Spina Ventosa of the Left Ring Finger With Tuberculous Pyomyositis in the Forearm Muscles in a Young Immunocompetent Indian Male With No Pulmonary Involvement: A First Report of Its Type.

Tuberculous infection of the extrapulmonary sites, especially the small bones, is a seldom reported entity even in endemic countries. Moreover, simultaneous involvement of the forearm muscles is a very rare presentation with no such case reported showing concurrent involvement of the two sites. The diagnosis is challenging due to the paucibacillary nature of the disease, a lack of awareness among primary clinicians, and ambiguity in clinical features with other musculoskeletal disorders, especially when there is no pulmonary involvement. Herein, we present a first-of-its-type case of spina ventosa of the left ring finger with a tuberculous abscess in the forearm in a 15-year-old Indian male with no pulmonary seeding. The diagnosis was achieved through a detailed diagnostic workup, which resulted in the detection of Mycobacterium tuberculosis. He was initiated on antituberculous treatment with a remarkable improvement.

Isolated Tuberculosis of the Radius in an Immunocompetent Indian Male Without Pulmonary Involvement: A Report of a Rare Case.

Extrapulmonary tuberculosis is less commonly reported, and isolated tuberculous involvement of bones such as the radius, without any pulmonary lesions, is extremely rare. Diagnosing this condition can be challenging due to ambiguous clinical features and non-specific radiological findings in the early stages. The present case describes a rare instance of isolated tuberculosis of the radius in an immunocompetent Indian male with no pulmonary involvement. The diagnosis was achieved through a high index of suspicion in an endemic region, advanced radiometric investigations, and the isolation of Mycobacterium tuberculosis using the cartridge-based nucleic acid amplification test. The patient was started on a 12-month course of appropriate chemotherapy.

Understanding the Spectrum and Management of Post-Tuberculosis Lung Disease: A Comprehensive Review.

Post-tuberculosis lung disease (PTLD) poses a significant clinical challenge in regions with a high burden of tuberculosis (TB). This review provides a comprehensive overview of PTLD, encompassing its pathogenesis, clinical manifestations, diagnostic modalities, management strategies, long-term outcomes, and public health implications. PTLD arises from residual lung damage following TB treatment and is characterized by a spectrum of pathological changes, including fibrosis, bronchiectasis, and cavitation. Clinical presentation varies widely, from chronic cough and hemoptysis to recurrent respiratory infections, which are oftentimes a diagnostic dilemma. Radiological imaging, pulmonary function tests, and careful consideration of patient history play pivotal roles in diagnosis. Management strategies involve pharmacological interventions to alleviate symptoms and prevent disease progression, which are influenced by the extent of lung damage, comorbidities, and access to healthcare. Rehabilitation programs and surgical options are available for select cases. Prognosis is influenced by the extent of lung damage, comorbidities, and access to healthcare. Prevention efforts through a TB control program and early detection are crucial in reducing the burden of PTLD. This review stresses the importance of understanding and addressing PTLD to mitigate its impact on individuals and public health systems worldwide.

Tuberculosis of the Femur With Intramedullary Abscesses and No Pulmonary Foci in an Immunocompetent Male: A Rare Case.

Tuberculosis of the long bones/femur, especially in an immunocompetent person, is a challenging diagnosis. It is a rare entity, even in endemic settings. The non-specific clinical features, backed by a low suspicion about such presentations even in endemic settings, may result in delayed diagnosis and often unfavorable treatment outcomes. The situation becomes even more challenging in the absence of pulmonary foci and a contact history of tuberculosis. Here is a case of a young adult male who presented with complaints of pain over his left leg for three months. A diagnosis was achieved with magnetic resonance imaging and the isolation of the bacteria from a bone biopsy using a cartridge-based nucleic acid amplification test. Antituberculous treatment was promptly initiated.

Advancements in Tuberculosis Diagnostics: A Comprehensive Review of the Critical Role and Future Prospects of Xpert MTB/RIF Ultra Technology.

Tuberculosis remains a persistent global health challenge, demanding swift and accurate diagnostic methods for effective treatment. The emergence of the Xpert MTB/RIF Ultra system marks a significant milestone in combating tuberculosis, streamlining the identification of Mycobacterium tuberculosis, and advancing our pursuit of eradicating the disease. Delving into the therapeutic landscape of tuberculosis and rifampicin resistance, this scientific narrative review offers a comprehensive exploration. It begins by delving into the historical backdrop and the hurdles encountered with traditional tuberculosis diagnostics. From there, it traces the journey of the Xpert MTB/RIF technology, underscoring its molecular underpinnings. In this narrative review, the performance of the Xpert MTB/RIF Ultra system undergoes thorough scrutiny, encompassing investigations into sensitivity, specificity, and comparisons with alternative diagnostic methods. The spotlight shines on its clinical applications across diverse scenarios, from diagnosing pulmonary and extrapulmonary tuberculosis to its pivotal role in identifying rifampicin resistance. The study also evaluates its clinical efficacy in enhancing patient outcomes and supporting global tuberculosis control initiatives. However, the review does not shy away from discussing the challenges and limitations associated with the Xpert MTB/RIF Ultra system. It meticulously addresses concerns regarding cost, infrastructure requirements, and potential diagnostic inaccuracies. Offering a panoramic view, the review assesses the system's impact in resource-constrained settings and its potential to bolster tuberculosis elimination endeavors worldwide. Peering into the future, it explores ongoing research avenues and potential enhancements in Xpert MTB/RIF Ultra technology, envisioning a landscape of improved performance, broader applications, and emerging diagnostic innovations in the realm of tuberculosis diagnostics.

Disseminated Tuberculosis of the Lungs, Brain, Pleurae, Mediastinal Lymphadenopathy, and Elbow Joint in an Immunocompetent Indian Female: A First-of-Its-Type Case.

Tuberculosis is usually seen in the lungs. However, the involvement of various extrapulmonary sites is due to the spread of the bacteria via blood, lymphatic, or direct inoculation. The present case is a rare presentation of tuberculosis in an Indian female who came with complaints of swelling in her right elbow joint, headache, and cough with expectoration. A diagnostic evaluation resulted in the isolation of Mycobacterium tuberculosis from the sputum samples and elbow joints, which was further supported by an exudative picture on the cerebrospinal fluid examination. The findings were supported by advanced radiometric techniques. She was commenced on an antituberculous treatment per her weight. Disseminated tuberculosis is a challenging diagnosis as there is often a delay in clinical presentation, a lack of awareness about the possibility of multiple sites with tuberculous infection in clinicians, and a time lag in the availability of the culture results.

Tuberculosis of the Parietal Bone in an Indian Boy: A Rare Entity.

Tuberculosis is a common issue in endemic regions. The disease can affect both adults and children. Tuberculosis involving the flat bones of the skull is infrequently reported. Besides, reports of parietal bone tuberculosis in children are rare and a diagnostic challenge. Often, these cases report late, and this could compromise the treatment outcomes. Herein, a case of post-traumatic tuberculosis of the left parietal bone is presented in a child. The diagnosis was achieved by radiometric investigations and the isolation of Mycobacterium tuberculosis from the pus. He was initiated on antituberculous chemotherapy.

Spina Ventosa of the Thumb With Valgus Deformity in a Female With No Pulmonary Involvement: A First Report of Its Type in an Immunocompetent Adult From India.

Small bone involvement caused by Mycobacterium tuberculosis infection is an uncommon clinical entity. Usually, the condition is linked to the spread of bacteria from the lungs. It is rather uncommon for people without pulmonary seeding, trauma, or a history of tuberculosis to experience isolated episodes of spina ventosa. We describe a rare case of an immunocompetent Indian woman, aged 25, who complained of swelling in her left thumb. The diagnosis of primary tubercular dactylitis of the thumb was made after a thorough clinical and laboratory workup, and she received conservative treatment.

Unifying Endotracheal Intracuff-Pressure Monitoring in the Intensive Care Unit: Bridging the Gap Between Standardization and Neglect.

Endotracheal cuff-pressure monitoring is a critical component of patient care in the intensive care unit, ensuring the safety and efficacy of mechanical ventilation. Despite its importance, there remains a lack of standardized protocols regarding optimal pressure targets and documentation practices. This editorial examines the significance of endotracheal intracuff-pressure monitoring in enhancing patient outcomes, highlighting the challenges and potential solutions in clinical practice.

Advances in Understanding and Managing Floating Knee Injuries: A Comprehensive Review.

Fractures of the ipsilateral tibia and femur, frequently combined with soft tissue damage and dislocations, describe floating knee injuries, a complicated orthopedic condition. Epidemiological data suggest that floating knee injuries account for a small but significant proportion of traumatic orthopedic injuries, with a higher incidence observed in younger males engaged in high-risk activities. Anatomically, floating knee injuries involve fractures of the femur and tibia, ligamentous disruptions, and soft tissue damage, contributing to the complexity and severity of these injuries. An extensive analysis of floating knee injuries is given in this paper, including information about epidemiology, anatomy, pathophysiology, categorization, management approaches, complications, prognosis, and current and upcoming developments.

GOLD-Induced Cytokine (GOLDIC): A Critical Review of Its Properties, Synthesis, and Biomedical Applications.

This narrative review examines the intricate landscape of gold-induced cytokine responses, delving into the anti-inflammatory and immune-modulating properties of gold compounds, with a primary focus on their application in treating rheumatoid arthritis and other autoimmune conditions. Utilizing a comprehensive search strategy across major scientific databases, we identified and analyzed a diverse range of studies published within the last two decades. The aim of this review is to provide a nuanced understanding of the current state of knowledge, addressing key questions regarding the mechanisms by which gold compounds modulate cytokine responses and their clinical implications. Our review encompasses an in-depth exploration of the anti-inflammatory effects of gold compounds, emphasizing their impact on pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin 1ß (IL-1ß), and interleukin 6 (IL-6). Moreover, we investigate the lesser-explored terrain of immune modulation, shedding light on the ability of gold compounds to influence anti-inflammatory cytokines, notably interleukin 10 (IL-10). Through an extensive analysis of the literature, we unravel the multifaceted mechanisms underlying gold-induced cytokine responses, including the inhibition of nuclear factor kappa B (NF-κB) signaling and interference with janus kinase/signal transducers and activators of transcription (JAK/STAT) pathways. In exploring the clinical applications of gold-induced cytokine modulation, we synthesize findings from relevant studies, elucidating the potential of gold compounds as therapeutic agents. However, challenges such as variability in formulations and diverse cytokine assessment methods are discussed, emphasizing the need for standardization in both research and clinical settings. Looking ahead, our scoping review identifies key unanswered questions and proposes future directions for research in this domain. We discuss emerging therapeutic strategies, considering the integration of gold compounds with other modalities to optimize treatment outcomes. This comprehensive review serves as a foundational resource for researchers, clinicians, and policymakers seeking a nuanced understanding of gold-induced cytokine responses, paving the way for further advancements in this critical area of study.

Traumatic Cerebral Myiasis in the Elderly: The First Reported Case From India.

A medical condition known as myiasis, or maggot infestation, occurs when fly larvae eat living tissue and continue to grow inside of it. Tropical and subtropical areas are where it is most commonly seen. Human myiasis is more prevalent among individuals who have close contact with domestic animals and those living in unhygienic conditions. Traumatic cerebral myiasis is a rare clinical condition in humans with only two such cases documented in the literature. It is brought on by a parasite infestation, also referred to as a maggot infestation of dipteran larvae, on an untended open wound due to trauma. In this report, we present an exceedingly rare case of cerebral myiasis in a 54-year-old Indian male, the first report from India, occurring as a result of trauma. Wound debridement with maggots removal and antibiotic administration was done. However, the patient was lost to follow-up.

India's Decision to Deny an Extension of Patent for Bedaquiline: A Public Health Imperative.

Tuberculosis (TB) remains a major global public health concern, which has become worse in low- and middle-income nations due to the rise of drug-resistant strains of the disease. Bedaquiline, a groundbreaking anti-TB drug, shows great promise for addressing multidrug-resistant TB (MDR-TB). However, the recent decision by India to reject the application for a patent extension on bedaquiline raises crucial questions regarding access to essential medicines and public health requirements. This article examines the significance of India's rejection of the patent extension for bedaquiline, outlining the global implications of this decision and its impact on intellectual property rights, access to medicines, and the future of drug development. India's stance serves as a model for other countries to prioritize public health in their patent-related decisions, underlining the need for a balanced approach to intellectual property rights, innovation, and affordability in the pharmaceutical sector. In the context of the ongoing battle against drug-resistant TB, India's decision on bedaquiline signifies the evolving landscape of pharmaceutical patent practices in the service of global public health.

Spina Ventosa of the Left Index Finger in an Indian Girl With No Pulmonary Involvement: A Rare Case.

Mycobacterium tuberculosis is a significant issue in endemic countries. The most common manifestation of skeletal tuberculosis in children is spondylitis, also known as Pott disease, but it may rarely involve small bones. Usually, a pulmonary focus is present from where the bacteria reach the extremities, but an isolated tuberculous involvement of the left index finger in a child without any pulmonary seeding is rare. It is a challenging diagnosis due to a lack of awareness among primary care physicians, the paucibacillary nature of the disease, and overlapping clinical features with other musculoskeletal disorders. A 13-year-old girl was brought in with complaints of pain, swelling, and discharging sinuses from her left index finger. A diagnosis was achieved after a histopathological correlation of clinical and radiological findings. She was started on anti-tubercular treatment for 12 months.

Spina Ventosa of the Right Index Finger in an Adult Indian Female With No Pulmonary Involvement: A Rare Case.

Tubercular involvement of small bones is a rare clinical condition. Often, the disease is associated with pulmonary involvement. Isolated cases of spina ventosa in adults with no pulmonary seeding or any history of tuberculosis or trauma are relatively infrequent occurrences. We report a case of a 22-year-old immunocompetent Indian female who presented with complaints of a swollen right index finger. A detailed clinical workup supported by radiographs and serological tests established the diagnosis as primary tubercular dactylitis of the right index finger. She was managed with anti-tubercular drugs.

Primary Tuberculosis of the Cuboid and Fifth Metatarsal Without Pulmonary Involvement: A Rare Case Report.

Tuberculosis affecting the smaller bones of the foot is relatively infrequent. There is a paucity of data related to the tubercular involvement of cuboid and metatarsal bones. Diagnosis is challenging, especially in the absence of pulmonary involvement, a history of trauma, and contact with tuberculosis. We present a rare case of primary tuberculosis of the cuboid and fifth metatarsal without pulmonary involvement. The patient was started on anti-tubercular chemotherapy. A detailed literature search revealed that no such case with concomitant involvement of the cuboid and fifth metatarsal without pulmonary seeding has ever been reported.

Tuberculosis of the Right Fifth Metatarsal and Fourth Web Space Without Pulmonary Involvement: A Rare Case.

Tuberculosis of the bones and joints is an uncommon entity. The bacterial infection of small bones of the foot, like the metatarsals, is extremely rare. Such cases are often detected late, and as a result, there is delayed management. The present case is that of a 12-year-old Indian boy who came with complaints of pain and swelling below his right foot. In the absence of pulmonary involvement, a definite diagnosis of tuberculosis of the fifth metatarsal with fourth web space was established using histopathology, a cartridge-based nucleic acid amplification test, magnetic resonance imaging, and culture of the pus. He was prescribed first-line anti-tubercular treatment for 12 months.

Isolated Tuberculosis of the First Metatarsal of the Right Foot Without Pulmonary Involvement: A Rare Case.

Tuberculosis of the small bones of the foot is a rare clinical condition. Oftentimes, there is a delay in diagnosis, which could adversely affect the results. Isolated cases of tuberculosis of the first metatarsal of the right foot without pulmonary involvement are seldom reported. Herein, a case of a 13-year-old Indian female who presented with complaints of pain, swelling, and discharge from her right foot is presented. A diagnostic workup led to a definite diagnosis of isolated tuberculosis of the first metatarsal of the right foot without pulmonary involvement, and she was put on anti-tubercular treatment.

Tuberculosis of Talonavicular Joint Without Pulmonary Involvement in an Indian Child: A Report of a Rare Case.

Osteoarticular tuberculosis is a rare entity, even in endemic countries. Isolated cases of tuberculosis of the talonavicular joint are sparse. Primary involvement of the talonavicular joint without pulmonary infection with Mycobacterium tuberculosis is rarest of rare. Here, we report a case of primary talonavicular joint tuberculosis without pulmonary involvement in an Indian child. To the best knowledge of the authors, it is the third such case ever reported in a child in the world. The patient presented with complaints of pain and swelling of the right foot. Detailed laboratory work-up backed by radiological investigations helped in establishing the diagnosis. He was managed conservatively with antitubercular chemotherapy with improvement in his symptoms and was transferred out to his native village.

Isolated Tuberculosis of the First Metatarsal of the Left Foot With Congenital Hallux Valgus Without Pulmonary Involvement: A First of Its Type Case.

Osteomyelitis caused by Mycobacterium tuberculosis is a rare entity. This clinical condition is even rarer when the bones of extremities like the foot are involved. There is a paucity of literature on the isolated tubercular involvement of the bones of the foot. Further, congenital hallux valgus is an infrequently reported condition. A case of tuberculosis of the first metatarsal of the left foot with congenital hallux valgus without pulmonary involvement is never reported in the literature. We herein present a first of its type case where tuberculous osteomyelitis of the first metatarsal of the left foot with congenital hallux valgus was diagnosed with the help of radiology, cartridge-based nucleic acid amplification test, and pus culture. The patient was initiated on anti-tubercular treatment but was ultimately lost to follow-up.