Stigma in Tuberculosis: Time to Act on an Important and Largely Unaddressed Issue.

Tuberculosis has afflicted mankind for centuries, serving as a prevalent cause of morbidity and mortality in high-burden countries. Despite ongoing efforts in tuberculosis control, critical issues, such as the psychological impact of the disease, often go unaddressed. This editorial sheds light on a crucial aspect of tuberculosis: the stigma associated with the infection and its profound impact. Additionally, it offers suggestions to overcome the shortcomings in the psychological management of patients.

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.

Nikshay Mitra: A Remarkable Initiative in Efforts Against Tuberculosis.

Tuberculosis continues to haunt the fragile healthcare systems in the developing world. It is a disease that is not only limited to the illness due to the bacterial infection but is associated with a number of other impacts, like social and psychological ones. Eliminating tuberculosis is an arduous task and requires a number of initiatives that were taken by the national governments and collaborating partners. One such remarkable development is the introduction of 'Nikshay Mitra'. It is an initiative where the donors are encouraged to support the tuberculosis patients by providing nutritional, additional diagnostic, and vocational support. Even after nearly two years of introduction, there is a paucity of data, especially from large-scale studies from across India. This editorial sheds light on this initiative.

Tuberculosis of the Cervical Vertebrae With Retropharyngeal and Parapharyngeal Abscesses Due to Staphylococcus aureus and Mycobacterium tuberculosis in an Adult: A Report of a Rare Case.

Tuberculosis is a disease with presentations both in the lungs and at other extrapulmonary sites. While pulmonary tuberculosis constitutes a significant proportion of total tuberculosis cases, extrapulmonary cases with infections at rare sites are also documented. Herein, an exceedingly rare case of tuberculosis of the cervical vertebrae with retropharyngeal and parapharyngeal abscesses due to Staphylococcus aureus and Mycobacterium tuberculosis in a young Indian male is presented. The rarity of the locations of the lesions with coinfections with two bacteria made the diagnosis challenging. Besides, the potential for a retropharyngeal abscess to compress the airway is an emergency situation. However, the ultimate diagnosis was achieved with the help of a radiograph of the neck, contrast-enhanced computed tomography of the neck, fine-needle aspiration cytology, and a cartridge-based nucleic acid amplification test. He was initiated on appropriate antibiotics and antituberculous chemotherapy per his weight.

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.

Tuberculous Pericardial Effusion With Pleural Effusion in an Indian Female: A Rare Case.

Tuberculosis can present at various extrapulmonary sites. However, even in endemic countries, concomitant involvement of different sites in the same patient is rarely reported. Further, tuberculous pericarditis represents a fraction of all tuberculosis infections and is an uncommon form of extrapulmonary tuberculosis. In underdeveloped nations, it is the most frequent cause of massive pericardial effusion. Additionally, it is the most common cause of constrictive pericarditis in adults, which has a high death rate and a poor prognosis. Furthermore, concomitant pleural effusion due to Mycobacterium tuberculosis is infrequently reported. Herein, a case of concomitant pericardial and left-sided pleural effusion in an Indian female is reported. She came with complaints of breathlessness, chest pain, night sweats, and loss of appetite. A diagnostic pleural thoracentesis and pericardiocentesis helped establish the diagnosis, and she was commenced on antituberculous treatment for 168 days.

Advancements in Artificial Intelligence for the Diagnosis of Multidrug Resistance and Extensively Drug-Resistant Tuberculosis: A Comprehensive Review.

Tuberculosis (TB) remains a significant global health concern, particularly with the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). Traditional methods for diagnosing drug resistance in TB are time-consuming and often lack accuracy, leading to delays in appropriate treatment initiation and exacerbating the spread of drug-resistant strains. In recent years, artificial intelligence (AI) techniques have shown promise in revolutionizing TB diagnosis, offering rapid and accurate identification of drug-resistant strains. This comprehensive review explores the latest advancements in AI applications for the diagnosis of MDR-TB and XDR-TB. We discuss the various AI algorithms and methodologies employed, including machine learning, deep learning, and ensemble techniques, and their comparative performances in TB diagnosis. Furthermore, we examine the integration of AI with novel diagnostic modalities such as whole-genome sequencing, molecular assays, and radiological imaging, enhancing the accuracy and efficiency of TB diagnosis. Challenges and limitations surrounding the implementation of AI in TB diagnosis, such as data availability, algorithm interpretability, and regulatory considerations, are also addressed. Finally, we highlight future directions and opportunities for the integration of AI into routine clinical practice for combating drug-resistant TB, ultimately contributing to improved patient outcomes and enhanced global TB control efforts.

Tuberculosis of the Scapula, Humerus, and Postero-Lateral Thoracic Wall Without Pulmonary Involvement Mimicking Ewing's Sarcoma: A Report of a Rare Case.

Tuberculosis can present in various atypical forms. The clinical manifestations could involve sites like bones. Tuberculosis of the scapula, humerus, and posterolateral thoracic wall is extremely rare, and diagnosis is challenging due to similarities with conditions like tumors. A young boy presented with swelling of the right shoulder joint for three months. The diagnosis was challenging due to similarities with Ewing's sarcoma on the initial radiometric workup. A clinical assessment and diagnostic workup with biopsy, a cartridge-based nucleic acid amplification test, and an advanced radiometric investigation resulted in a final diagnosis. He was started on antituberculous drugs for 12 months.

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.

Pulmonary Tuberculosis With Left Pleural Effusion and Lichen Scrofulosorum: A First-of-Its-Type Report.

Tuberculosis is prevalent in high-burden countries, but its cutaneous form, tuberculid, is rare and often misdiagnosed. Lichen scrofulosorum, a type of tuberculid, is uncommon and typically affects children and young adults, sometimes alongside other tuberculosis symptoms. Herein, a very rare case of lichen scrofulosorum in a 20-year-old Indian male with an underlying focus of tuberculosis in the lungs and pleura is presented. Prompt treatment after detailed lab work backed by clinical assessment helped in establishing the diagnosis. He was put on antitubercular therapy, which led to a marked improvement in skin and pulmonary lesions. However, he was lost to follow-up.

Beyond Blame: Is India Ready for No-Fault Liability in Healthcare?

In contemporary healthcare systems, the pursuit of justice intertwines with fault attribution and liability determination. The exploration of no-fault liability as a potential alternative within India's healthcare landscape delves into its feasibility and implications. Drawing from international experiences, regulatory frameworks, and societal readiness, the complexities and potential benefits of adopting a no-fault liability system are elucidated. Perspectives from patients, healthcare providers, and broader societal stakeholders are considered, highlighting both the advantages and challenges associated with such a transition. Addressing disparities in access, legal reforms, and logistical hurdles underscores the groundwork necessary for potential adoption, signaling a potential paradigm shift toward equitable compensation and accountability within India's healthcare system.

Primary Rifampicin Mono-Resistant Tuberculosis of the Cervical, Mediastinal, and Axillary Lymphadenopathy in an Indian Male: A First-of-Its-Type Case.

Tuberculosis is common in endemic countries. However, extrapulmonary tuberculosis is relatively rare, and primary extrapulmonary rifampicin mono-resistant tuberculosis of the cervical, mediastinal, and axillary lymph nodes simultaneously without pulmonary focus in an immunocompetent male has never been reported. Herein is a case of a 27-year-old Indian male with no previous history of tuberculosis who was diagnosed after an extensive clinical assessment with a radiometric and cartridge-based nucleic acid amplification assay of the swollen lymph nodes. He was put on antituberculous treatment per the all-oral longer regimen of the national program.

Spina Ventosa of the Left Second Metacarpal in an Adult Indian Male With No Pulmonary Involvement: A First-of-Its-Type Case.

Tuberculosis inflicting small bones is infrequently reported, even in endemic countries. A case of isolated involvement of the left second metacarpal in an adult Indian male with no pulmonary involvement is rare and has never been documented before in the medical literature. It's a diagnostic challenge due to non-specific clinical features, absence of constitutional signs of tuberculosis, ambiguity on radiograph films at early stages, and often results in delayed diagnosis. Moreover, it's a paucibacillary disease, and hence, diagnosis can be an arduous task. Herein, a case of a 20-year-old Indian male is presented who came with complaints of pain and swelling with a discharging sinus from the dorsum of his left hand. A detailed evaluation with the isolation of Mycobacterium tuberculosis on a cartridge-based nucleic acid amplification test helped in the diagnosis and initiation of appropriate antituberculous chemotherapy per his weight.

Non-traumatic Diaphragmatic Eventration With Extrapulmonary Tuberculosis Presenting As Pleural Effusion in an Indian Male: The First Report of Its Type.

Tuberculosis is rampant in endemic countries. Extrapulmonary tuberculosis, like pleural effusion, is infrequently reported in outpatient departments. However, diaphragmatic eventration is rare and is not reported in active tuberculosis. Herein, the first-of-its-type case of a diaphragmatic eventration with tuberculous right pleural effusion in an Indian male is presented. The diagnosis was challenging and achieved through radiometric investigations and diagnostic pleural tapping. He was put on an anti-tuberculous treatment based on his weight.

Tuberculosis of the Elbow Joint in an Indian Boy: A Rare Entity With a Diagnostic Challenge.

Tuberculosis of the bones and joints is an infrequently reported entity. Isolated involvement of the elbow joint is exceedingly rare, even in endemic countries. The diagnosis is an arduous task, especially if it presents in younger age groups. Herein, a case of tuberculosis of the right elbow joint in a seven-year-old Indian child is presented. The diagnosis was challenging due to the vague clinical features and rarity of the disease, but he was diagnosed after a detailed clinical examination along with a radiometric assessment. He was initiated on the appropriate chemotherapy.

Primary Rifampicin Mono-Resistant Extrapulmonary Tuberculosis of the Scapula With Cold Abscesses: A Report of a Rare Case.

Extrapulmonary tuberculosis is rare. Tuberculous involvement of the scapula is an infrequently reported entity. Such cases are exceptionally rare, as there is no documented case of an isolated primary rifampicin mono-resistant extrapulmonary tuberculosis of the scapula with cold abscesses in the medical literature. This case report features a 25-year-old Indian male patient whose main complaint was a painful swelling with a discharging sinus in his left shoulder that limited his range of motion. A thorough blood workup, clinical assessment, and scans led to a definitive diagnosis. The patient was commenced on antituberculous therapy.

Clinical Drug-Resistant Cutaneous Tuberculosis Presenting as Lupus Vulgaris Ulcerative Type in an Indian Female With Poncet's Disease: A First-of-Its-Type Report.

Tuberculosis of the skin is rare and a difficult diagnosis. Moreover, recurrent episodes of mycobacterial infection in the skin with Poncet's disease are rarely reported in females. Herein, the first of its type case of clinical drug-resistant tuberculosis of the skin in an Indian female is presented. She had a history of cutaneous tuberculosis five times in the past. At the sixth time, she came with complaints of an ulcerative lesion over her right forearm and cubital fossa with left knee swelling. The paucibacillary nature of the infection made the diagnosis exceedingly challenging. However, a detailed clinical examination with a suspicion of drug resistance resulted in management with significant clinical improvement.

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.

Discussing the Debate: Leukocyte-Rich Platelet-Rich Plasma Versus Leukocyte-Poor Platelet-Rich Plasma.

This editorial touches on the persistent debate related to platelet-rich plasma (PRP) therapy. It focuses on the different approaches involving leukocyte-rich and leukocyte-poor PRP formulations of the PRP. It looks into the reasons behind these approaches, their potential effects on clinical practice, i.e., pros and cons, and the evidence supporting each method within the field of regenerative medicine. Examining these different views highlights the complexity of PRP therapy. It's important to proceed carefully, relying on evidence to enhance patient outcomes. Understanding the ongoing debates can help healthcare professionals make informed decisions. We need to consider various factors before implementing PRP therapy, ensuring it's done responsibly.

Applications of Blockchain-Based Technology for Healthcare Devices Post-market Surveillance.

The volume of data analysis for medical device post-market surveillance (PMS) has increased dramatically in recent years. It is the more stringent and intricate regulatory criteria of the health authorities that are meant to improve the medical device safety review. As regulators scrutinize device safety more closely, proactive approaches to PMS processes are becoming crucial. To solve some of the issues brought on by this shifting regulatory landscape, new technologies have been investigated. This study envisages the technical features of blockchain technology (BCT) and its role in enhancing the PMS for medical devices. To address the aforementioned challenges, our model involves the establishment of a secure, permissioned blockchain for PMS data management, utilizing a proof-of-authority consensus mechanism. This blockchain framework will exclusively permit a carefully vetted and designated set of participants to validate transactions and record them in the PMS data ledger. The utilization of BCT holds the potential to introduce enhanced efficiency and provide several advantages to the various stakeholders involved in the PMS procedure, including its potential to support emerging regulatory efforts.