In general, chest radiographs (CXR) have high sensitivity and moderate specificity for active pulmonary tuberculosis (ptB) screening when interpreted by human readers. However, they are challenging to scale due to hardware costs and the dearth of professionals available to interpret cXR in low-resource, high ptB burden settings. Recently, several computer-aided detection (cAD) programs have been developed to facilitate automated cXR interpretation. We conducted a retrospective case-control study to assess the diagnostic accuracy of a cAD software (qXR, Qure.ai, Mumbai, india) using microbiologically-confirmed PTB as the reference standard. To assess overall accuracy of qXR, receiver operating characteristic (Roc) analysis was used to determine the area under the curve (AUc), along with 95% confidence intervals (CI). Kappa coefficients, and associated 95% CI, were used to investigate inter-rater reliability of the radiologists for detection of specific chest abnormalities. In total, 317 cases and 612 controls were included in the analysis. The AUC for qXR for the detection of microbiologicallyconfirmed PTB was 0.81 (95% CI: 0.78, 0.84). Using the threshold that maximized sensitivity and specificity of qXR simultaneously, the software achieved a sensitivity and specificity of 71% (95% CI: 66%, 76%) and 80% (95% CI: 77%, 83%), respectively. The sensitivity and specificity of radiologists for the detection of microbiologically-confirmed PTB was 56% (95% CI: 50%, 62%) and 80% (95% CI: 77%, 83%), respectively. For detection of key PTB-related abnormalities 'pleural effusion' and 'cavity', qXR achieved an AUC of 0.94 (95% CI: 0.92, 0.96) and 0.84 (95% CI: 0.82, 0.87), respectively. For the other abnormalities, the AUC ranged from 0.75 (95% CI: 0.70, 0.80) to 0.94 (95% CI: 0.91, 0.96). The controls had a high prevalence of other lung diseases which can cause radiological manifestations similar to PTB (e.g., 26% had pneumonia, 15% had lung malignancy, etc.). In a tertiary hospital in india, qXR demonstrated moderate sensitivity and specificity for the detection of PTB. There is likely a larger role for cAD software as a triage test for ptB at the primary care level in settings where access to radiologists in limited. Larger prospective studies that can better assess heterogeneity in important subgroups are needed.

Paraquat is a commonly used herbicide in India that has lethal consequences even on minimal consumption. The case fatality rate for this poisoning is high and there is dearth of evidence-based recommendation for the treatment of this poison. This review article explores the diagnosis and management of paraquat poisoning with an emphasis on recent advances in treatment. Though immunosuppressants and antioxidants are conventionally used, there is a gap in evidence to prove survival benefit of these treatment regimens. There are also some data showing the use of hemoperfusion (with toxin-specific cartridges) as an early intervention, i.e., within 4 hours of exposure to the poison. The recent drug, Edaravone, has also shown promise in the prevention of renal and hepatic injury in paraquat poisoning. Though it did not reduce pulmonary fibrosis in patients with paraquat poisoning, it delays the generation and development of pulmonary fibrosis. However, there is a need for more clinical and experimental studies to validate its use in paraquat poisoning.

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Background: Anaerobic organisms have been known to have an association with dental infections, bacteremia, endocarditis and soft tissue infections. However, anaerobic isolation from bone and joint infections are relatively rare. Sparse literature has been found on reports of anaerobic osteomyelitis. There is no literature reported on anaerobic osteomyelitis complicating Tuberculosis of spine. Case Report: We report two cases of tuberculosis of spine complicated by aerobic and anerobic infections. The first is a case of a young female who presented with chronic lower backache and fever. Examination revealed a lumbar scoliosis with paraspinal tenderness. Magnetic resonance imaging (MRI) of the spine showed lumbar spondylodiscitis with multiple abscesses. There were air-fluid levels noted in the abscesses. The pus sent for CBNAAT (cartridge based nucleic acid amplification test) was positive. Further the cultures also grew Escherichia coli (aerobic) Bacteroids fragilis and Peptoniphilus asachrolyticus (anaerobic) organisms. She improved with a course of intravenous antibiotics and decompression surgery. The second case is a middle aged man who presented with chronic neck pain and fever. Examination revealed kyphosis of the neck with spasm of the neck muscles and midline tenderness. MRI showed C4-5 cervical spondylodiscitis with parapharyngeal collections showing air-fluid levels. The pus culture showed Streptococcus constellatus (aerobic) and  Prevotella sps. (anaerobic). The CBNAAT report was positive for Mycobacterium tuberculosis. The patient was treated with intravenous antibiotics and cervical decompression. Conclusion: Though tubercular vertebral osteomyelitis (TVO) is usually a diagnosis in itself, it should not hinder us from considering secondary infections (both aerobic and anaerobic) complicating the osteomyelitis. Further, the presence of air-fluid levels on imaging studies and the presence of foul smell during operative exploration of the spine must arouse the suspicion of an anaerobic co-infection. Isolation and treatment of these organisms are crucial as they may hamper the clinical outcome of the primary TVO.