Mycobacterium avium ssp. paratuberculosis and Crohn's Disease-Diagnostic Microbiological Investigations Can Inform New Therapeutic Approaches.

Mycobacterium avium ssp. paratuberculosis (MAP) is the cause of Johne's disease (JD), which is a chronic infectious gastrointestinal disease of ruminants and is often fatal. In humans, MAP has been associated with Crohn's disease (CD) for over a century, without conclusive evidence of pathogenicity. Numerous researchers have contributed to the subject, but there is still a need for evidence of the causation of CD by MAP. An infectious aetiology in CD that is attributable to MAP can only be proven by bacteriological investigations. There is an urgency in resolving this question due to the rising global incidence rates of CD. Recent papers have indicated the "therapeutic ceiling" may be close in the development of new biologics. Clinical trial outcomes have demonstrated mild or inconsistent improvements in therapeutic interventions over the last decades when compared with placebo. The necessity to revisit therapeutic options for CD is becoming more urgent and a renewed focus on causation is essential for progress in identifying new treatment options. This manuscript discusses newer interventions, such as vaccination, FMT, dietary remediation and gut microbiome regulation, that will become more relevant as existing therapeutic options expire. Revisiting the MAP theory as a potential infectious cause of CD, rather than the prevailing concept of an "aberrant immune response" will require expanding the current therapeutic programme to include potential new alternatives, and combinations of existing treatments. To advance research on MAP in humans, it is essential for microbiologists and medical scientists to microscopically detect CWDM and to biologically amplify the growth by directed culture.

Osteoporosis and Vertebral Column.

Background: Osteoporosis is an age-related metabolic disease which has a significant impact on bone health and overall quality of life. It is gaining importance as a major medical consideration with the rapid increase in geriatric population globally. It increases the risk of vertebral fractures, progressive spinal deformities and neurological complications, contributing significantly to morbidity and mortality. Increase in life expectancy and advancement of medical technology has led to an increase in the proportion of geriatric patients undergoing orthopaedic procedures. It is becoming vital to adequately evaluate, investigate and treat osteoporosis before planning spinal surgery, especially spinal fusions and instrumentation. Content: Historically, osteoporosis was considered a contraindication to spine surgery adding to the burden of Disability Adjusted Life Years (DALYs) and mortality. Conversely, osteoporotic patients who underwent spine surgery were not adequately optimized, leading to an increase in failure and complication rates. Better understanding of the pathophysiology of osteoporosis and the biomechanics of an osteoporotic spine with knowledge of current standards of treatment of osteoporosis facilitate the timely and adequate management of this disease. Advances in surgical and anaesthetic techniques facilitate successful surgeries on high-risk elderly and osteoporotic patients with multiple comorbidities allowing for a significantly high predictability for long-term positive outcomes.This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal disease, and the new treatments, recommendations, surgical indications, strategies and advances in instrumentation in patients with osteoporosis who require spinal surgery. Implications: In this article, the authors aim to provide a generalized overview for better understanding of the pathophysiological processes underlying osteoporosis in the vertebral column. This review provides a comprehensive set of guidelines for overall health and management of spine patients with pathologies, either caused by or compounded with osteoporosis. An overview of current techniques, strategies and technologies designed to address the challenges associated with spine surgery in osteoporotic patients is also outlined. Sources: Content for this article has been sourced from routinely cited articles available via PubMed, from National Institute of Health consensus development conference, from the recommendations by World Health Organization technical report series, from previous articles by the authors and from the protocols established by the authors in their clinical practice based on experience and detailed case reviews.

Ethics and Morality.

Introduction: Ethics and morality are a branch of philosophy dealing with moral principles. Morals conceptualise the tenets of human character or behaviour as good or bad, right or wrong. However, morals are an individual and subjective concept which vary across individuals, cultures and time. Intentions, decisions and actions which may be considered moral by one individual or society may be considered amoral by another. The need for an organised system of guidelines, which can be universally applicable to all members of a society and against which all moral or immoral actions can be judged is the driving factor behind foundation of ethics. History of Ethics: A study of ancient Mesopotamian, Greek and Indian cultures over the millennia give a unique insight into ethics as a structural foundation of civilised society. The historical aspect of ethics and ethical systems helps guide present and future generations towards a harmonious and secure society across regional, organizational and global stages. Study of Ethics: A study of moral philosophy endeavours to classify ethical systems based on various schools of thought which act as the guiding principle on which an ethical system is structured. The major branches of ethical philosophy include descriptive ethics which studies the prevalent ethical and moral standards, normative ethics which evaluates the prevalent moral norms and their interpretation and application, meta-ethics which reevaluates the prevalent ethical systems and applied ethics dealing with ethical considerations specific to a particular field. Importance in Life and Clinical Orthopaedics: In this chapter, the authors have attempted to outline the importance of a structured ethical system in various walks of life, including personal, professional and social. A sound ethical system clearly outlines moral versus amoral behaviour, provides an objective means for judging the morality of decisions and actions, provides aids to teaching moral behaviour to new members of a society, defines behaviour of individuals professionally and personally, guides individuals in making decisions over issues of moral conflict or ambiguity and helps maintain structure and order in society so as to achieve the greatest good for the greatest number. The authors also discuss the essential role played by ethics in the life and practice of the modern-day Clinical Orthopaedician.

Computed tomography evaluation of variations in positions and measurements of appendix in patients with non-appendicular symptoms: time to revise the diagnostic criteria for appendicitis.

Purpose: To estimate the frequency distribution of different anatomical positions, and to measure the diameter, wall thickness, and length of appendix in patients with non-appendicular symptoms. Material and methods: This retrospective observational study was conducted among 1,575 patients, who had undergone computed tomography (CT) scan of abdomen for various non-appendicular signs and symptoms. Frequency of distribution of different anatomic locations and measurements of various morphologic parameters were recorded. Results: The most common location of appendix was retrocecal, followed by sub-cecal, post-ileal, and pelvic locations. The mean length of appendix was 66.7 mm (range, 6.3-123 mm), and the diameter was 6.3 mm (range, 2.8-11.3 mm). Diameter of > 6 mm was noted in 48.12% patients. The mean wall thickness was 2.37 mm, ranging 1.2-4.2 mm. The most common intra-luminal content was air-mixed with hypodense or hyperdense material observed in 70.5% of cases. Conclusions: Although an appendix with diameter less than 6 mm may be considered normal, a diameter above 6 mm has an overlap between a normal and inflamed appendix. Therefore, it should be considered in association with clinical and secondary findings to avoid overdiagnosis and unnecessary appendicectomies. We strongly recommend that diameter-based CT criteria to diagnose appendicitis should be revised and standardized.

How Not To Fix a Tibial Fracture: A Case Report on Treatment By a Quack.

Quackery in the orthopaedic profession has existed for quite a long time. Due to the shortage of orthopaedic healthcare staff in public hospitals and the high costs in private facilities, members of disadvantaged communities turn to unlicensed and unskilled practitioners (quacks). The main factors responsible for the increased number of quacks performing orthopaedic treatment are illiteracy, high treatment cost, mismatch in the orthopaedic surgeon-to-population ratio, especially in rural areas, and the absence of any form of health insurance. Moreover, their easy availability and offer of low-cost treatment draw innocent and illiterate patients to them, even though these quacks perform orthopaedic treatment in the most unhygienic, unsterilized, and unconventional manner. The government should intervene and take measures to make orthopaedic treatment more affordable and accessible, especially to the rural population.

Isolated Tillaux Fracture in a Skeletally-Mature Patient: A Rare Presentation.

Isolated Tillaux fractures are uncommon injuries that occur due to external rotational forces acting on the ankle joint. They are more commonly seen in adolescents due to the presence of open epiphyses. In adults, isolated Tillaux fractures present as plafond fractures well described with the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Classification as well as Types 1, 2, and 3 according to the degree of articular comminution present. They occur rarely and can be easily missed or misdiagnosed as other ankle injuries. A thorough clinical examination, combined with imaging studies such as X-rays and CT scans, can aid in accurate diagnosis and treatment planning. Management typically involves open reduction and internal fixation, followed by a short period of immobilization and early mobilization with non-weight bearing. We present a case report of a 27-year-old female who presented with an isolated Tillaux fracture of the ankle following a road traffic accident. This type of fracture is typically seen in teenagers and young adults due to the incomplete closure of the growth plate, which makes it more susceptible to injury. The patient underwent open reduction and internal fixation with a contoured three-hole 3.5 mm titanium T-plate, followed by immobilization in a plaster splint for one week. Early mobilization was encouraged with strict non-weight bearing for 8-10 weeks. Follow-up at 12 weeks revealed complete union at the fracture site, with the patient being asymptomatic except for minimal pain and mild restriction in dorsiflexion.

Effect of Real-Time Environment on Mechanical Properties of Preformed Stainless Steel Archwires: An In Vivo Study.

Introduction: Clinicians should be aware of any effect the oral environment may have on archwires. Laboratory models fail to closely imitate intraoral conditions. The aim was to evaluate the change in mechanical properties of preformed stainless steel archwires after 15 weeks of exposure to the oral environment. Methods: Three commercially manufactured 0.019 × 0.025″ stainless steel archwires were evaluated. Young's modulus, yield strength, spring factor, and hardness were studied. The unexposed distal end cuts (control samples) and archwires were tested after 15 weeks of intraoral exposure (test samples). Tension tests, Vickers microhardness tests, and nanoindentation tests were carried out. Results: Normality was tested using the Shapiro-Wilk test. Statistical analyses included the paired t-test for intragroup comparisons and Kruskal-Wallis ANOVA with the post hoc Dunn test for comparison of mean percentage reduction in values. At T15, Young's modulus showed a statistically significant decrease. Changes in yield strength and spring factor were not significant for groups other than American Orthodontics wires. The reduction in hardness was significant in 3M Unitek. Vickers, tension, and nanoindentation tests demonstrated an expansive range between hardness and Young's modulus so determined. Conclusion: 3M Unitek archwires showed the highest difference in Young's modulus. Yield strength values increased in Ortho Organizers archwires. Spring factor decreased only in 3M Unitek archwires. Hardness values obtained from various tests did not produce identical results.

Electrospun Nanofiber-Based Drug Carrier to Manage Inflammation.

Significance: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most widely prescribed drugs to treat inflammation and related ailments. In recent years, loading these drugs onto nanodevices like nanoparticles, nanofibers, etc. as a drug delivery system has gained momentum due to its desirable properties and advantages. The purpose of this review is to examine the existing research on the potential and novel use of nanofiber-assisted delivery of NSAIDs. Recent Advances: Electrospun nanofibers have recently garnered considerable attention from researchers in a variety of sectors. They have proved to be promising vehicles for drug delivery systems because of their exceptional and favorable features like prolonged drug release, controllable porosity, and high surface area. In this article, various polymers and even combinations of polymers loaded with single or multiple drugs were analyzed to achieve the desired drug release rates (burst, sustained, and biphasic) from the electrospun nanofibers. Critical Issues: The administration of these medications can induce major adverse effects, causing patients discomfort. Thus, encapsulating these drugs within electrospun nanofibers helps to reduce the severity of side effects while also providing additional benefits such as targeted and controlled drug release, reduced toxicity, and long-lasting effects of the drug with lower amounts of administration. Future Directions: This review covers previous research on the delivery of NSAIDs using electrospun nanofibers as the matrix. Also, this study intends to aid in the development of enhanced drug delivery systems for the treatment of inflammation and related issues.

Intercalary Elbow Resection and Arthrodesis for Giant Cell Tumor of Distal Humerus: Something Is Better Than Nothing.

Giant cell tumor (GCT) of the bone is a benign, locally aggressive neoplasm of epiphyseal origin. Most common sites for GCTs include the distal femur, proximal tibia, and the distal end of radius with the distal humerus being involved rarely. GCT is predominantly managed by extended curettage followed by adjuvant therapy to reduce recurrence. Juxta-articular GCTs are difficult to manage due to the destruction of the articular cartilage and subchondral bone which necessitates the need for joint reconstruction or fusion to salvage the joint. Aggressive and recurrent GCTs can be managed by wide resection of the tumor to reduce local recurrence followed by joint reconstruction or fusion. Joint reconstruction using a total elbow arthroplasty has been described for limb salvage as it provides a good functional outcome. We present a case of an aggressive GCT of the distal humerus that was treated using wide resection with humero-ulnar arthrodesis as an alternative in situations where joint reconstruction is not possible due to the unavailability of the prosthesis or socio-economic factors. The patient was asymptomatic after two years of follow-up, had no signs of recurrence, and had good hand functions.

Iatrogenic Foot Drop After Anterior Cruciate Ligament Reconstruction With Peroneus Longus Tendon Autograft: Report of a Rare Case.

Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel's sign was noted on follow-up. The patient finally recovered after a 3-month follow-up.

Comparative Evaluation of Surface Roughness of Porcelain Fused to Metal and Stainless-Steel Crown Following Ultrasonic and Hand Scaling: A Comparative Study.

Introduction Surface roughness encourages plaque retention and causes mechanical, chemical, and biological irritation to surrounding soft tissues. Hence, a smooth surface of restoration is preferred for optimal plaque control and the health of the periodontium. Aim The aim is to evaluate and compare the surface roughness of porcelain fused to metal and stainless-steel crowns following ultrasonic and hand scaling techniques. Material and methods An in-vitro study was conducted on 30 porcelain fused to metal crowns and 30 stainless-steel crowns. Their surface roughness following instrumentation was evaluated by scanning electron microscope (SEM) and profilometry. Results Evaluation by profilometry indicated that porcelain fused to metal following ultrasonic instrumentation has a statistically more significant surface roughness and indentation as compared to hand scaling with p-values < 0.05. Conclusion The surface roughness of any restoration may act as a plaque retentive factor which would affect the health of the periodontium. Ultrasonic scaling is capable of creating roughness to a more extent as compared to hand scaling and porcelain fused to the metal type of restorations is more vulnerable to roughness.

Usability and accessibility-based quality evaluation of Indian airline websites: An MCDM approach.

A tourist may be one of the most diverse kinds of consumer, including many people with disabilities. As a technologically driven industry, the tourism industry focused more on providing online services during the COVID-19 pandemic, where physical activity is limited and people practice social distancing. A company's success may be large extend depend on the quality of the website through which they supply their services. The primary goal of the study presented in this paper is to evaluate the overall quality of Indian commercial airline websites. This study evaluated the seven websites of passenger airlines on usability and accessibility parameters using an online diagnostic tool. Page size, load time, response time, broken links, contrast errors were used as the usability parameters, and the TAW tool was used to evaluate the websites' compliance with WCAG 2.0. The paper proposes a system for determining the best website by utilizing the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), The Analytic Hierarchy Process (AHP), and the Fuzzy AHP methods. The result shows that Indian airline websites have many usability issues, and none of the websites adheres to WCAG 2.0 accessibility guidelines. Friedman's test is applied to compare the ranking given by various MCDM techniques, resulting in no significant difference in the various ranking methods adopted.

Persistent left superior vena cava-An alternative feasible technique during Senning procedure.

Although rarely performed today in most centers, Senning procedure continues to be a good option for patients with transposition of great arteries presenting late with either regressed left ventricle or pulmonary hypertension. There are many subsets of patients including those having deficient atrial septal tissue, situs inversus, dextrocardia, and atrial isomerism which require complex modifications of technique. One such subset is patients having bilateral superior vena cavae (SVC), which requires coronary sinus cutback and creating a wide flap for the posterior venous baffle which unduly increases the complexity of the surgery. We describe an alternative way of rerouting a persistent left SVC by reimplanting onto the left atrial appendage which forms the part of the systemic atrium after the atrial switch surgery.

What do patients want out of their Total Knee Arthroplasty?: An Indian perspective.

INTRODUCTION AND AIM: Total Knee Arthroplasty surgery is one of the most successful operations in orthopaedics. Still a sizable percentage of patients remain dissatisfied. Various studies have been conducted to analyse the red flags associated with poor outcome. In this study we tried to have insight on actual requirements of Indian patients from TKA operation. MATERIAL & METHODS: 300 patients undergoing TKA were studied by way of patient expectation feedback form. The form had various patient related capture points. It had a leading question: What are your expectations from TKA? They were asked to rank the 5 most important options in the order of importance. The patient expectation form was distributed and collected by an independent observer. RESULTS: 70% of patients ranked relief of pain as the most important expectation. 20% reported improvement in walking as the number one expectation. Nearly equal number listed improvement in walking and ease of doing day-to-day activities as the second most important expectation. This was followed by improvement in climbing the stairs and improvement in quality of life. Correction of deformity and no pain while squatting and getting up from sitting position ranked at the bottom. CONCLUSION: Our study shows that the primary expectations of Indian population from their TKA are relief from pain and improvement in walking. Secondary expectations include ease of doing day-to-day activities and improvement in quality of life.

Prevalence of breast imaging reporting and data system (BIRADS) categories and breast consistencies in Central India -A cross-sectional survey.

BACKGROUND: For recognizing the initial stages of breast cancer, mammography is regarded as one of the best modalities and plays a crucial part to lessen morbidity and mortality. For collaborative studies and planning of preventive strategies, it is significant to have baseline data. Thus, in this survey, the frequency distribution of breast imaging reporting and data system (BIRADS) classification and breast consistencies was investigated during the mammographic screening program in the Gwalior region, India. MATERIAL AND METHODS: A descriptive, cross-sectional survey was conducted in the Gwalior region, India, in which 1,838 patients were screened with the aid of mammography. The mammography films were evaluated by a single radiologist who determined the BIRADS score, breast composition, and any other abnormal findings. After tabulating the data into MS Excel (MS Office version 2007 developed by Microsoft, Redmond, WA), descriptive analysis and Chi-square test were performed to determine the association between the BIRADS score and breast consistency and setting significance level at (below) 0.05. RESULTS: The most commonly found BIRADS score was score 1 (53.4%), followed by score 2 (20.4%), and score 5 was of the least frequency (1.3%). Similarly, the most common consistency found was fatty (48.2%) and the least common was heterogeneously dense (3.97%). The most BIRADS category of 0 was seen in heterogeneously dense (n = 22; 26%) followed by dense breast compositions (n = 18; 25%). The most common consistency found with known breast malignancy (BIRADS 6) patients was the extremely dense breast (n = 11; 40.7%). CONCLUSION: In this study, it was observed that about 57.3% of all the cases were categorized as BIRADS 1 and 20.8% as BIRADS 2.

A Mycobacterium species for Crohn's disease?

In ruminants Mycobacterium avium subspecies paratuberculosis (MAP) is the causative organism of a chronic granulomatous inflammatory bowel disease called Johne's disease (JD). Some researchers have hypothesised that MAP is also associated with Crohn's disease (CD), an inflammatory bowel disease in humans that shares some histological features of JD. Despite numerous attempts to demonstrate causality by researchers, direct microbiological evidence of MAP involvement in CD remains elusive. Importantly, it has not been possible to reliably and reproducibly demonstrate mycobacteria in the tissue of CD patients. Past attempts to visualise mycobacteria in tissue may have been hampered by the use of stains optimised for Mycobacterium tuberculosis complex (MTB) and the lack of reliable bacteriological culture media for both non-tuberculous mycobacteria (NTM) and cell-wall-deficient mycobacteria (CWDM). Here we describe a Ziehl-Neelsen (ZN) staining method for the demonstration of CWDM in resected tissue from patients with Crohn's disease, revealing the association of CWDM in situ with host tissue reactions, and posit this as a cause of the tissue inflammation. Using the ZN stain described we demonstrated the presence of CWDM in 18 out of 18 excised tissue samples from patients diagnosed as having Crohn's disease, and in zero samples out of 15 non-inflammatory bowel disease controls.

Impact of COVID-19 on cancer care in India: a cohort study.

BACKGROUND: The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. METHODS: We did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FINDINGS: Between March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities). INTERPRETATION: The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial. FUNDING: None. TRANSLATION: For the Hindi translation of the abstract see Supplementary Materials section.

Anti-Mycobacterium paratuberculosis (MAP) therapy for Crohn's disease: an overview and update.

The role of Mycobacterium avium subspecies paratuberculosis (MAP) in the pathogenesis of Crohn's disease (CD) has been strongly debated for many years. MAP is the known aetiological agent of Johne's disease, a chronic enteritis affecting livestock. At present, due to the paucity of high-quality data, anti-MAP therapy (AMT) is not featured in international guidelines as a treatment for CD. Although the much-quoted randomised trial of AMT did not show sustained benefits over placebo, questions have been raised regarding trial design, antibiotic dosing and the formulation used. There are several lines of evidence supporting the CD and MAP association with uncontrolled and controlled trials demonstrating effectiveness, including a retrospective review of cases treated at our own institution. Here, we provide an overview of the evidence supporting and refuting AMT in CD before focussing on updates of the current research in the field, including the ongoing trials with the novel RHB-104 formulation and the MAP vaccine trial. While controversial, gastroenterologists are often asked about long-term combination antibiotic therapy for CD. There has been broadcast and social media coverage surrounding this, particularly with regard to current trials. Although patients should not be deterred from treatments of proven effectiveness, this review aims to help with commonly asked questions and highlights our own approach for the use of anti-MAP in specific circumstances.

Putting Crohn's on the MAP: Five Common Questions on the Contribution of Mycobacterium avium subspecies paratuberculosis to the Pathophysiology of Crohn's Disease.

For decades, Mycobacterium avium subspecies paratuberculosis (MAP) has been linked to the pathogenesis of Crohn's disease. Despite many investigations and research efforts, there remains no clear unifying explanation of its pathogenicity to humans. Proponents argue Crohn's disease shares many identical features with a granulomatous infection in ruminants termed Johne's disease and similarities with ileo-cecal tuberculosis. Both are caused by species within the Mycobacterium genus. Sceptics assert that since MAP is found in individuals diagnosed with Crohn's disease as well as in healthy population controls, any association with CD is coincidental. This view is supported by the uncertain response of patients to antimicrobial therapy. This report aims to address the controversial aspects of this proposition with information and knowledge gathered from several disciplines, including microbiology and veterinary medicine. The authors hope that this discussion will stimulate further research aimed at confirming or refuting the contribution of MAP to the pathogenesis of Crohn's disease and ultimately lead to advanced targeted clinical therapies.