Bilateral Cavities Research Articles

Tuberculosis and COVID-19 co-infection in Serbia: Pandemic challenge in a low-burden country.

COVID-19 and tuberculosis (TB) represent global threats to the public health system. The impact of COVID-19 on TB results in a reduction in the number of notified TB cases, delayed diagnosis and treatment, and increased case fatality and mortality rates. The aim of the study was to analyze the TB/COVID-19 co-infected cohort in Serbia as a low-burden country and compare it to the global TB/COVID-19 cohort. A retrospective analysis was done on 53 TB and COVID-19 co-infected patients treated in COVID hospital "Batajnica" in Belgrade and Special Hospital for Pulmonary Diseases "Ozren" Sokobanja in the period from 6 March 2020 to 1 April 2022. A comparative analysis with the global cohort published recently was also performed. TB/COVID-19 cohort in Serbia included significantly fewer migrants and diabetes cases, but more cases with chronic respiratory diseases compared to the global. Descriptive analysis of TB cases in the Serbian TB/COVID-19 cohort showed fewer cases diagnosed with sputum smear and Gene Xpert/HAIN, fewer EPTB and mono-resistant cases, and more cases diagnosed with solid culture, unilateral pulmonary infiltrate (with bilateral cavity lesions), and bilateral pulmonary infiltrate (no cavities) compared to TB/COVID-19 cases worldwide. Nasal congestion and fever were more common COVID-19 symptoms in the global cohort. Radiology was more commonly used for the diagnosis of COVID-19 in Serbia. Typical bilateral ground opacities were less common among Serbian patients. Serbian patients spent fewer days in the hospital and achieved a higher PCR conversion rate and TB treatment success rate. The Serbian TB/COVID-19 cohort achieved a higher treatment success rate compared to the global cohort. Encouraging vaccination against SARS-CoV-2 for people with a current or past TB disease, as well as rapid diagnosis and targeted treatment of TB in highly specialized pulmonology institutions, presents key points to avoid excessive morbidity and mortality.

Tuberculosis reinfection and relapse in eastern China: a prospective study using whole-genome sequencing

ObjectivesTuberculosis recurrence after an initial successful treatment episode can occur from either reinfection or relapse. In a population-based sample and whole genome sequencing in eastern China, we aimed to evaluate risk factors for tuberculosis recurrence and assess the proportion of recurrence because of either reinfection or relapse. MethodsSuccessfully treated pulmonary tuberculosis patients with sputum culture positive results were recruited from five cities in Jiangsu Province from 2013 to 2015 and followed for 2 years for tuberculosis recurrence. Among patients developing a second tuberculosis episode, whole genome sequencing was performed to distinguish relapse or reinfection through a distance threshold of 6-single-nucleotide polymorphisms. We analyzed risk factors for recurrence and epidemiological characteristics of different types of recurrent patients. ResultsOf 1897 successfully treated tuberculosis patients, 7.4% (141/1879) developed recurrent tuberculosis. Compared with nonrecurrent tuberculosis, patients were at higher risk of recurrence in older age (adjusted odds ratio, 1.02 for each additional year; 95% CI, 1.01 to 1.03, p = 0.003), patients previously treated for tuberculosis (adjusted odds ratio = 2.22; 95% CI, 1.52 to 3.26, p < 0.001), or with bilateral cavities (adjusted odds ratio, 1.56; 95% CI, 1.05 to 2.32, p = 0.029). Among 27.0% (38/141) recurrent tuberculosis patients with successfully sequenced pairs, relapse was substantially more common than reinfection (71.1% vs 28.9%, p = 0.014). DiscussionEndogenous relapse was significantly more common than exogenous reinfection in the first 2 years after treatment in eastern China. Prioritization of high-risk groups for recurrence, such as the elderly, with a previous tuberculosis diagnosis, or with bilateral cavities, may provide opportunities to reduce post-tuberculosis morbidity.

COVID-19 in Socially Vulnerable Patients with Tuberculosis in Brazil

INTRODUCTION: COVID-19 is a global public health problem. The first case reported in the socially vulnerable population in the territory of Mato Grosso do State/Brazil occurred in August 2020. However, information about the co-infection of Tuberculosis (TB) and COVID-19 is rarely described in the world literature. Objective: to describe for the first time a group of vulnerable patients who died or not due to Tuberculosis and COVID-19, using a Cohort study of a control group and a treatment group. &#x0D; &#x0D; METHODS: Reporting 7 cases of TB associated with COVID-19 confirmed by respiratory RT-PCR, hospitalized in a hospital department of COVID-19 (CEAA: 42969320.0.0000.0021).&#x0D; &#x0D; RESULTS: The patients included in this case report were aged between 19 and 83 years, respectively, with a predominance of females, 4 patients were vaccinated with BCG. In addition, 3 patients died from COVID-19, and 2 patients were considered cured by COVID-19. The mean time to diagnosis between Tuberculosis and COVID-19 in the &amp;ldquo;control group&amp;rdquo; was 43 days and the mean time to diagnosis in the &amp;ldquo;treatment group&amp;rdquo; was 37 days. The average number of days of hospital stay in the &amp;ldquo;control group&amp;rdquo; was 50 days and in the &amp;ldquo;treatment group&amp;rdquo; it was 40 days. In the patients in the &amp;ldquo;control group&amp;rdquo;, 2 presented a unilateral pulmonary cavity lesion on the X-ray. In the &amp;ldquo;treatment group&amp;rdquo;, only 1 patient presented a unilateral pulmonary cavity lesion on the X-ray, and 2 presented a bilateral pulmonary cavity lesion, and only one developed bilateral non-cavitary lesion with infiltrates. Regarding drug resistance to the treatment of Tuberculosis, in the &amp;ldquo;treatment group&amp;rdquo; only 2 patients were sensitive and 3 were resistant. On the other hand, in the &amp;ldquo;control group&amp;rdquo;, 1 patient presented resistance and 1 sensitivity. It was found that 4 patients with drug resistance to Tuberculosis died (57%). Among the patients who died, it was observed that patients aged 83, 70 years and 66 years were not vaccinated with Bacillus Calmette-Gu&amp;eacute;rin (BCG). It was found in this case report that patients with COVID-19 and Tuberculosis have 60% less chance of cure. Furthermore, patients cured with pulmonary sequelae of COVID-19 may be at greater risk of developing advances in the worsening of Tuberculosis in the future. However, according to the results found in this case report, in some socially vulnerable regions where the forms of advanced Tuberculosis occur there is the presence of drug-resistant Mycobacterium Tuberculosis strains. &#x0D; &#x0D; CONCLUSION: Our study showed that Mycobactrium tuberculosis (MTB) infection in the socially vulnerable population increased the susceptibility to SARS-CoV-2 and the severity of COVID-19 or vice-versa. Based on this case report, it is recommended that, in the socially vulnerable population, the status of MTB infection be verified in patients with suspected COVID-19 at hospital admission.

Purple Haze: An unusual cause of cavitating pneumonia

A 40-year-old man, recently recalled to prison, was referred to hospital after presenting to the prison infirmary with right sided chest pain, fever, weight loss and haemoptysis. The initial presentation raised suspicion of Tuberculosis prompting referral to the infection service. Radiological investigations revealed bilateral cavities in the upper apices of both lobes with enlarged hilar. The patient had a previous hospitalisation with Staph aureus bacteraemia predicated by an infected groin injection site and during this admission he revealed he had recently self-lanced a dental abscess causing pus to pour from his nose. He was treated with Clindamycin, but this failed to reduce his CRP or his chest symptoms. Purpureocillium lilacinum was isolated from BAL samples after extended incubation and voriconazole therapy was initiated. Within a week of starting voriconazole, the patient clinically improved and after two weeks his CRP normalised and CXR improved. The isolation of a rare fungal pathogen prompted an extensive investigation into the patients practices and exposures, he revealed he smoked heavily and relied upon sniping to support his addiction. Sniping is a slang term for scavenging discarded cigarette oddments to either smoke or to manufacture “new” cigarettes, it is proposed that this practice may connect Purpureocillium lilacinum, a soil associated filamentous fungus, with our patients’ pathology as no other risk factors have been identified. High-risk smoking practices are not often revealed by proponents due to the associated social stigma which may lead to under-reporting of this practice as a risk factor for fungal lung infection. Abstract without diagnosis A 40-year-old man, recently recalled to prison, was referred to hospital after presenting to the prison infirmary with right sided chest pain, fever, weight loss and haemoptysis.

Thoracoscopic resection of bilateral multiple superior mediastinal neurofibromas

BackgroundThe indications for surgical resection concerning multiple bilateral neurofibromas in the superior mediastinum remain controversial, because vascular injury or development of postoperative Horne syndrome are concerned.Case presentationA 60-year-old woman presented with multiple nodules in her right neck and bilateral chest cavity tops which indicated neurofibromatosis. The thoracic masses grew slowly over 9 years, and she then underwent a 2-stage resection starting with the left to right side. Bilateral tumors were completely removed via video-assisted thoracic surgery. The patient’s postoperative course was uneventful, without postoperative Horner syndrome.ConclusionsTo the best of our knowledge, this is the first case of multiple bilateral superior mediastinal neurofibromas resected from the pulmonary apices via thoracoscopy. We selected a minimally invasive pure video-assisted thoracoscopic surgery approach and enucleated some tumors to avoid nerve injury. This approach may be safe and useful for multiple neurofibromas in patients with neurofibromatosis.

Maxillary sinusitis with unusual image on cone-beam computed tomography

The maxillary sinuses are the largest of the paranasal sinuses. They consist of pneumatized bilateral cavities, lined by respiratory mucosa, identical to the nasal mucosa, consisting of pseudostratified epithelium, with hair cells and goblet cells, producing mucus. Radiographically, the maxillary sinus is seen as a radiolucent area, ovoid or rounded, with a well-defined contour, delimited by a continuous radiopaque line or with small interruptions and radiolucency similar to that of the orbit. When a change in the maxillary sinus is suspected, images of the sinus are usually found, the presence of septa, thickening of the mucosa, or polyps. Sinusitis is the main pathology of the maxillary sinus, being of multifactorial etiology, and may be due to anatomical, environmental factors or viral, bacterial, or fungal infections. The diagnosis of sinusitis is clinical, but it can be confirmed by imaging exams such as panoramic radiography or cone beam computed tomography (CBCT). Case Presentation: In this case of a 21-year-old patient treated by the FOB-USP Surgery team, due to the proximity of the third molar to the maxillary sinus, a cone-beam scan was performed in which bubbles were noted on the surface of the maxillary sinus content. The image is compatible with sinusitis however, the presence of bubbles is a very unusual image in this type of alteration of the maxillary sinus. Conclusions: CT images with fluid levels and bubbles on their surface, although uncommon in dental practice, are characteristic of acute sinusitis and the dentist must have this knowledge for the correct diagnosis of maxillary sinusitis.

Novel Autosegmentation Spatial Similarity Metrics Capture the Time Required to Correct Segmentations Better Than Traditional Metrics in a Thoracic Cavity Segmentation Workflow

Automated segmentation templates can save clinicians time compared to de novo segmentation but may still take substantial time to review and correct. It has not been thoroughly investigated which automated segmentation-corrected segmentation similarity metrics best predict clinician correction time. Bilateral thoracic cavity volumes in 329 CT scans were segmented by a UNet-inspired deep learning segmentation tool and subsequently corrected by a fourth-year medical student. Eight spatial similarity metrics were calculated between the automated and corrected segmentations and associated with correction times using Spearman’s rank correlation coefficients. Nine clinical variables were also associated with metrics and correction times using Spearman’s rank correlation coefficients or Mann–Whitney U tests. The added path length, false negative path length, and surface Dice similarity coefficient correlated better with correction time than traditional metrics, including the popular volumetric Dice similarity coefficient (respectively ρ = 0.69, ρ = 0.65, ρ = − 0.48 versus ρ = − 0.25; correlation p values < 0.001). Clinical variables poorly represented in the autosegmentation tool’s training data were often associated with decreased accuracy but not necessarily with prolonged correction time. Metrics used to develop and evaluate autosegmentation tools should correlate with clinical time saved. To our knowledge, this is only the second investigation of which metrics correlate with time saved. Validation of our findings is indicated in other anatomic sites and clinical workflows. Novel spatial similarity metrics may be preferable to traditional metrics for developing and evaluating autosegmentation tools that are intended to save clinicians time.

The role of cavity shape on spatially confined laser-induced breakdown spectroscopy

The influence of a columnar cavity with different shapes on laser-induced Cu plasma was investigated by optical emission spectroscopy. The circle, square, triangle, and bilateral cavities were used to confine the plasmas. The measured spectral lines were Cu (I) 510.5 nm, 515.3 nm, and 521.8 nm. An obvious enhancement in the emission intensity and plasma temperature was observed when the cavities with different shapes were used to confine the laser-induced Cu plasma. By comparing the spectral intensities under the cavities with different shapes, it was found that the emission intensity was the strongest and the plasma temperature was the highest under the spatial confinement with the cylindrical cavity. Therefore, the spatial confinement effect with the cylindrical cavity is the most appropriate. The spatial confinement effect is attributed to the plasma plume compressed by the reflected shock wave.

Evaluating treatment outcomes and durations among cases of smear-positive pulmonary tuberculosis in Yemen: a prospective follow-up study

BackgroundEvaluating outcomes after tuberculosis (TB) treatment can help identify the primary reasons for treatment success or failure. However, Yemen has a treatment success rate that remains below the World Health Organization’s target. This study aimed to identify factors that were associated with unsuccessful treatment and prolonged treatment (>1 year).MethodNewly diagnosed cases of smear-positive pulmonary TB were prospectively followed at two centers (Taiz and Alhodidah, Yemen) between April 2014 and March 2015. Standardized forms were used to obtain information from the patients regarding their socio-demographic and clinical characteristics, treatment duration, and TB-related information. Multivariate logistic regression analyses were performed to identify factors that were associated with unsuccessful treatment and prolonged treatment (>1 year).ResultsThe study included data from 273 cases of newly diagnosed TB, with treatment being successful in 227 cases (83.1%) and unsuccessful in 46 cases (16.9%). Among the 46 patients with unsuccessful treatment, 29 patients (10.6%) stopped treatment, 6 patients (2.2%) transferred to another facility, 6 patients (2.2%) experienced treatment failure, and 5 patients (1.8%) died. The multivariate logistic regression analyses revealed that unsuccessful treatment was associated with female sex, illiterate status, and the presence of comorbidities. Prolonged treatment durations were associated with living in a rural area, smoking, chewing khat, a cough that lasted for >3 weeks at the beginning of treatment, and bilateral cavities during radiography.ConclusionThese results confirm that the treatment success rate in Yemen is lower than the World Health Organization’s target for smear-positive pulmonary tuberculosis. Targeting the risk factors that we identified may help improve treatment outcomes. Furthermore, it may not be prudent to re-treat patients using first-line TB drugs after an initial treatment failure.

ПРИМЕНЕНИЕ ЭНДОБРОНХИАЛЬНЫХ КЛАПАНОВ И ЭКСТРАПЛЕВРАЛЬНОЙ ПЛОМБИРОВКИ ДЛЯ ЛЕЧЕНИЯ ДВУСТОРОННИХ ГИГАНТСКИХ КАВЕРН У БОЛЬНОЙ ТУБЕРКУЛЕЗОМ ЛЕГКИХ С МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ

The clinical case demonstrates the cure of pulmonary tuberculosis with multiple drug resistance and massive bilateral cavities in a female patient of 31 years old with a severe disorder of pulmonary ventilation of the mixed type, hypoxemic respiratory failure, post-tuberculosis bullous changes in both lungs. Treatment lasted for 4 years. Treatment included anti-tuberculosis chemotherapy, artificial pneumoperitoneum, three endobronchial valves in the bronchi for draining of massive cavities and extrapleural sealing with silicon plug.

Fulminant Pulmonary Tuberculosis by Infliximab in Patient with Rheumatoid Arthritis

A 72-year-old Japanese woman who had been suffering from rheumatoid arthritis for five years started treatment with infliximab. The screening of a chest X-ray before initiating infliximab treatment showed no abnormal shadows. After a month of infliximab, she was admitted to the emergency hospital with a half-month history of a fever, fatigue, dyspnea, and cough. She was diagnosed with tuberculosis from a culture smear and referred to our hospital. The chest images showed a bilateral massive cavity and infiltration. Despite the administration of an anti-tuberculous agent, the cavity and infiltration were enlarged on a chest X-ray and the patient died due to respiratory failure. Cases of tuberculosis resulting in death after a short duration of infliximab treatment have been rarely reported. We speculate that chest CT and the interferon-gamma release assay (IGRA) for tuberculosis screening should be evaluated before starting infliximab treatment, and preventive administration of isoniazid should be considered with consultation with a pulmonologist.

P30: A case of anterior mediastinitis and bilateral multiple lung abscesses occurring after TsTET

Trans-subxiphoid thoracoscopic extended thymectomy (TsTET), which can provide a better exposure of bilateral upper thymus lobes and the contralateral phrenic nerve, was reported superior to unilateral thoracoscopic approach in treatment of myasthynia gravis or anterior mediastinal tumour. However, the postoperative complications for TsTET have hardly been discussed. Here we reported a 68-year-old female suffered subxiphoid incision infection, anterior mediastinitis, concomitant bilateral pneumonia and multiple lung abscesses after TsTET. In our experience, because the subxipoid incision, the anterior mediastinum and the bilateral thoracic cavity communicated directly after TsTET, it should be aware of the risk of infection in anterior mediastinitis and bilateral thoracic cavity following subxiphoid incision infection.

An Unusual Case of Invasive Kaposi's Sarcoma with Primary Effusion Lymphoma in an HIV Positive Patient: Case Report and Literature Review.

We report a case of AIDS-related Kaposi's sarcoma (KS) with Primary Effusion Lymphoma (PEL) in a 28-year-old, African American male. Kaposi's sarcoma is an AIDS defining disease and typically will disseminate early in the course of the disease affecting the skin, mucous membranes, gastrointestinal tract, lymph nodes, and lungs. This case reports an unusual presentation of the disease along with primary effusion lymphoma. Although the most common organ systems affected by KS are the respiratory and the gastrointestinal systems, the lungs of this patient did not show any evidence of KS. Additionally, the patient demonstrates the rarely seen liver and unique pancreatic involvement by KS along with unusual synchronous bilateral pleural and peritoneal cavity involvement by PEL, adding to the distinct pattern of invasive AIDS-related Kaposi's sarcoma.

Implications of pentraxin 3 levels in patients with acute aortic dissection

Acute aortic dissection (AAD) causes transient inflammation with occasional pleural fluid (PF) accumulation. Although pentraxin 3 (PTX3) is a vascular inflammation-related biomarker, little is known about PTX3 levels in patients with AAD. We explored the serial changes in plasma PTX3 levels and the association of peak levels with the amount of PF accumulation. Consecutive patients (n=41) with Stanford type B AAD were enrolled, and blood samples for the measurements of serum albumin, plasma PTX3 and high-sensitivity C-reactive protein (CRP) were collected daily until 7days after symptom onset. PF accumulation on computed tomography imaging on the third hospital day was divided into 3 grades (I: none or slight, II: mild in the uni- or bilateral pleural cavity, III: moderate or more). PTX3 and CRP levels were analyzed after logarithmic transformation because of their skewed distributions. Peak PTX3 and CRP levels were observed at 4.3±2.1 and 4.7±2.0days after symptom onset, and their values were 12.2 [interquartile range (IQR), 8.2-20.9] ng/mL and 12.0 (IQR, 8.6-15.2) mg/dL, respectively. On univariate analysis, the peak level of PTX3 had a negative correlation with the minimum level of serum albumin, and a positive correlation with PF grade and duration of intensive care unit stay. On multivariate analysis, the peak level of PTX3 was correlated with PF grade (P=0.037). In conclusion, the peak level of PTX3 in patients with AAD was associated with the amount of transient PF accumulation, which may be associated with inflammatory vascular permeability.

Cochlear implantation for a child with cochlear nerve deficiency: Parental perspectives explored through narrative

Objective: The objective of this study was to explore, from the parents’ perspectives, decision-making regarding a cochlear implant (CI) for their child when a favourable outcome is less likely because of abnormal neurophysiology. Design: The primary research method of this single case study was qualitative interviewing drawing on a narrative approach to elicit the parents’ perspectives about their experiences over time. Each parent was interviewed separately, but thematic analyses were undertaken both within and across interviews in order to identify overlaps and differences. Study sample: Participants included the parents of a five-year old child with severe-profound hearing loss, cochlear nerve deficiency, and bilateral common cavities who had received a CI at the age of 18 months. Results: Four themes were identified across the four narrative stages that emerged from the parents’ accounts of their experiences regarding their daughter's CI. Themes included hope and despair, questioning professionals’ motivations, does deafness need a cure, and bringing the child into the family. Although these themes emerged from both parents’ accounts, each parent expressed different perspectives and insights within them. Conclusions: Findings highlight the central place of parental needs and perspectives in decision-making regarding a CI, particularly in the context of uncertain outcomes.

288 DEVELOPMENT OF AN EXPERIMENTAL MODEL FOR ANOSMIA FOR CELL THERAPY PURPOSES

The olfactory sense is most important for social and environmental interaction, contributing to the quality of life. Its dysfunction, called anosmia, is followed by severe social problems. Anatomically, this is associated with changes in the nasal epithelium and the central and peripheral nervous system. Anosmia can be caused by infection, trauma, and cancer. Along with other olfactory disorders, anosmia occurs in ~50% of the population between 65 and 80 years of age and 75% of the population above 80 years of age. Because of the dramatic effect of such diseases, we aim to develop an experimental model of anosmia in rats as well as to culture stem cells that may be used for future cell therapy purposes. We used 15 adult Wistar rats (60 days). As a first step of our project, the animals were submitted to an experimental surgery to ablate the olfactory bulb (OB). The ocular bulb was used as reference to localizate transfrontal craniotomy. The surgical time for this procedure ranged from 40 to 50 min. The olfactory bulb has an elliptical shape and consists of soft tissue, almost gelatinous, which breaks up easily when manipulated or restrained by surgical instruments. Therefore, we chose to aspirate the tissue, using a urethral probe coupled to an aspirator. Removal of the OB resulted in bilateral cavities, elongated, situated between the cribriform plate of the ethmoid bone and brain. The postoperative period passed without major incidents. The skin suture was removed between 7 and 10 days after surgery. The animals were clinically evaluated each day for a period of 60 days. No animal showed signs of pain or discomfort, apathy, loss of appetite, or hypersensitivity in the surgical wound. However, the consumption of food and water was increased. Some animals lost their feeding selectivity, eating pieces of paper, shavings, and surgical drapes used to line the cages. In addition, we observed behavioural changes such as excitability and aggressiveness. Tests of revulsion at the smell of cats and perception of pungent odor demonstrated the lack of odor perception, consequently regarded as signs of anosmia. We conclude that the surgical technique used was effective and easy to perform in order to establish an experimental model for anosmia in rats. As a next step, potential stem cells derived from the olfactory epithelium were successfully isolated. A characterisation of these cells is currently under way, as well as preclinical tests to reveal the recovery of olfactory functions after cell therapy.

Chest X-rays and associated clinical parameters in pulmonary Tubercolosis cases from the National Tubercolosis Program, Mumbai, India

The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of Xrays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.

Chest X-rays and associated clinical parameters in pulmonary tuberculosis cases from the National Tuberculosis Programme, Mumbai.

The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of X-rays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.

Bilateral pulmonary cavities in a young female

A 17-year-old otherwise healthy female presented with a painless mass in her right neck after an upper respiratory infection. She denied fever, night sweats, weight loss or dyspnea. The laboratory findings were unremarkable. Chest radiograph revealed mediastinal widening and alveolar opacities with cavitations in the bilateral lower …

Effects of cavity on leakage loss in straight-through labyrinth seals

Labyrinth seals are widely used in rotating fluid machinery, due to its low-cost, simplicity and reliability. A straight-through labyrinth seal consists of a clearance between the stator and rotor, and sometimes cavities which are included on the stator or the rotator side. In this type of seals, making cavities are an effective way to convert turbulence kinetic energy into thermal energy by forming turbulence vortices, thereby reducing pressure difference and leakage flow. In this paper, the effect of cavities on leakage loss in straight-through labyrinth seals are studied by changing cavity dimensions such as depth and length, cavity number and cavity location. The influences of unilateral cavities and bilateral cavities on the leakage loss in straight-through labyrinth seals are also compared. The fluid flow characteristics through straight-through labyrinth seals were obtained by using viscous flow analysis along with a standard k-ωturbulence model. The cavity dimensions and cavity numbers have significant effects on the leakage as well as on the flow pattern in the seal. The bilateral cavity has better leakage performance than the unilateral cavity when cavity dimensions are identical. However, the cavity location shows no significant influences on the leakage flow.