonary TB individuals against MGIT-960 culture, whereas a significantly higher sensitivity (p<0.01) was obtained by TruPlus than Xpert with extrapulmonary TB individuals.

Introduction Respiratory muscle weakness is proportional to the degree of thyroid function and is reversible by replacement therapy with thyroxine. Aim To evaluate the changes in pulmonary functions in newly diagnosed hypothyroid patients as compare with healthy controls by spirometry and to observe the improvement in pulmonary functions after hormone replacement therapy. Patients and methods A total of 30 newly diagnosed hypothyroid patients and 30 healthy controls of age between 18 to 50 years of either sex were included in our study. Clinical criteria and biochemical tests were registered, and spirometry was done. Results Approximately 17% of the hypothyroid patients were normal, whereas 33% had mild restrictive lung impairment and the rest 50% had moderate to severe restrictive impairment on spirometry. Conclusion On comparing the hypothyroid patients with normal healthy person of same age group through spirometer, the ventilatory functions were diminished and these pulmonary functions improved after levothyroxine therapy for 6 months but could not reach the normal healthy values. A spirometric evaluation should be considered in hypothyroid patients, even in the absence of respiratory illness.

Objective.Tuberculosis (TB) is a significant cause of mortality and morbidity worldwide.Vitamin D deficiency has been implicated to cause pulmonary TB (PTB).On the other hand, anti-TB drugs, like rifampicin and isoniazid have been hypothesised to cause vitamin D deficiency.The objective of this study was to evaluate and compare serum vitamin D status in patients with PTB before and after anti-tuberculosis therapy (ATT).Methods.A single centre, prospective, observational, double-blinded study was conducted in 50 patients with PTB on category I ATT.Vitamin D samples were collected at baseline, two months and at the end of six months. Results.The mean age of the study population was 46.7±21.2years.The mean serum vitamin D level at baseline was 18.1±6.7 ng/mL (Normal >30ng/mL), 17.9±7.1 ng/mL at two months and, 17.5±7.8ng/mL at six months.The progressive decline in the mean vitamin D levels was statistically significant (P<0.001).However, it was also observed that in some patients [n=8 (16%)] vitamin D levels increased after ATT; though in majority [n=42 (84%)] vitamin D levels decreased after ATT. Conclusion.It is postulated that vitamin D supplementation in TB treatment programmes may also have an effect on outcome, thereby the need for further studies to ascertain the exact role, dose and duration of vitamin D augmentation in improving the outcomes.[

Distant metastases in squamous cell carcinoma of head and neck are most often to the lung, liver and bone. They rarely metastasise to chest wall. We report a 60-year-old male patient who initially presented with an abscess over the anterior chest wall that was initially treated for infective pathology. Due to lack of response, cytological examination was performed that turned out to be metastasis from carcinoma larynx.

Chylothorax is an unusual cause of pleural effusion that is formed when chyle enters the pleural space owing to disruption of lymphatic duct. Tuberculosis, especially multidrug-resistant tuberculosis, is an uncommon cause of chylothorax. Here, we present a case of pleural effusion, which on thoracocentesis showed milky white fluid. The pleural fluid had triglyceride content of 75 mg/dl, and lipoprotein electrophoresis showed chylomicrons, confirming the diagnosis of chylothorax. Bacteriological examination of sputum yielded acid‐fast bacilli which were resistant to rifampicin by Gene-Xpert. The patient was started on appropriate drug-resistant antituberculosis regimen. She improved clinically and had complete resolution of chylothorax.

Background: Rifampicin (RIF) resistance in new cases of pulmonary tuberculosis is a matter of concern. Diabetes Mellitus triples the risk of developing tuberculosis. Early detection of TB and its resistance status in diabetics can help in improving the care and treatment outcomes of both diseases.Methods: It was a prospective study conducted from February 2019 to March 2020 in PGIMS, Rohtak on 50 patients of DM with newly diagnosed Pulmonary TB. Rifampicin resistance was detected by CBNAAT on sputum, induced sputum and BAL samples. Results: Mean age of study subjects was 51.24±10.421 (in years) with M: F ratio of 3:1 and maximum patients in 50-59 age group. The average BMI in patients was 22.49±2.42 kg/m2. The most common presenting complaint was cough (92%) followed by fever (68%). Mean serum HBA1c was 9.66±2.24 and mean FBS and PPBS was 195.81±59.08 and 302.02±99.01 mg/dl respectively. Out of 36 cases who gave sputum, 29 (80.55%) were detected rifampicin sensitive and 7 (19.44%) were rifampicin resistant whereas out of 11 who were induced, 9 (81.8%) were rifampicin sensitive and 2(18.18%) were rifampicin resistant. Out of 3 cases detected by BAL CBNAAT, 2 (66.6%) were rifampicin sensitive and 1 (33.33%) was rifampicin resistant. Overall, 10(20%) patients were detected Rifampicin resistant by CBNAAT.Conclusions: We found that TB-DM patients had a higher proportion of drug resistance (20%), so DM should be considered as an independent risk factor for MDR-TB and effective measures are required for early diagnosis of MDR-TB.

Aim: To determine the Diagnostic accuracy of drop peroxide test using Hydrogen peroxide to differentiate exudative and transudative pleural fluid. Materials & Methods: We screened 830 patients in the outpatient department and included 75 patients in the study who had clinical and chest X-ray evidence of pleural effusion. These patients underwent aseptic thoracocentesis. 0.25 ml of 30% hydrogen peroxide is added to 5 ml of pleural fluid, which is aspirated bedside, and we looked for presence of bubbles. The rest of the pleural fluid is simultaneously sent for routine analysis, and the results are compared. Results: There were 75 patients who had pleural effusion, 63 (84%) of them had exudative pleural effusion and 12 (16%) had transudative pleural effusion by Light’s criteria and 54 (72%) of them had exudative pleural effusion and 21 (28%) had transudative pleural effusion by hydrogen peroxide test. 53 were the true Positives, and 11 were true negatives. 1 sample was false positive, and 10 samples were a false negative. The sensitivity of Hydrogen peroxide test was 84.13%, Specificity was 91.67%, PPV was 98.15%, and NPV was 52.38%, and Diagnostic Accuracy was 85.33%. Conclusion: This Bedside Test allows for more rapid determination of the nature of pleural effusions and can rapidly characterize effusion as an exudate or transudate.

Tuberculosis in the past decade has emerged to be a risk factor for the development of venous thrombo-embolism. However, its association with arterial thrombosis is rare. We present a case of thrombus of the distal arch of aorta in a patient with pulmonary tuberculosis. To the best of our knowledge, this is the first reported case of its kind. A 46-year-old male, reformed smoker, with history of multiple antitubercular therapy intake presented to the Emergency Department of PGIMS Rohtak with shortness of breath for 1 month, cough with expectoration for 15 days, fever and generalized itching over the body for 7 days, and inability to speak since 2 days. A Contrast Enhanced Computed Tomography scan (CECT) of neck and thorax was done, which revealed a large ovoid hypodensity in the distal arch of aorta causing 70–80% luminal narrowing, suggestive of a thrombus. To further evaluate the hypodensity, a Computed Tomography Pulmonary Angiography (CTPA) was done, which revealed a moderate (40–50%) luminal narrowing in distal aortic arch of descending thoracic aorta, with no obvious pulmonary thromboembolism. His leukocytic count was 34 000 (86|10|2|2), was hepatitis C positive, Prothrombin Time (PT)|International Normalised Ratio (INR) was 14.6|1.08, d-dimer was 10.00 (normal<0.5), had complete paralysis of the left vocal cord, and sputum Acid Fast Bacilli (AFB) was 3+. In our patient, absence of any risk factor, comorbidity and family history of coagulation disorder points to the underlying tuberculosis as the most possible cause of the aortic thrombus. We hope that in view of this case report, studies that aim to find a causal relationship between tuberculosis and arterial thrombus are.

More than six decades after the term “Artificial Intelligence” was coined by John McCarthy to describe intelligent behavior displayed by machines, finally the technology enabled world with automation in every aspect of human life is becoming a reality. Artificial intelligence (AI) is used to describe the intelligence displayed by machines, which defers from the intelligence displayed by humans and other animals often referred to as Natural Intelligence (NI). Right from the inception of AI, game playing has been an area of research. One of the first examples of AI being employed in game playing was the computer game of Nim which was developed in 1951 and published in 1952. After that AI has been used in many computer games like Chess, Tic-tactoe, and Connect-4. The game of Connect-4 was first solved by James Dow Allen in 1988. Connect-4 Gaming Portal using Adversarial Search (Artificial Intelligence), provides an online interface to the zero sum, perfect information strategy game of Connect 4. A user will be able to log in to the system where he / she can challenge various levels of AI with increasing degree of difficulty. The moves of the AI will be optimized by using mini-max algorithm and alpha beta pruning.

Background: Lung cancer is generally diagnosed during late stage of the disease so early diagnosis of lung cancer is very important to reduce lung cancer death rate. Flexible fibreoptic bronchoscopy revolutionized early diagnosis of lung cancer as it provides sufficient cytologic and histologic specimens in form of bronchial brushings, broncho-alveolar lavage and bronchial forceps biopsy. Cytologic techniques are safe, economical, and provide quick results. They not only complement tissue biopsies in the diagnosis of lung cancer but are also comparable in yield.Methods: The present study analyzes cytology of Bronchoalveolar lavage, Bronchial Brushings and histology of bronchial biopsy in 45 patients diagnosed as lung cancer by fiber-optic bronchoscopy. Age, gender, smoking habits, various histological types of malignancies, and yield of various bronchoscopic diagnostic techniques in the diagnosis of lung cancer were evaluated.Results: Of the 45 cases with confirmed diagnosis, 37 (82.22%) were males and 8 (17.17%) were females with male to female ratio of 4.6:1. The mean age in this study group was 54.71 years. Squamous cell carcinoma was the most common primary bronchogenic tumor (62.22%) followed by adeno carcinoma (26.66%). The overall diagnostic yield of fiber-optic bronchoscopy procedures was 100% (32/32 patients) in bronchoscopically visible tumors. Bronchial biopsy was most sensitive (100%) followed by Bronchial Brushings (88%) and BAL (81.25%). However, in non-visible tumors, biopsy, brush and BAL yielded diagnostic specimens for lung cancer in 84.61%, 76.92% and 46.15% of patients respectively.Conclusions: Lung cancer is a common malignancy with male preponderance. Bronchial biopsy has a very high diagnostic yield. Cytopathological examination of bronchial brushings and broncho-alveolar lavage not only complement tissue biopsies in the diagnosis of lung cancer but have comparable diagnostic yield.

Aim: The aim of this study is to ascertain the burden and trend of HIV sero-positivity among children attending ICTC in a teaching tertiary care hospital.Study Design: Retrospective study.Methodology: HIV seropositivity among children of age group 18 months-14 years was determined by serological tests for HIV antibodies among children enrolled in ICTC of a teaching tertiary care hospital from Jan 2011 - Dec 2013 as per NACO guidelines.Result: Of 2529 children tested for HIV infection, 10.4% were found to be seropositive. Statistically significant (p < 0.05) fall in the seropositivity was observed over the three years study period. In all the three years male children were more seropositive than female children (1.78:1). Most of the children were serodiagnosed late in our study, with mean age of 5.30 years / 63.64 months.Conclusion: Our study reports a declining trend of sero-positivity (from 13.1% to 9.8%) among children attending ICTC. But the prevalence is still high (>9%) which calls for re-intensified efforts on health education and risk control programme.

A Visual Speech Recognition system is completely dependent on correct extraction of lip contours. The extracted lip contour can be useful in tracking the lip movements in Visual Speech Recognition. The accuracy of the system can be improved by correct extraction of the lip contours. In this paper, a computer vision approach is proposed to automatically extract lip contour from the face image. The proposed technique uses Viola Jones algorithm to localize the face and mouth in the image. Unlike existing methods merge thresholds used in Viola Jones are made iterative and adaptive which makes it invariant to the quality of input image. The colour space conversion and clustering method results in separation of lip from non lip pixels which are further subjected to morphological operations and ellipse fitting for an efficient lip contour extraction. The proposed method has been tested on 4000 images from the VidTimit database and results showed significant improvement in lip segmentation than some of the existing methods for lip contour extraction. The proposed method is computationally efficient and robust and can be used for real time applications.

This paper describe the reactive power flow solution based BBO to amend the performance of the power system. Biogeography-based optimization is incorporating flexible AC transmission systems (FACTS). Static Synchronous Series Compensator (SSSC) is type of FACTS device used in this paper. In this BBO Store best parent solution and apply mutation and migration process on remaining parents to produce best fitted child sets. This paper define the problem of optimal power flow solution is very severe in modern interconnected transmission system the control of reactive and real power has to be fast to insure that the system remains stable under all condition of operation. The use of thyristor based controllers enable a transmission system to be flexible using SSSC FACTS is a series connected FACTS controller. The proposed BBO method gives better solution quality compared to particle swarm optimization with static synchronous series compensator facts device. The simulation results show that the proposed BBO algorithm is effective, fast and accurate in finding the optimal parameter settings for FACTS devices to solve OPF problems. BBO algorithm is tested on IEEE 14-bus with SSSC FACTS device gives better solution to enhance the system performance.

A 47-year-old-female presented with dyspnea and unproductive cough for 4 months. General examination revealed pulsatile swelling in the midline below the thyroid cartilage present since childhood. Computed tomography-angiography of the neck showed right innominate artery dilated, elongated and coursing above downward, anterior to the trachea below the thyroid, compressing the trachea and origin of the right subclavian artery higher up. A case of anomalous innominate artery causing symptomatic compression of the trachea in adults is a rare entity.

BACKGROUND:Prevention of nosocomial infections, pre-operative and post-operative complications is directly linked with effective disinfection and decontamination. Microbial decontamination is the most serious challenge to the today's health care practice despite the abundance of disinfectants and chemicals as there are increasing reports of emergence of resistance to the action of commonly used disinfectants. There is a need to evaluate the efficacy of newer methods of asepsis for better patient management. AIM:This study was designed to evaluate the microbiocidal activity of superoxidized water (SOW) on common clinical isolates, ATCC strains, vegetative cells and spores of Bacillus subtilis. MATERIALS AND METHODS:Bacterial suspensions were treated with SOW and deionized water (control). All the tubes were incubated at 37°C for 0.5, 2.5 and 5.0 min. The number of viable cells was counted. RESULTS:All the clinical isolates and ATCC strains were killed within 0.5 min of exposure to the SOW. Vegetative cells and spores of B. subtilis were killed after 5.0 min. CONCLUSION:We conclude that SOW is an effective microbiocidal agent for routine hospital use.