Product development and characterization of the Ayurvedic herbo-mineral-metallic compound- Hridayarnava Rasa.

BACKGROUND: Herbo-mineral-metallic formulations are an inseparable part of the Ayurveda system of traditional medicine. Hridayarnava Rasa (HR) is a preparation containing metals like copper, sulphur, and mercury in processed forms and other herbs that do not produce toxic effects and adverse drug reactions when taken in appropriate dosage. Ayurveda practitioners use it in treating cardiac diseases like hypertension, cardiotoxicity and many more. The rasa-aushadhis possess characteristics such as rapid efficacy, little dosage required, and extensive therapeutic applicability. Hridayarnava Rasa [AFI Part-1, 20:55] has been employed for the treatment of various diseases from ancient times. A systematic study of these formulations manufacturing is required to maintain their quality, safety, and efficacy is a need of time to protect the immense faith of patients in Ayurveda. OBJECTIVES: The present study aimed to prepare HR as per standard operating procedures mentioned in the classical text and to characterize it physio-chemically using advanced analytical techniques. MATERIALS AND METHODS: HR was prepared and physicochemical analyses and assay of elements by ICP-AES were carried out as per Ayurvedic Pharmacopoeia of India (API). Powder X-ray diffraction (XRD), Field emission gun scanning electron microscopy with energy dispersive spectroscopy (FEG SEM, EDAX), CHNS-O analysis, Fourier Transform Infrared Spectroscopy (FTIR), Thermo-gravimetric analysis (TGA), Particle size distribution analysis (PSD) was carried out. RESULTS: The XRD analysis of HR showed the presence of unreacted sulphur and sulfides of copper and mercury. FEG SEM revealed the particles in the form of aggregates as nanocrystallites in the range of 100-1000 nm. Elemental analysis showed the presence of copper, sulphur, and mercury in major, along with traces of iron, calcium, sodium, potassium, and magnesium. In FTIR analysis, 18 peaks were observed, which strongly suggests the presence of various organic groups. In the TGA, four peaks were seen, which can be attributed to sulphur volatilization and oxidative changes in mercury. In PSD analysis, 50% of the material was found below 16.40 µm. CONCLUSION: To establish a piece of fundamental knowledge and ensure uniformity of these rasa-aushadhis, it is imperative to conduct an analysis of their characteristics as per classical texts and modern analytical techniques. Additionally, it is crucial to investigate the significance of each procedural step included in the preparation process. The inferences drawn are helpful as an essential aid for quality assurance and standardization of this herbo-mineral-metallic formulation.

Effectiveness of Semecarpus anacardium Linn. fruits in cancer and inflammatory diseases: A mini review.

BACKGROUND: Semecarpus anacardium Linn. (SCA) fruits are found in India's sub-Himalayan, tropical, and central regions and have been utilized for centuries in traditional Indian medicine to treat various ailments. In recent times, a growing body of research has emerged indicating that the extracts and active components found in SCA fruits possess qualities that can potentially inhibit the development of cancer and inflammatory markers. PURPOSE: This study aims to provide a comprehensive review of the existing literature on the pharmacological mechanisms underlying the effects of extracts and phytochemicals of SCA fruits in cellular, animal models, and clinical trials of cancer and inflammatory diseases. METHODS: A comprehensive literature search was conducted utilizing several databases, including PubMed, Scopus, Google Scholar, preprint platforms, and the Cochrane Database of Systematic Reviews using the keywords "Semecarpus anacardium", "Anti-inflammatory," and "cancer". The collection of articles started with establishing the database and continued until April 2024. RESULTS: Out of 1130 retrieved database records, 316 pertained to systematic reviews. The remaining 814 records focused on examining the anticancer and anti-inflammatory properties of SCA fruits. In the course of these investigations, the four primary cancer types linked to SCA fruits are identified as lung cancer, hepatocellular carcinoma, breast cancer, and blood cancer. CONCLUSION: The findings will provide more support for investigating SCA fruits in cancer treatment and will furnish thorough reference data and recommendations for future studies on this botanical medication.

Translation Research in Therapeutic Approaches from Conventional to Novel Nano-therapeutics for Rheumatoid Arthritis Treatment.

Rheumatoid arthritis is a systemic autoimmune disorder related to joint inflammation, bone erosion, and deformity. Numerous studies indicate that the causes and consequences of RA are still being debated, and therapeutic strategies are in the translation stage. Non-steroidal anti-inflammatory drugs continue to be often used to relieve pain. Still, due to their poor efficacy, failure to halt the spread of the disease, and undesirable adverse effects, they are no longer regarded as first-line treatments. The development of biologic DMRDs designed to reduce the inflammatory response led to substantial changes to the strategy for managing this disease. Although biologic DMRDs have made significant strides in the management of Rheumatoid arthritis, certain patients' lack of response to biological approaches and therapy cessation due to systemic toxicity are unresolved problems. Therefore, to improve the in vivo effect and reduce systemic adverse effects, new approaches are needed to proactively target and transport therapeutic molecules to target sites. The intriguing method of nanotechnology enables the encapsulation of drugs to prevent their deterioration and systemic adverse effects. The next generation of Rheumatoid arthritis therapies might be based on advances in nanomaterial-based drug delivery, Trojan horse, and antibody targeting approaches. This article presents an overview of the advancements in Rheumatoid arthritis therapy, ranging from traditional methods to recent cutting-edge, ongoing pre-clinical and clinical approaches.

A Snapshot of Selenium-enclosed Nanoparticles for the Management of Cancer.

Among the primary causes of mortality in today's world is cancer. Many drugs are employed to give lengthy and severe chemotherapy and radiation therapy, like nitrosoureas (Cisplatin, Oxaliplatin), Antimetabolites (5-fluorouracil, Methotrexate), Topoisomerase inhibitors (Etoposide), Mitotic inhibitors (Doxorubicin); such treatment is associated with significant adverse effects. Antitumor antibiotics have side effects similar to chemotherapy and radiotherapy. Selenium (Se) is an essential trace element for humans and animals, and additional Se supplementation is required, particularly for individuals deficient in Se. Due to its unique features and high bioactivities, selenium nanoparticles (SeNPs), which act as a supplement to counter Se deficiency, have recently gained worldwide attention. This study presented a safer and more economical way of preparing stable SeNPs. The researcher has assessed the antiproliferative efficiency of SeNPs-based paclitaxel delivery systems against tumor cells in vitro with relevant mechanistic visualization. SeNPs stabilized by Pluronic F-127 were synthesized and studied. The significant properties and biological activities of PTX-loaded SeNPs on cancer cells from the lungs, breasts, cervical, and colons. In one study, SeNPs were formulated using chitosan (CTS) polymer and then incorporated into CTS/citrate gel, resulting in a SeNPs-loaded chitosan/citrate complex; in another study, CTS was used in the synthesis of SeNPs and then situated into CTS/citrate gel, resulting in Se loaded nanoparticles. These formulations were found to be more successful in cancer treatment.

Design and evaluations of a nanostructured lipid carrier loaded with dopamine hydrochloride for intranasal bypass drug delivery in Parkinson's disease.

AIM: The goal of this study is to optimisation and evaluation of dopamine-loaded NLC (NLC-DOPA) for achieve dopamine concentrations into brain for treatment of Parkinson's disease which causes progressive neuronal death. METHOD: NLC-DOPA prepared by homogenisation method using solid lipids (Cholesterol and Soya lecithin), liquid lipid (Oleic acid) and surfactant (Poloxamer- 188) as major excipients, optimised by central composite design using design expert-13 software. The optimised formulations were characterised by particle size, zeta potential, entrapment efficiency, SEM, TEM, FTIR, DSC, XRD, stability study and in-vitro drug release. The histopathology of rat brain tissues and goat nasal tissues were performed. The ex-vivo (permeability and nasal ciliotoxicity study) and in vivo pharmacodynamics study were also accomplished to determine its efficacy and potency of NLC. RESULT: The NLC-DOPA formulations were optimised in particle size and (EE)% with range from 85.53 ± 0.703 to 106.11 ± 0.822 nm and 82.17 ± 0.794 to 95.45 ± 0.891%, respectively. The optimised formulation F11 showing best goodness-fitted model kinetic, followed by Korsmeyer-Peppas equation and zero order kinetic. The SEM and TEM confirmed the spherical and smooth morphology of formulation. FTIR and DSC spectra were given compatibility of compound and XRD diffractograms confirmed the amorphous nature. An ex-vivo study was showed the high permeability coefficient (6.67*1 0 -4 cm/min, which is twice, compare to pure drug) and there was no damage in nasal mucosa, confirmed by the ciliotoxicity study. In-vivo study was shown significant effects of optimised NLC-DOPA on locomotor activity, force-swimming test and neurochemical assessment using rotenone induced Parkinson's model on Albino Wistar rats. CONCLUSION: NLC-DOPA was prepared and optimised successfully with increased bioavailability of drug from the NLC into brain with reduce toxicity in effective treatment of Parkinson's disease.

A Comprehensive Review on Liver Targeting: Emphasis on Nanotechnology- based Molecular Targets and Receptors Mediated Approaches.

BACKGROUND: The pathogenesis of hepatic diseases involves several cells, which complicates the delivery of pharmaceutical agents. Many severe liver diseases affecting the worldwide population cannot be effectively treated. Major hindrances or challenges are natural physiological barriers and non-specific targeting of drugs administered, leading to inefficient treatment. Hence, there is an earnest need to look for novel therapeutic strategies to overcome these hindrances. A kind of literature has reported that drug safety and efficacy are incredibly raised when a drug is incorporated inside or attached to a polymeric material of either hydrophilic or lipophilic nature. This has driven the dynamic investigation for developing novel biodegradable materials, drug delivery carriers, target-specific drug delivery systems, and many other novel approaches. OBJECTIVE: Present review is devoted to summarizing receptor-based liver cell targeting using different modified novel synthetic drug delivery carriers. It also highlights recent progress in drug targeting to diseased liver mediated by various receptors, including asialoglycoprotein, mannose and galactose receptor, Fc receptor, low-density lipoprotein, glycyrrhetinic, and bile acid receptor. The essential consideration is given to treating liver cancer targeting using nanoparticulate systems, proteins, viral and non-viral vectors, homing peptides and gene delivery. CONCLUSION: Receptors based targeting approach is one such approach that was explored by researchers to develop novel formulations which can ensure site-specific drug delivery. Several receptors are on the surfaces of liver cells, which are highly overexpressed in various disease conditions. They all are helpful for the treatment of liver cancer.

CuO Nanoparticles Decorated ZnO Nanorods Based Extended-Gate Field-Effect-Transistor (EGFET) for Enzyme-Free Glucose Sensing Application.

In this work, CuO nanoparticles (NPs) decorated zinc oxide nanorods (ZnO NRs) on fluorine-doped tin oxide (FTO) substrate has been used as a working electrode. This working electrode has been used as an extended gate for field-effect transistor. The main objective is to use the EGFET (extended gate field effect transistor) as a glucose sensor. The proposed glucose sensor has good sensitivity of 6.643 mV/mM with a wide range of linearity (1mM-8mM) which covers the glucose level of human blood ranging from 4.4 mM to 6.6 mM. This novel concept of the glucose sensing using CuO NPs decorated ZnO nanorods based EGFET may be explored for sensing other saccharides such as mannose, fructose, and sucrose. This vertically grown ZnO nanorods decorated with CuO NPs based electrode gives reliable selectivity, good repeatability, and more stability. The performance of proposed sensor is also compared with commercially available glucose sensors. The sensitivity performance of the glucose sensor also confirms the capability to detect the glucose level from human blood and serum.

Autophagic Dysfunction in Dementia: Scope for Development of Potential Remedies.

Dementia is a diverse category of chronic and progressive disorder, which is commonly associated with a loss of memory, difficulty in judgment, impaired language, cognitive impairment, and various other symptoms that affect a person's daily routine life and social life. Dementia affects about 50 million people around the globe. Dementia exists in varied forms and is associated with various neurodegenerative disorders. Alzheimer's disease is the most common form, which accords for about 60% of thecases. Abnormal agglomeration of proteins in the brain has been linked to the pathogenesis of dementia. Autophagy is a necessary protein clearance mechanism, which is dependent on lysosomes. It is a basic physiological process that performs the crucial function of maintaining protein homeostasis within the cells. The autophagic dysfunction in dementia further complicates the disease by hampering the degradation and removing abnormal pathogenic proteins. In order to understand autophagic dysfunction, it is essential to know the genetics of autophagy as well as the mutations This understanding at the genetic level helps definethe relationship between dementia and autophagic dysfunction for developing the potential remedies for the treatment of dementia.

Author Correction: Au nanoparticles modified CuO nanowire electrode based non-enzymatic glucose detection with improved linearity.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Synergistic effect of CdSe quantum dots (QDs) and PC61BM on ambient-air processed ZnO QDs/PCDTBT: PC61BM:CdSe QDs/MoO3 based ternary organic solar cells.

This paper reports the synergistic effect of colloidal CdSe quantum dots (QDs) and PC61BM on the performance of ITO/ZnO QDs/PCDTBT:PC61BM:CdSe QDs/MoO3/Ag based ternary organic solar cells (OSCs). The MoO3 and ZnO QDs (∼2.87 nm) layers work as the transparent hole transport layer (HTL) and electron transport layer (ETL), respectively. The CdSe QDs (∼4.58 nm) are blended with PC61BM:PCDTBT binary solution to improve the optical properties and charge transportation. Significant photoluminescence (PL) quenching is observed when part of the PC61BM is replaced by CdSe QDs with equivalent weight in the PCDTBT. The proposed ternary OSC gives an open-circuit voltage of 854 mV, a short circuit current density of 14 mA cm-2, fill factor of 42% and power conversion efficiency (PCE) of 5.02%. The PCE of the ternary OSC is increased by more than 38% compared to the binary OSC. This significant improvement in the performance parameters is attributed to the enhanced absorption and higher transportation of photo-generated charge carriers, as well as the increased charge dissociation due to the synergistic effect of CdSe QDs and PC61BM. The external quantum efficiency is also enhanced significantly in the ternary OSC due to the better conversion of solar energy into electrical energy.

Au nanoparticles modified CuO nanowireelectrode based non-enzymatic glucose detection with improved linearity.

This paper explores gold nanoparticle (GNP) modified copper oxide nanowires(CuO NWs)based electrode grown on copper foil for non-enzymatic glucose detection in a wide linear ranging up to 31.06 mM, and 44.36 mM at 0.5 M NaOH and 1 M NaOH concentrations. The proposed electrode can be used to detect a very low glucose concentration of 0.3 µM with a high linearity range of 44.36mM and sensitivity of 1591.44 µA mM-1 cm-2. The electrode is fabricated by first synthesizing Cu (OH)2 NWs on a copper foil by chemical etching method and then heat treatment is performed to convert Cu (OH)2 NWs into CuO NWs. The GNPs are deposited on CuO NWs to enhance the effective surface-to-volume ratio of the electrode with improved catalytic activity. The surface morphology has been investigated by XRD, XPS, FE-SEM and HR-TEM analysis. The proposed sensor is expected to detect low-level of glucose in urine, and saliva. At the same time, it can also be used to measure extremely high sugar levels (i.e. hyperglycemia) of ~ 806.5454 mg/dl. The proposed sensor is also capable of detecting glucose after multiple bending of the GNP modified CuO NWs electrode. The proposed device is also used to detect the blood sugar level in human being and it is found that this sensor's result is highly accurate and reliable.

Fabrication and characterization of a ZnO quantum dots-based metal-semiconductor-metal sensor for hydrogen gas.

This paper reports an interdigitated metal-semiconductor-metal (MSM) based hydrogen gas (H2) sensor using colloidal zinc oxide (ZnO) quantum dots (QDs) as the sensing material. The active layer is obtained by spin coating of as-synthesized colloidal ZnO QDs on a SiO2/Si substrate in which the SiO2 layer is grown by oxidation of the Si substrate. The surface morphology of a ZnO QDs -based active film is measured using scanning electron microscopy (SEM) and atomic force microscopy (AFM) support for enhanced gas response. The change in current is measured for different concentrations of H2 gas at 175 °C in an ambient air atmosphere. Reasonably good gas responses of ∼41% for 1% H2 gas and 83.2% for 4% H2 gas have been obtained in ambient air condition. A high selectivity of the proposed sensor with respect to ammonia, sulfur dioxide and organic vapours such as acetone, methanol, chlorobenzene, and chloroform has also been achieved due to nanostructure ZnO films.

Superficial fabrication of gold nanoparticles modified CuO nanowires electrode for non-enzymatic glucose detection.

This paper describes a low-cost facile method to construct gold (Au) nanoparticles (NPs) modified copper oxide (CuO) nanowires (NWs) electrode on copper foil for the detection of glucose. Copper foil has been converted to aligned CuO NWs arrays by sequential formation of Cu(OH)2 followed by heat treatment induced phase transformation to CuO. Au NPs are deposited on CuO NWs via simple reductive solution chemistry to impart high surface to volume ratio and enhanced catalytic activity of the resulting electrode. Structure, microstructure and morphology of Cu, Cu(OH)2 NWs, CuO NWs, and Au NPs modified CuO NWs are investigated by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The homogeneous distribution of Au NPs (average diameter ∼12 nm) on CuO NWs (average diameter 100 nm and aspect ratio ∼20) is confirmed by high-resolution transmission electron microscopy (HRTEM), scanning transmission electron microscopy (STEM) and elemental mapping. This CuO based glucose detection method gives the highest sensitivity along with the maximum linearity range. This non-enzymatic glucose sensor based on Au modified CuO NWs electrode gives broad linearity range from 0.5 µM to 5.9 mM. The sensor exhibits sensitivity of 4398.8 µA mM-1 cm-2, lower detection limit of 0.5 µM, and very fast response time of ∼5 s. Properties of the proposed glucose sensor are also investigated in human blood and it is found that the sensor is highly accurate and reliable. In addition, higher sensitivity and lower detection limit confirm that this device is suitable for invasive detection in saliva and urine.

Coexistence of hard palate carcinoma with tuberculosis: A rarity.

Coexistence of tuberculosis (TB) and palatal malignancy is a rare phenomenon and it has never been reported. Here, we present a case of hard palate carcinoma with TB in a 60-year-old male patient who was successfully managed by three pronged approaches by combining antitubercular therapy with chemotherapy and radiotherapy.

Renal tuberculosis presenting as acute pyelonephritis - A rarity.

One of the major health problems faced particularly by the developing world since ages is that of tuberculosis (TB). Genito-urinary tuberculosis (GUTB) is the second most common extrapulmonary TB, with kidney being the most frequent site of infection. Due to the diverse and atypical clinical manifestations of urinary TB, the disease is easy to misdiagnose. The diagnosis of renal TB should be suspected in a nonspecific bacterial cystitis associated with a therapeutic failure or a sterile pyuria and a past history of pulmonary TB with important radiologic findings, particularly with the help of CT scan. Here, we describe a case of renal TB where no clinical or radiological features suggestive of renal TB were present. The diagnosis was only evident after the histopathological examination of the excised kidney. This case highlights the importance of suspecting renal TB as an important cause of kidney disease, which can lead to irreversible renal function loss particularly in an endemic area, and also the diversity that this disease may acquire in its presentation leading to misdiagnosis. In such a case, particularly in a high endemic area for TB, therapeutic trial of ATT may also be considered to avoid unnecessary surgical intervention and end-stage renal disease.

A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion.

BACKGROUND: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB). MATERIALS AND METHODS: This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB. RESULTS: 46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular. CONCLUSIONS: TPB has much greater diagnostic efficacy than CPB.

Correlation between clinical characteristics, spirometric indices and high resolution computed tomography findings in patients of chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease affecting the airways, leading to significant morbidity and mortality throughout the world. There is a need to have a holistic evaluation of COPD patients, other than just measuring the level of obstruction as performed by spirometry. High resolution computed tomography (HRCT) scan of thorax partly fulfills this requirement. MATERIALS AND METHODS: Fifty patients of COPD (confirmed on spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. Complete clinical evaluation was done. The Philips computer program for lung densitometry was used with these limits (-800/-1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes. RESULTS: There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). Mean upper lobe MLD was -839.27 HU, mean lower lobe MLD was -834.91 HU and the mean MLD was -837.08 HU. The lower lobes MLD were found to be decreasing with increasing disease severity. A mild linear correlation of pre forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of Post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. A predictive model can be derived to quantify obstruction severity (FEV1). CONCLUSION: HRCT may be an important additional tool in the holistic evaluation of COPD. HRCT can well be correlated with the spirometric and clinical features and the level of obstruction can be indirectly derived from it by measuring the MLD.

A prospective study of ocular toxicity in patients receiving ethambutol as a part of directly observed treatment strategy therapy.

BACKGROUND AND OBJECTIVES: India is among the largest countries to implement the revised National Tuberculosis Control Program (RNTCP). This program provides intermittent regimens to the patients, where the doses of isoniazid and ethambutol are more as compared to the daily regimen, which is a cause of concern, particularly with regard to the ocular toxicity of ethambutol. The present study was undertaken to explore the ocular toxicity in the patients registered under the program. MATERIALS AND METHODS: This was a prospective single center cohort study of 64 patients of categories I and II, coming to the RNTCP-Directly Observed Treatment Strategy (DOTS) center at a tertiary care referral hospital. The detailed history, best corrected visual acuity, fundus examination, and color vision test were carried out in all patients at the start of treatment and then at the first and second month of treatment. RESULTS: Loss in visual acuity from the baseline was noted at the second month follow up in 12 (9.4%) eyes (P = 0.001), visual field defects were seen in eight (6.3%) eyes (P = 0.0412), and optic disc abnormalities were observed in six (4.7%) (P = 0.013) eyes. Color vision abnormalities were noted in 16 (12.6%) eyes (P = 0.003), four eyes showed impairment in red-green color perception, and the others showed impairment in blue-yellow color perception as well. Patients with ocular symptoms were advised to stop ethambutol and they showed improvement in visual acuity after follow up of one to two months. The overall outcome of treatment was not affected by discontinuation of ethambutol in these patients. CONCLUSION: Ethambutol when taken according to program could cause ocular toxicity. The early recognition of ocular symptoms is important to prevent unnecessary delay in diagnosis and probable irreversible visual loss.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis.

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.