One-third of the world's population has been infected with Mycobacterium tuberculosis, with new infections occurring in about 1% of the population each year. However 90–95% of infections remain asymptomatic. Thus early diagnosis of tuberculosis and drug resistance improves survival and helps to promote contact tracing, implementation of institutional cross-infection procedures, and other public-health actions. There have been many advances and modifications to the methodology for tuberculosis diagnosis some of which are very promising. But these advances have not kept pace with the explosion of tuberculosis or the outbreak of drug resistant tuberculosis. This review describes some of the newer advances in tuberculosis diagnostics and the challenges they face.
The document discusses the development and recommendation of a new tuberculosis diagnostic test called Xpert MTB/RIF Ultra. It notes that while previous tests like Xpert MTB/RIF were a breakthrough, Ultra offers higher sensitivity especially in difficult cases like children and HIV patients. A WHO expert group evaluated Ultra and recommended its use as an improved alternative to existing tests for TB diagnosis and rifampin resistance detection in all settings. However, the increased sensitivity of Ultra may also increase false positives which will require adjustments to diagnostic algorithms.
Recent advances in Tuberculosis diagnosisNishantTawari
This document discusses recent advances in tuberculosis diagnosis. It notes that in 2017 there were over 10 million new TB cases globally, including 2.8 million in India. New diagnostic techniques have been developed to improve detection of both drug-sensitive and drug-resistant TB. These include nucleic acid amplification tests like Xpert MTB/RIF, which can detect TB and rifampin resistance in under 3 hours. Other techniques discussed are line probe assays, automated liquid culture systems, and urine lipoarabinomannan tests. The document examines the advantages and limitations of various methods for directly and indirectly detecting active TB.
Tuberculosis is a raging problem round the globe. Eradicating TB is a herculean task but is possible is efforts from all corners from the world. The diagnostics have taken a big leap and with effective medications, our dream of TB free world may come true. But unlimited efforts are need to reach our goal.
This presentation is about lab diagnosis of tuberculosis. It highlights use of currently available diagnostic methods in identifying pulmonary and extrapulmonary tuberculosis.
This document discusses new technologies for the diagnosis of tuberculosis. It describes how microscopy using light emitting diodes has advanced diagnosis by providing a simple, robust method. Molecular tests like PCR and line probe assays can rapidly detect TB and drug resistance from samples, but are more expensive and complex. The WHO endorses tests like Xpert MTB/RIF that can simultaneously detect TB and rifampicin resistance in a few hours. While promising, molecular methods still have limitations around cost, availability, and cannot replace clinical assessment.
MTB/RIF Ultra was developed to improve on the sensitivity of the original MTB/RIF assay for detecting tuberculosis (TB), especially in smear-negative and HIV-associated cases. MTB/RIF Ultra uses multiple genetic targets and has a lower limit of detection, resulting in improved sensitivity. It can detect TB at very low bacillary levels and has categories for trace results that may need confirmation with a second specimen. MTB/RIF Ultra performance for rifampicin resistance detection is similar to the original assay. Proper recording of patient category and results is important for correct interpretation. Countries need monitoring plans as they transition cartridge types to track impact.
1) Tuberculosis (TB) is commonly diagnosed through direct microscopy, culture, immunodiagnostic tests, molecular tests, and histopathology using samples from sputum, BAL, CSF, tissues, and other body fluids.
2) Direct microscopy has low sensitivity but is quick, while culture has higher sensitivity and allows drug susceptibility testing but takes 1-2 weeks for results. Newer liquid culture systems can provide results in only a few days.
3) Molecular tests like PCR and interferon-gamma release assays provide rapid results within hours and are also used for diagnosis, but many have high costs.
The document discusses the development and recommendation of a new tuberculosis diagnostic test called Xpert MTB/RIF Ultra. It notes that while previous tests like Xpert MTB/RIF were a breakthrough, Ultra offers higher sensitivity especially in difficult cases like children and HIV patients. A WHO expert group evaluated Ultra and recommended its use as an improved alternative to existing tests for TB diagnosis and rifampin resistance detection in all settings. However, the increased sensitivity of Ultra may also increase false positives which will require adjustments to diagnostic algorithms.
Recent advances in Tuberculosis diagnosisNishantTawari
This document discusses recent advances in tuberculosis diagnosis. It notes that in 2017 there were over 10 million new TB cases globally, including 2.8 million in India. New diagnostic techniques have been developed to improve detection of both drug-sensitive and drug-resistant TB. These include nucleic acid amplification tests like Xpert MTB/RIF, which can detect TB and rifampin resistance in under 3 hours. Other techniques discussed are line probe assays, automated liquid culture systems, and urine lipoarabinomannan tests. The document examines the advantages and limitations of various methods for directly and indirectly detecting active TB.
Tuberculosis is a raging problem round the globe. Eradicating TB is a herculean task but is possible is efforts from all corners from the world. The diagnostics have taken a big leap and with effective medications, our dream of TB free world may come true. But unlimited efforts are need to reach our goal.
This presentation is about lab diagnosis of tuberculosis. It highlights use of currently available diagnostic methods in identifying pulmonary and extrapulmonary tuberculosis.
This document discusses new technologies for the diagnosis of tuberculosis. It describes how microscopy using light emitting diodes has advanced diagnosis by providing a simple, robust method. Molecular tests like PCR and line probe assays can rapidly detect TB and drug resistance from samples, but are more expensive and complex. The WHO endorses tests like Xpert MTB/RIF that can simultaneously detect TB and rifampicin resistance in a few hours. While promising, molecular methods still have limitations around cost, availability, and cannot replace clinical assessment.
MTB/RIF Ultra was developed to improve on the sensitivity of the original MTB/RIF assay for detecting tuberculosis (TB), especially in smear-negative and HIV-associated cases. MTB/RIF Ultra uses multiple genetic targets and has a lower limit of detection, resulting in improved sensitivity. It can detect TB at very low bacillary levels and has categories for trace results that may need confirmation with a second specimen. MTB/RIF Ultra performance for rifampicin resistance detection is similar to the original assay. Proper recording of patient category and results is important for correct interpretation. Countries need monitoring plans as they transition cartridge types to track impact.
1) Tuberculosis (TB) is commonly diagnosed through direct microscopy, culture, immunodiagnostic tests, molecular tests, and histopathology using samples from sputum, BAL, CSF, tissues, and other body fluids.
2) Direct microscopy has low sensitivity but is quick, while culture has higher sensitivity and allows drug susceptibility testing but takes 1-2 weeks for results. Newer liquid culture systems can provide results in only a few days.
3) Molecular tests like PCR and interferon-gamma release assays provide rapid results within hours and are also used for diagnosis, but many have high costs.
Recent advances in the diagnosis of tuberculosis include molecular methods that can rapidly detect Mycobacterium tuberculosis and resistance to rifampicin. The Xpert MTB/RIF assay can detect M. tuberculosis and rifampicin resistance directly from sputum samples in less than one day, which is much faster than traditional solid or liquid culture methods requiring weeks. Meta-analyses show the Xpert MTB/RIF assay has high sensitivity and specificity for detecting rifampicin resistance. While a major improvement, the Xpert MTB/RIF assay is still being evaluated for use with extra-pulmonary samples which typically yield lower sensitivity. Rapid molecular diagnostics are transforming tuberculosis diagnosis and treatment monitoring.
This document discusses mycobacteria other than tuberculosis (MOTT), also known as nontuberculous mycobacteria (NTM). It describes how NTM are classified into four groups based on their pigment production and growth rate. Some important NTM species that can cause disease in humans are described for each group, including M. kansasii, M. marinum, M. avium complex, and rapidly-growing species like M. fortuitum. The document outlines methods for diagnosing NTM infections through specimen collection, acid-fast staining of smears, and culture-based identification.
Line Probe Assay: A New Arrival at the PRL discusses a new diagnostic tool, the line probe assay, that has arrived at the Provincial Tuberculosis Reference Lab in Sindh, Pakistan. The line probe assay can simultaneously detect resistance to rifampicin and isoniazid in mycobacterium tuberculosis, with a sensitivity of over 90% and specificity of over 99% for smear-positive specimens. It provides results faster than conventional drug susceptibility testing methods like solid and liquid culture. The new diagnostic tool will help improve case detection and management of drug-resistant tuberculosis in Pakistan.
This document discusses molecular assays for tuberculosis diagnosis and drug resistance testing. It begins with an introduction to the global burden of TB and importance of accurate diagnosis. It then describes various microbiological diagnostic methods including smear microscopy, culture techniques, nucleic acid amplification tests (NAATs), and molecular methods like whole genome sequencing (WGS). Specific NAATs discussed in detail are Xpert MTB/RIF and targeted sequencing approaches. Centralized high-throughput diagnostic tests are also mentioned. Overall the document provides an overview of established and emerging molecular methods that can improve TB diagnosis and detection of drug resistance.
RECENT ADVANCES IN DIAGNOSIS OF TUBERCULOSISANGAN KARMAKAR
TRADITIONAL TESTS AND RECENT DIAGNOSTIC MODALITIES FOR TUBERCULOSIS WITH EMPHASIS TO MOLECULAR DETECTION TECHNIQUES, DRUG SENSITIVITY ASSESMENT IN INDIAN PERSPECTIVE
This document discusses newer diagnostic methods for tuberculosis (TB), specifically focusing on liquid culture and drug susceptibility testing (DST). It describes several technologies used for TB diagnosis, including light-emitting diode (LED) microscopy, liquid culture methods like MGIT, and nucleic acid amplification tests (NAATs) like Xpert MTB/RIF. Liquid culture methods like MGIT and BACTEC provide results faster than solid culture, in 2-3 weeks versus 6-8 weeks, and also allow simultaneous DST. Newer NAATs like Xpert MTB/RIF can provide results in under 2 hours and detect TB as well as rifampin resistance directly from sputum samples.
This document summarizes newer diagnostic techniques for tuberculosis (TB), including polymerase chain reaction (PCR) and other nucleic acid amplification tests. PCR allows for rapid amplification of TB bacterial DNA, enabling detection of the pathogen sooner than traditional culture-based methods. Several FDA-approved PCR tests are described that can detect TB within 1-3 hours versus weeks for cultures, though PCR sensitivity is slightly lower than cultures. Limitations and potential errors of PCR for TB diagnosis are also outlined. Flow cytometry and other automated techniques for TB testing are mentioned as areas of ongoing development.
This document discusses atypical mycobacteria (NTM). It describes the Runyon classification system for NTM based on pigment production and growth rate. The most common NTM species are Mycobacterium avium complex (MAC) and Mycobacterium kansasii. MAC is ubiquitous in the environment and a major cause of pulmonary NTM disease. M. kansasii is associated with tap water and causes lung disease resembling tuberculosis, often in older male smokers with COPD. Host immune deficiencies increase risk of NTM infections.
This document provides information on the laboratory diagnosis of tuberculosis. It discusses the classification of mycobacteria, specimen collection, and the various diagnostic methods used which include smear microscopy, culture, and molecular tests. Smear microscopy has limitations but is widely used due to its low cost. Culture is the gold standard but is more complex and requires biosafety. Liquid culture systems allow for faster results than solid media. Drug sensitivity testing determines resistance and is important for treatment. Molecular tests like line probe assays and GeneXpert can rapidly detect M. tuberculosis and resistance, with GeneXpert suitable to test pulmonary and some extrapulmonary samples directly. The document concludes with details about Microcare Laboratory which provides accredited tuberculosis diagnostic services
This document discusses diagnostic modalities for tuberculosis, including both pulmonary and extrapulmonary TB. It provides details on various bacteriological examinations for diagnosing TB, such as sputum smear microscopy, culture, drug susceptibility tests, and molecular techniques like Xpert MTB/RIF and line probe assays. Radiological examinations like chest X-rays are also discussed. The global burden of TB is summarized, with over 10 million new cases and 1.8 million deaths annually. Prompt diagnosis is important for treatment and minimizing transmission.
Diagnostics of tuberculosis: An insight into Genexpert 27 4-15Yahya Noori, Ph.D
This document discusses the GeneXpert diagnostic test for tuberculosis. It provides an overview of tuberculosis as the second leading infectious disease globally. It then discusses the GeneXpert test, noting that it can detect tuberculosis and rifampicin resistance in under 2 hours, much faster than traditional diagnostics. The document reviews studies showing high sensitivity and specificity of GeneXpert for pulmonary and extra-pulmonary tuberculosis. It concludes by outlining the current recommendations in Pakistan for using GeneXpert to diagnose tuberculosis in high-risk patient groups.
Newer diagnostic methods for tuberculosis Shweta Anand
The document discusses newer diagnostic methods for tuberculosis. It describes various specimen collection methods that improve sample quality like the Lung Flute device. Sputum smear microscopy and automated methods like the TBDx system are outlined. Culture-based techniques involving liquid and solid media are explained, including automated systems like MGIT and BacT/Alert. Newer culture-based drug susceptibility tests such as MODS, TLA, and NRA are also introduced. Overall the document provides an overview of advances in TB diagnostics from sample collection to molecular and culture-based methods.
This document summarizes methods for diagnosing tuberculous infections. Key methods include:
1. Clinical examination, routine lab tests like ESR, sputum smear microscopy, culture and nucleic acid amplification tests from clinical samples.
2. Chest radiography and collection of appropriate clinical samples from sites of disease are important.
3. Newer rapid diagnostics like Xpert MTB/RIF and line probe assays can directly detect tuberculosis and multidrug-resistant strains in a few hours.
The document provides information on the molecular diagnosis of tuberculosis. It discusses the historical aspects of TB identification and increasing drug resistance. It notes that in 1993, WHO declared TB a global emergency, with one-third of the world's population infected. Current estimates from WHO in 2010 show over 8 million new TB cases annually. Molecular diagnostic methods like the AMTD and MTBDRplus tests can rapidly detect Mycobacterium tuberculosis complex and resistance patterns in days rather than the months needed for conventional culture. These new tests are especially useful for screening patients in high burden areas and for detecting drug resistant TB.
Non-tuberculous mycobacteria (NTM), also known as atypical mycobacteria, are categorized into four groups based on pigment production and growth rate: photochromogens, scotochromogens, non-photochromogens, and rapid growers. Medically important NTM in these groups can cause localized lymphadenitis, skin lesions like swimming pool granuloma, tuberculosis-like pulmonary lesions, and disseminated disease. NTM are commonly found in the environment and occasionally cause opportunistic infections in humans through the skin or lungs.
Investigations in Tuberculosis and advancesNirish Vaidya
This document discusses various techniques for investigating Mycobacterium tuberculosis and advances in the field. It summarizes key characteristics of M. tuberculosis and the global burden of tuberculosis. It then describes several laboratory techniques for detecting and diagnosing tuberculosis, including sputum smear microscopy, mycobacterial culture methods, tuberculin skin testing, and newer molecular techniques such as nucleic acid amplification tests and interferon-gamma release assays. Advances in rapid molecular diagnostics and their applications for tuberculosis detection and drug resistance testing are also discussed.
The document discusses CBNAAT (Xpert MTB/RIF), a qualitative PCR test that detects Mycobacterium tuberculosis complex DNA and rifampin resistance mutations. It can aid in TB diagnosis when used with clinical findings. The test is intended for use on untreated or short-term treated patients. Positive results must be confirmed by a reference lab, and it does not provide rifampin susceptibility confirmation. Xpert MTB/RIF has high sensitivity and specificity compared to smear microscopy and culture, especially for smear-negative TB. It can also detect rifampin resistance and has applications for extrapulmonary TB diagnosis from various samples.
This document provides an overview of tuberculosis diagnosis and treatment in India. It discusses:
1) India's goal to end TB by 2025 and new programs to support TB patients and educate communities.
2) Recommendations that all medical colleges have facilities for multidrug-resistant TB management and that 5 whole genome sequencing facilities be established for surveillance and research.
3) Diagnostic tests for TB including smear microscopy, molecular tests like CBNAAT and line probe assay, and culture. It provides details on each test's methodology, turnaround time, and sensitivity.
4) Classification of TB cases as new, previously treated, clinically diagnosed or microbiologically confirmed. Treatment regimens are outlined according
This document discusses the diagnosis of pulmonary tuberculosis. It emphasizes that diagnosis requires a combination of clinical presentation, medical history, physical examination, chest radiography, and bacteriological examination. Sputum smear microscopy and mycobacterial culture are important for laboratory confirmation, with culture being the gold standard. A presumptive diagnosis of tuberculosis can be made if acid-fast bacilli are seen on smear, but treatment should not be initiated solely on this basis without further evaluation.
n engl j med 368;24 nejm.org june 13, 2013 2319s o u n d i.docxrosemarybdodson23141
n engl j med 368;24 nejm.org june 13, 2013 2319
s o u n d i n g b o a r d
T h e n e w e n g l a n d j o u r n a l o f m e d i c i n e
How Point-of-Care Testing Could Drive Innovation
in Global Health
Ilesh V. Jani, M.D., Ph.D., and Trevor F. Peter, Ph.D., M.P.H.
The investment in health services in low- and mid-
dle-income countries has increased substantially
in recent years.1 Such investment has been led by
unprecedented efforts to combat major diseases,
enabled by the availability of lower-cost and effec-
tive drug regimens for treatment and prophylaxis,
along with improved vector control. As health
services have expanded, so has the demand for
diagnostic tests that are essential in identifying
patients, determining prognosis, monitoring treat-
ment, and assessing the efficacy of prevention.2
Classic diagnostic technologies are not well
suited to meeting the expanded testing needs.
Laboratory tests require complex infrastructure,
skilled technicians, and a stable supply of elec-
tricity, all of which are scarce, particularly in
nonurban areas. Traditional testing is usually
performed in remote laboratories, which increas-
es the cost and inconvenience of accessing health
care and leads to a high number of patients who
leave the system before a diagnosis is established.3
These limitations are a critical barrier to equity
in health services. Microscopy requires less in-
frastructure and is more widely available, but it
can be inaccurate (e.g., sputum tests for tubercu-
losis) or slow and underutilized (e.g., smear tests
for malaria, schistosomiasis, and other parasitic
infections).4-6 Many patients with tuberculosis or
malaria are simply treated on the basis of a pre-
sumptive clinical diagnosis. Although convention-
al laboratory testing and microscopy will still be
needed, it is expected that faster and more ac-
curate point-of-care diagnostic tests that do not
require laboratory infrastructure will play an in-
creasing role in expanding health care in low- and
middle-income countries.7
T h e S h if t t o w a r d P o in t- o f - C a r e
T e s t in g
Rapid point-of-care testing for diabetes, anemia,
pregnancy, human immunodeficiency virus (HIV),
and malaria have long been available and have be-
come common diagnostic tools in both high- and
low-income countries (Fig. 1). The first generation
of point-of-care testing relied on easy-to-detect
biomarkers, such as antibodies, antigens, and sim-
ple biochemical reactions. Such biomarkers are
also increasingly used in point-of-care tests for a
wide range of infectious diseases (e.g., syphilis,
hepatitis, measles, schistosomiasis, and tricho-
moniasis) and for applications such as blood
typing.8-11
A second generation of point-of-care diagnos-
tics is now on the horizon, partly because of re-
cent industry and donor investment. These tests
detect more complex and less accessible biomark-
ers, such as nucleic acids and cell-surface markers,
an.
This document discusses pool testing as a strategy to increase testing capacity and reduce costs during the COVID-19 pandemic. Pool testing involves combining multiple patient samples and testing them as a single pool. If the pool tests negative, then all samples in that pool are considered negative. Only positive pools would require individual re-testing to identify the positive sample(s). The document recommends pool testing in areas with low COVID-19 prevalence (<5%) as a way to screen asymptomatic individuals or for community surveillance. Pool sizes should be adjusted based on local positivity rates. Pool testing has been used successfully for other infectious diseases and could help address shortages in testing capacity and supplies for COVID-19.
Recent advances in the diagnosis of tuberculosis include molecular methods that can rapidly detect Mycobacterium tuberculosis and resistance to rifampicin. The Xpert MTB/RIF assay can detect M. tuberculosis and rifampicin resistance directly from sputum samples in less than one day, which is much faster than traditional solid or liquid culture methods requiring weeks. Meta-analyses show the Xpert MTB/RIF assay has high sensitivity and specificity for detecting rifampicin resistance. While a major improvement, the Xpert MTB/RIF assay is still being evaluated for use with extra-pulmonary samples which typically yield lower sensitivity. Rapid molecular diagnostics are transforming tuberculosis diagnosis and treatment monitoring.
This document discusses mycobacteria other than tuberculosis (MOTT), also known as nontuberculous mycobacteria (NTM). It describes how NTM are classified into four groups based on their pigment production and growth rate. Some important NTM species that can cause disease in humans are described for each group, including M. kansasii, M. marinum, M. avium complex, and rapidly-growing species like M. fortuitum. The document outlines methods for diagnosing NTM infections through specimen collection, acid-fast staining of smears, and culture-based identification.
Line Probe Assay: A New Arrival at the PRL discusses a new diagnostic tool, the line probe assay, that has arrived at the Provincial Tuberculosis Reference Lab in Sindh, Pakistan. The line probe assay can simultaneously detect resistance to rifampicin and isoniazid in mycobacterium tuberculosis, with a sensitivity of over 90% and specificity of over 99% for smear-positive specimens. It provides results faster than conventional drug susceptibility testing methods like solid and liquid culture. The new diagnostic tool will help improve case detection and management of drug-resistant tuberculosis in Pakistan.
This document discusses molecular assays for tuberculosis diagnosis and drug resistance testing. It begins with an introduction to the global burden of TB and importance of accurate diagnosis. It then describes various microbiological diagnostic methods including smear microscopy, culture techniques, nucleic acid amplification tests (NAATs), and molecular methods like whole genome sequencing (WGS). Specific NAATs discussed in detail are Xpert MTB/RIF and targeted sequencing approaches. Centralized high-throughput diagnostic tests are also mentioned. Overall the document provides an overview of established and emerging molecular methods that can improve TB diagnosis and detection of drug resistance.
RECENT ADVANCES IN DIAGNOSIS OF TUBERCULOSISANGAN KARMAKAR
TRADITIONAL TESTS AND RECENT DIAGNOSTIC MODALITIES FOR TUBERCULOSIS WITH EMPHASIS TO MOLECULAR DETECTION TECHNIQUES, DRUG SENSITIVITY ASSESMENT IN INDIAN PERSPECTIVE
This document discusses newer diagnostic methods for tuberculosis (TB), specifically focusing on liquid culture and drug susceptibility testing (DST). It describes several technologies used for TB diagnosis, including light-emitting diode (LED) microscopy, liquid culture methods like MGIT, and nucleic acid amplification tests (NAATs) like Xpert MTB/RIF. Liquid culture methods like MGIT and BACTEC provide results faster than solid culture, in 2-3 weeks versus 6-8 weeks, and also allow simultaneous DST. Newer NAATs like Xpert MTB/RIF can provide results in under 2 hours and detect TB as well as rifampin resistance directly from sputum samples.
This document summarizes newer diagnostic techniques for tuberculosis (TB), including polymerase chain reaction (PCR) and other nucleic acid amplification tests. PCR allows for rapid amplification of TB bacterial DNA, enabling detection of the pathogen sooner than traditional culture-based methods. Several FDA-approved PCR tests are described that can detect TB within 1-3 hours versus weeks for cultures, though PCR sensitivity is slightly lower than cultures. Limitations and potential errors of PCR for TB diagnosis are also outlined. Flow cytometry and other automated techniques for TB testing are mentioned as areas of ongoing development.
This document discusses atypical mycobacteria (NTM). It describes the Runyon classification system for NTM based on pigment production and growth rate. The most common NTM species are Mycobacterium avium complex (MAC) and Mycobacterium kansasii. MAC is ubiquitous in the environment and a major cause of pulmonary NTM disease. M. kansasii is associated with tap water and causes lung disease resembling tuberculosis, often in older male smokers with COPD. Host immune deficiencies increase risk of NTM infections.
This document provides information on the laboratory diagnosis of tuberculosis. It discusses the classification of mycobacteria, specimen collection, and the various diagnostic methods used which include smear microscopy, culture, and molecular tests. Smear microscopy has limitations but is widely used due to its low cost. Culture is the gold standard but is more complex and requires biosafety. Liquid culture systems allow for faster results than solid media. Drug sensitivity testing determines resistance and is important for treatment. Molecular tests like line probe assays and GeneXpert can rapidly detect M. tuberculosis and resistance, with GeneXpert suitable to test pulmonary and some extrapulmonary samples directly. The document concludes with details about Microcare Laboratory which provides accredited tuberculosis diagnostic services
This document discusses diagnostic modalities for tuberculosis, including both pulmonary and extrapulmonary TB. It provides details on various bacteriological examinations for diagnosing TB, such as sputum smear microscopy, culture, drug susceptibility tests, and molecular techniques like Xpert MTB/RIF and line probe assays. Radiological examinations like chest X-rays are also discussed. The global burden of TB is summarized, with over 10 million new cases and 1.8 million deaths annually. Prompt diagnosis is important for treatment and minimizing transmission.
Diagnostics of tuberculosis: An insight into Genexpert 27 4-15Yahya Noori, Ph.D
This document discusses the GeneXpert diagnostic test for tuberculosis. It provides an overview of tuberculosis as the second leading infectious disease globally. It then discusses the GeneXpert test, noting that it can detect tuberculosis and rifampicin resistance in under 2 hours, much faster than traditional diagnostics. The document reviews studies showing high sensitivity and specificity of GeneXpert for pulmonary and extra-pulmonary tuberculosis. It concludes by outlining the current recommendations in Pakistan for using GeneXpert to diagnose tuberculosis in high-risk patient groups.
Newer diagnostic methods for tuberculosis Shweta Anand
The document discusses newer diagnostic methods for tuberculosis. It describes various specimen collection methods that improve sample quality like the Lung Flute device. Sputum smear microscopy and automated methods like the TBDx system are outlined. Culture-based techniques involving liquid and solid media are explained, including automated systems like MGIT and BacT/Alert. Newer culture-based drug susceptibility tests such as MODS, TLA, and NRA are also introduced. Overall the document provides an overview of advances in TB diagnostics from sample collection to molecular and culture-based methods.
This document summarizes methods for diagnosing tuberculous infections. Key methods include:
1. Clinical examination, routine lab tests like ESR, sputum smear microscopy, culture and nucleic acid amplification tests from clinical samples.
2. Chest radiography and collection of appropriate clinical samples from sites of disease are important.
3. Newer rapid diagnostics like Xpert MTB/RIF and line probe assays can directly detect tuberculosis and multidrug-resistant strains in a few hours.
The document provides information on the molecular diagnosis of tuberculosis. It discusses the historical aspects of TB identification and increasing drug resistance. It notes that in 1993, WHO declared TB a global emergency, with one-third of the world's population infected. Current estimates from WHO in 2010 show over 8 million new TB cases annually. Molecular diagnostic methods like the AMTD and MTBDRplus tests can rapidly detect Mycobacterium tuberculosis complex and resistance patterns in days rather than the months needed for conventional culture. These new tests are especially useful for screening patients in high burden areas and for detecting drug resistant TB.
Non-tuberculous mycobacteria (NTM), also known as atypical mycobacteria, are categorized into four groups based on pigment production and growth rate: photochromogens, scotochromogens, non-photochromogens, and rapid growers. Medically important NTM in these groups can cause localized lymphadenitis, skin lesions like swimming pool granuloma, tuberculosis-like pulmonary lesions, and disseminated disease. NTM are commonly found in the environment and occasionally cause opportunistic infections in humans through the skin or lungs.
Investigations in Tuberculosis and advancesNirish Vaidya
This document discusses various techniques for investigating Mycobacterium tuberculosis and advances in the field. It summarizes key characteristics of M. tuberculosis and the global burden of tuberculosis. It then describes several laboratory techniques for detecting and diagnosing tuberculosis, including sputum smear microscopy, mycobacterial culture methods, tuberculin skin testing, and newer molecular techniques such as nucleic acid amplification tests and interferon-gamma release assays. Advances in rapid molecular diagnostics and their applications for tuberculosis detection and drug resistance testing are also discussed.
The document discusses CBNAAT (Xpert MTB/RIF), a qualitative PCR test that detects Mycobacterium tuberculosis complex DNA and rifampin resistance mutations. It can aid in TB diagnosis when used with clinical findings. The test is intended for use on untreated or short-term treated patients. Positive results must be confirmed by a reference lab, and it does not provide rifampin susceptibility confirmation. Xpert MTB/RIF has high sensitivity and specificity compared to smear microscopy and culture, especially for smear-negative TB. It can also detect rifampin resistance and has applications for extrapulmonary TB diagnosis from various samples.
This document provides an overview of tuberculosis diagnosis and treatment in India. It discusses:
1) India's goal to end TB by 2025 and new programs to support TB patients and educate communities.
2) Recommendations that all medical colleges have facilities for multidrug-resistant TB management and that 5 whole genome sequencing facilities be established for surveillance and research.
3) Diagnostic tests for TB including smear microscopy, molecular tests like CBNAAT and line probe assay, and culture. It provides details on each test's methodology, turnaround time, and sensitivity.
4) Classification of TB cases as new, previously treated, clinically diagnosed or microbiologically confirmed. Treatment regimens are outlined according
This document discusses the diagnosis of pulmonary tuberculosis. It emphasizes that diagnosis requires a combination of clinical presentation, medical history, physical examination, chest radiography, and bacteriological examination. Sputum smear microscopy and mycobacterial culture are important for laboratory confirmation, with culture being the gold standard. A presumptive diagnosis of tuberculosis can be made if acid-fast bacilli are seen on smear, but treatment should not be initiated solely on this basis without further evaluation.
n engl j med 368;24 nejm.org june 13, 2013 2319s o u n d i.docxrosemarybdodson23141
n engl j med 368;24 nejm.org june 13, 2013 2319
s o u n d i n g b o a r d
T h e n e w e n g l a n d j o u r n a l o f m e d i c i n e
How Point-of-Care Testing Could Drive Innovation
in Global Health
Ilesh V. Jani, M.D., Ph.D., and Trevor F. Peter, Ph.D., M.P.H.
The investment in health services in low- and mid-
dle-income countries has increased substantially
in recent years.1 Such investment has been led by
unprecedented efforts to combat major diseases,
enabled by the availability of lower-cost and effec-
tive drug regimens for treatment and prophylaxis,
along with improved vector control. As health
services have expanded, so has the demand for
diagnostic tests that are essential in identifying
patients, determining prognosis, monitoring treat-
ment, and assessing the efficacy of prevention.2
Classic diagnostic technologies are not well
suited to meeting the expanded testing needs.
Laboratory tests require complex infrastructure,
skilled technicians, and a stable supply of elec-
tricity, all of which are scarce, particularly in
nonurban areas. Traditional testing is usually
performed in remote laboratories, which increas-
es the cost and inconvenience of accessing health
care and leads to a high number of patients who
leave the system before a diagnosis is established.3
These limitations are a critical barrier to equity
in health services. Microscopy requires less in-
frastructure and is more widely available, but it
can be inaccurate (e.g., sputum tests for tubercu-
losis) or slow and underutilized (e.g., smear tests
for malaria, schistosomiasis, and other parasitic
infections).4-6 Many patients with tuberculosis or
malaria are simply treated on the basis of a pre-
sumptive clinical diagnosis. Although convention-
al laboratory testing and microscopy will still be
needed, it is expected that faster and more ac-
curate point-of-care diagnostic tests that do not
require laboratory infrastructure will play an in-
creasing role in expanding health care in low- and
middle-income countries.7
T h e S h if t t o w a r d P o in t- o f - C a r e
T e s t in g
Rapid point-of-care testing for diabetes, anemia,
pregnancy, human immunodeficiency virus (HIV),
and malaria have long been available and have be-
come common diagnostic tools in both high- and
low-income countries (Fig. 1). The first generation
of point-of-care testing relied on easy-to-detect
biomarkers, such as antibodies, antigens, and sim-
ple biochemical reactions. Such biomarkers are
also increasingly used in point-of-care tests for a
wide range of infectious diseases (e.g., syphilis,
hepatitis, measles, schistosomiasis, and tricho-
moniasis) and for applications such as blood
typing.8-11
A second generation of point-of-care diagnos-
tics is now on the horizon, partly because of re-
cent industry and donor investment. These tests
detect more complex and less accessible biomark-
ers, such as nucleic acids and cell-surface markers,
an.
This document discusses pool testing as a strategy to increase testing capacity and reduce costs during the COVID-19 pandemic. Pool testing involves combining multiple patient samples and testing them as a single pool. If the pool tests negative, then all samples in that pool are considered negative. Only positive pools would require individual re-testing to identify the positive sample(s). The document recommends pool testing in areas with low COVID-19 prevalence (<5%) as a way to screen asymptomatic individuals or for community surveillance. Pool sizes should be adjusted based on local positivity rates. Pool testing has been used successfully for other infectious diseases and could help address shortages in testing capacity and supplies for COVID-19.
This research article describes a multi-center study that compared 20 different methods for identifying pneumococcal serotypes carried in the nasopharynx. Laboratory-prepared samples containing known serotypes and nasopharyngeal samples from children in six countries were tested. The microarray method, which included a culture amplification step, performed best with high sensitivity and accuracy in detecting both dominant and minor serotypes carried. However, most methods could reliably detect the dominant serotype carried but performed poorly in identifying minor serotypes. This study provides valuable data to help evaluate pneumococcal vaccines and carriage patterns, especially in low-income settings with high disease burden.
Implementing rapid testing for tuberculosis in MozambiqueSystemOne
Using rapid molecular tests to diagnose tuberculosis increased case detection in Mozambique but posed logistical challenges. From 2012-2013, Xpert® MTB/RIF testing of smear-negative samples in four hospitals detected an additional 1081 tuberculosis cases, increasing detection by 69%. However, only 67% of patients diagnosed by Xpert® started treatment compared to 82% diagnosed by smear microscopy. Machine failures and lack of connectivity posed operational difficulties. While rapid diagnostics can improve tuberculosis control, more affordable platforms and strengthened treatment initiation are still needed.
Comparison of Ziehl Neelsen Microscopy with GeneXpert for Detection of Mycoba...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DIAGNOSTICS - Diagnosis of TB - A Nanodiagnostic Approach.pdfsudeepbhattacharyya
The document discusses diagnosis of tuberculosis and highlights opportunities for nanotechnology-based diagnostic approaches. It summarizes several existing methods for TB diagnosis including microscopy, culture-based techniques, immunological methods, and molecular tests. However, current diagnostics have limitations such as low sensitivity, long turnaround time, and requirements for specialized equipment and facilities. The document proposes that nanodiagnostics utilizing nanoparticles, antigens, and antibodies may enable the development of improved point-of-care tests for more rapid, affordable and accurate TB detection.
The Diagnostic & Testing virtual conference held on the 11th June 2020 was an inspiring event examining the role of both molecular and rapid diagnostics in tackling disease, infection and reducing the impact of COVID-19 within our communities and hospitals. The virtual conference explored how health professionals, academics and industry are driving diagnostic and testing usage within laboratories, pharmacies and community practice.
The conference built upon the UK Diagnostics Summit held annually in London discussed how diagnostics and testing are tackling COVID-19, the technology in development, accuracy of COVID-19 tests as well as exploring current testing methods for cancer, diabetes, sepsis, urinary tract infections and HAI’S.
Catridge based nucleic acid amplification test(CBNAAT) / RIF assay gene xpert POWER PONT. other normal tests versus CBNAAT. issues for cbnaat by WHO & CONCLUSION.
This document discusses the use of multiplex nucleic acid amplification tests (NAATs) to diagnose infectious diarrhea. It notes that traditional diagnostic methods have low sensitivity and long turnaround times. Multiplex NAATs allow simultaneous testing of stool for multiple pathogens, with higher sensitivity and shorter turnaround. However, they cannot provide antibiotic susceptibility or confirm identifications. The document reviews the pathogens detected by five FDA-approved multiplex NAAT platforms and notes their limitations, such as inability to distinguish carriers from infections or serotypes. It concludes that interpretation requires acknowledging limitations and clinical judgment, and more studies are needed on their cost-effectiveness and impact.
This study compared same day sputum microscopy (two sputum samples collected one hour apart) to conventional sputum microscopy (spot sample and early morning sample collected over two days) for tuberculosis diagnosis in Chhattisgarh, India. The study found that same day microscopy missed 17% of smear-positive tuberculosis cases compared to 1% missed by conventional microscopy. Additionally, same day microscopy had a lower proportion of presumptive tuberculosis patients providing both required samples and had a lower proportion of samples with good quality. These findings suggest that same day microscopy may not be as effective as conventional microscopy for tuberculosis diagnosis in this setting.
1) Recent advances in TB diagnosis include automated liquid culture systems like MGIT 960 and molecular diagnostic tests like Xpert MTB/RIF, which can detect TB and rifampin resistance in under 2 hours.
2) WHO recommends eight TB diagnostic tools including LED microscopy, liquid culture, rapid speciation strips, Xpert/MTB-RIF, urine LAM assay, LAMP, LPA, and SL-LPA to detect drug resistance.
3) Newer centralized high-throughput NAATs like RealTime MTB, FluoroType MTB, Cobas MTB, and Max MDR-TB run on automated platforms and can process hundreds of samples with high accuracy in
This document discusses establishing mycobacteriology laboratory services in India. It outlines the need to improve diagnostic capacity for tuberculosis (TB) and drug-resistant TB. Establishing quality-assured diagnosis through microscopy, culture, and drug susceptibility testing (DST) in laboratories is critical for effective TB care and treatment. The document also reviews various TB diagnostic tools and their limitations, including microscopy, culture, and newer molecular tests. It emphasizes the importance of strengthening laboratory infrastructure, supplies, training, and quality management to enhance diagnostic capacity.
1) The document discusses the need for better diagnostic approaches for parasitic infections. Traditional diagnostic methods have changed little in over a century and cannot distinguish between different stages of infection or response to treatment.
2) While new technologies like PCR and ELISA have improved diagnosis, many facilities still lack resources and trained technicians to utilize advanced methods. Reliance on microscopy remains common but is time-consuming and requires skill.
3) The author argues that improving diagnostic capabilities for parasitic diseases through incorporating new technologies and training more experts could help reduce antibiotic overprescription and emergence of drug resistance.
Biomarker is an objective measure that has been evaluated and confirmed either as an indicator of physiologic health, a pathogenic process or a pharmacologic response to a therapeutic intervention. Biomarkers, whether produces by normal healthy individuals or by individuals affected by specific systemic diseases, are tell tale molecules that could be used to monitor health status, disease onset, treatment response and outcome.The biomarkers can help for the determination of present as well as future disease activity along with diagnosis and previous periodontal diseases.
1. A significant milestone in cancer immunotherapy was the 2010 FDA approval of Provenge for prostate cancer, but most immunotherapies have failed due to low effectiveness.
2. New initiatives aim to better define biomarkers and endpoints to improve cancer immunotherapy trials by accounting for delayed responses and variable immune monitoring results.
3. A study presented preliminary results showing the Onko-Sure cancer test was more effective than CEA alone at detecting early-stage colorectal cancer.
The National University of Singapore (NUS) is partnering with the Foundation for Innovative New Diagnostics (FIND) to develop a novel point-of-care diagnostic test for tuberculosis (TB) detection. NUS researchers have identified specific mycolic acid biomarkers in sputum samples that can distinguish active TB infections from non-infections or cured cases. NUS will work to develop antibodies to these biomarkers for use in an immunoassay-based diagnostic test, while FIND will provide expertise to develop the test into a product. The goal is to make TB diagnosis more affordable, easy-to-use, and accurate for use in resource-limited settings.
This document discusses various laboratory methods for diagnosing tuberculosis (TB), including:
- Sputum smear microscopy to detect acid-fast bacilli, the most common initial diagnostic method.
- Nucleic acid amplification tests like PCR and GeneXpert that can rapidly detect TB in sputum through DNA amplification.
- Culture-based methods grown on solid or liquid media to isolate Mycobacterium tuberculosis from clinical samples, which is then tested for drug susceptibility.
- Immunological tests like interferon-gamma release assays that detect TB infection by measuring T-cell responses to TB antigens.
It provides details on the principles, advantages, and limitations of different microbiological, molecular,
Similar to Newer diagnostic methods in tuberculosis detection (20)
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Improved Patient Satisfaction At Apollo – A Case StudyApollo Hospitals
1) Indraprastha Apollo Hospital utilized patient satisfaction surveys called Voice of Customer (VOC) tools to identify ways to improve various hospital departments and services.
2) Factors that contributed to an increasing trend in VOC scores over 1.5 years included leadership commitment to quality improvement, improved efficiency, superior clinical care, soft skills enhancement for staff, and improved patient information and complaint resolution.
3) Through consistent efforts such as staff training, improved processes, and addressing issues identified in VOC surveys, Apollo Hospitals achieved higher than target patient satisfaction scores, creating loyal patients with memorable hospital experiences.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
A 34-year-old woman presented with accidental ingestion of mercury that was used in her household to preserve grains. She experienced abdominal radiopaque shadows on X-ray that cleared after two days. Mercury poisoning can result from inhalation, ingestion, or absorption and affects the neurological, gastrointestinal, and renal systems. Diagnosis involves determining exposure history and elevated mercury levels in blood and urine. Supportive treatment includes removal of contaminated materials, irrigation, activated charcoal, chelation agents, and hemodialysis in severe cases.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
This document describes two cases of unusual manifestations of dengue fever. Case 1 is a 40-year-old man who presented with fever, headache, body aches, and a rash who developed hepatitis, thrombocytopenia, and respiratory distress from dengue hemorrhagic fever. Case 2 is a 24-year-old man who presented with fever and was found to have an intraocular hemorrhage, retinal detachment, ARDS, myocarditis, and hepatitis, also from dengue hemorrhagic fever. The document then reviews atypical neurological and gastrointestinal manifestations that have been reported with dengue infection.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
This document discusses pediatric liver transplantation. It begins by stating that pediatric liver transplantation is now an established treatment for end-stage liver failure from various causes, with excellent results due to improved immunosuppressive regimens, surgical techniques, and intensive care. It then discusses the historical development of liver transplantation, including the first attempts in the 1960s and key innovations like cyclosporine in the 1980s. The most common indications for pediatric liver transplantation are discussed as extrahepatic biliary atresia and acute liver failure. The document provides an overview of the pre-transplant evaluation process and post-transplant medical management and immunosuppression. It notes that living-related transplantation has helped address the shortage of donor l
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
3. The major drawback of sputum smear microscopy is that
it is laborious and has poor sensitivity, estimated to be
~70%.3
It's sensitivity further drops to around ~35% in some
settings with HIV co-infection and highly prevalent TB.4
This leads to increased workload, as more sputum tests
are needed per patient leading to diagnostic delay and pa-
tient loss to follow-up. The fluorescent AuramineeRhod-
amine stain is an additional armor apart from Ziehl Neelsen
acid-fast stain for smear microscopy, decreasing the time to
review the slide and improving the yield. Extrapulmonary
TB needs histopathological examination of the tissue spec-
imens; sensitivity and specificity depending on the ease of
sample collection; but the facilities and resources needed
for such methods are often unavailable in developing
countries.5
Culture can be performed using solid media, such as
LowensteineJensen (3e8 weeks), or liquid media, such as
Dubos' medium or Middlebrook 7H9 Broth etc. (10e14 days),
using the commercially available automated systems. Cul-
ture was also a prerequisite for phenotypic drug susceptibil-
ity testing until recent advances in molecular tests were
made. The longer waiting time for culture results makes it
difficult for clinicians to prove a diagnosis of TB in cases of
diagnostic doubt, especially in populations with low TB
incidence, and in the management of suspected drug-
resistant TB.
Tuberculin skin testing using purified protein derivative
(PPD) has poor sensitivity and specificity for active TB and is
used mainly to screen high risk population and diagnose
Latent TB.
3. Newer diagnostic tests e the need,
barriers and the impact they can have
With the limitation of the present day tests there is a need
for faster, user-friendly, low cost, highly specific and sen-
sitive diagnostic tests. New ways of performing “old” tests
(e.g. sputum smear microscopy) and completely innovative
tools (e.g. new technologies for molecular diagnosis) are
under investigation or have already been endorsed by
WHO.6
3.1. Optimizing smear
The strength of the smear test is its simplicity and low cost.
Thus approaches, which increase its sensitivity and reduce
the need for multiple visits will be beneficial.7,8
Practices,
which combine improved techniques with different ap-
proaches, have been endorsed by WHO to optimize yield of
microscopy.
Some of them include,
Collecting two supervised specimens in one visit (e.g. spot,
spot) instead of the age-old three early morning sputum
samples.9
Other practice which is not yet endorsed by WHO, but still
very promising, is the use of Light Emitting Diode (LED)
based microscopy as a replacement for conventional fluo-
rescent microscopy.10
3.2. Culture
The advances in culture methods are mostly in use already.
They employ the use of a liquid medium like Dubos' media,
Middlebrook 7H9 Broth, Sula's or Sauton's or Proskauer and
Beck's medium over the more traditional LowensteineJenson
medium. Not only is it more sensitive, it also reduces the delay
of drug sensitivity testing to about 10 days.
3.3. Antigen and antibody based tests
Antigen detecting test if developed into a point-of-care test
would allow for immediate diagnosis and initiation of treat-
ment. Urine samples and Breathalyzer are the most
commonly used. A urine specimen would be particularly
useful for children, who can have difficulty providing sputum.
In patients suspected of extrapulmonary TB, an antigen
detection test might prevent the use of more invasive tests.
The major and most promising antigens currently under
study are Lipoarabinomannan (LAM),11
a major glycolipid
component of the cell wall of Mycobacterium tuberculosis;
ESAT-6 (early secretory antigen target-6) and CFP-10 (culture
filtrate protein-10), both located in the RD1 (region of
difference-1) region that is lacking in BCG and in most Atypical
Mycobacteria.12
Antibodies to several antigens such as malate synthase,
TBF613,14
and cord factor are in use now, especially in the
developing countries. The accuracy of these tests has not been
found encouraging.15
There are still a large number of
commercially available serological tests in use, in developing
countries in spite of no International Guideline recommen-
dation. WHO issued a policy against these tests in 2011. The
Indian government banned antibody-based serological tests
in 2012.
3.4. Interferon-g release assays
These tests are currently used in many countries as a substi-
tute for Tuberculin test to diagnose Latent TB. These are based
on T-cell responses to antigens such as ESAT-6 and CFP-10,
which are more specific to M. tuberculosis than PPD. Presently
two such tests, in use in many countries, are the blood based
QuantiFERON-TB Gold In-Tube and T-SPOT.TB. They are
found to be more specific than the Tuberculin skin test16,17
in
diagnosing Latent TB and have good sensitivity but decreased
specificity to active TB.18
WHO has recommended against the
use of these tests for active TB diagnosis in high burden
countries, as these tests, like Mantoux, cannot separate latent
infection from active TB disease.
3.5. Molecular diagnostics
These tests use nucleic acid amplification techniques like
Polymerase Chain Reaction (PCR) for the diagnosis of TB and
drug susceptibility testing. The sensitivity of these tests has
been found to be 95% in sputum smear positive samples with
specificity around 90e100%,19
but in smear negative/culture
positive samples the sensitivities has been found to be
reduced. The main advantage of these tests, like GeneXpert, is
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e52
Please cite this article in press as: Narreddy S, Muthukuru S, Newer diagnostic methods in tuberculosis detection, Apollo
Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.05.008
4. Table 1 e Widely used and WHO endorsed tuberculosis diagnostic tests.29,30
Tests Intended use Advantages Drawbacks Comments
Chest X-ray Case detection of pulmonary TB Can diagnose other pulmonary
conditions too
Low specificity Widely in use
Acid-fast smear and
microscopy
Rapid, point-of-care test Rapid. Low cost. Minimal equipment
and training needed
Low sensitivity. Cannot detect drug
resistance and substantial quality
assurance is needed
Widely in use
Culture on solid media Confirmation of TB and drug
susceptibility testing
Good sensitivity Takes 8e12 weeks for results to
be available
Widely in use
Culture on liquid media Confirmation of TB and drug
susceptibility testing
Higher sensitivity than solid media,
takes lesser time (10e14 days); gold
standard for drug susceptibility testing
as of now
Time to detection is still slow.
Requires quality Lab environment
Endorsed by WHO
Tuberculin skin test Used to diagnose Latent TB Low cost and easy to administer Low sensitivity and specificity with
active TB, immunocompromised
host. Not recommended for active
TB. Low specificity for Latent TB
because of cross-reaction with
BCG vaccine and Nontuberculous
Mycobacteria
Widely in use
Interferon release assay Used to diagnose Latent TB More specific than Tuberculin skin
test and doesn't cross react with
BCG vaccination
Cannot differentiate active TB from
Latent TB, therefore not recommended
for active TB diagnosis. More expensive
than Tuberculin skin test
Widely in use
Serological tests Not recommended NA Highly inaccurate and expensive.
Used commercially in some developing
countries
In 2011 WHO issued a negative
policy against their use
Nucleic acid amplification
test (NAAT)
TB case detection High specificity but sensitivity lesser
than that of culture
Requires moderate training, increased
labor. Potential for cross contamination
Widely in use
Xpert MTB/RIF assay Detect TB and susceptibility
to Rifampin
Minimal processing time, high accuracy
even with some forms of extrapulmonary
TB like TB meningitis and lymphadenitis
Relatively expensive than other
conventional tests
WHO approved
Hain Genotype MTBDR
plus assay
Confirm smear positive
pulmonary TB and susceptibility
to Rifampin and Isoniazid
Minimal processing time if done singly
but usually done in batches. Highly
accurate
Poor sensitivity in extrapulmonary and
smear negative TB; expensive, requires
extensive training and stringent quality
control
WHO approved
apollomedicinexxx(2014)1e53
Pleasecitethisarticleinpressas:NarreddyS,MuthukuruS,Newerdiagnosticmethodsintuberculosisdetection,Apollo
Medicine(2014),http://dx.doi.org/10.1016/j.apme.2014.05.008
5. the simplicity of the fully automated machinery and that re-
sults can be obtained within a few hours.
Currently the most common commercially available NAAT
tests are the amplified Mycobacterium Tuberculosis Direct
Test (MTD, Gen-Probe) and COBAS®
TaqMan®
MTB Test
(Roche Diagnostics). Variations of the NAAT tests are
currently in use to detect drug resistance. Currently these
tests are only useful in identifying resistance to Rifampin and
Isoniazid and such tests for other anti-TB drugs are much less
developed and are currently being studied.20
Xpert MTB/RIF assay is a new test that is revolutionizing
the TB world. It detects the Tubercle bacilli and resistance to
Rifampin in less than 2 h21
compared to the weeks it takes by
culture method. It's accuracy and minimal processing time
help in selecting treatment regimens quickly. It is relatively
expensive, has a sensitivity of 98% in smear positive samples,
67% in smear negative samples and a specificity of 99%. Xpert
also detected 95% of rifampicin-resistant TB cases with
specificity of 98%.22
In 2013 Xpert MTB/RIF was endorsed by
WHO as the initial diagnostic test for pulmonary TB, MDR
pulmonary TB and HIV associated pulmonary TB in both
adults and children and as a follow-up test for smear negative
pulmonary TB in adults who are not at risk of MDR TB and HIV
associated TB. WHO also strongly recommended the use of
Xpert MTB/RIF for cerebrospinal fluid samples for rapid diag-
nosis of TB meningitis and conditionally recommended it for
diagnosis of other extrapulmonary TB samples.23
It's sensi-
tivity and specificity being 83% and 94% for lymph nodes, 81%
and 98% for cerebrospinal fluid and 46% and 99% for pleural
fluid samples.24
Another WHO endorsed molecular test is the Hain Geno-
type MTBDR plus assay. It is a rapid test that has been found to
be accurate only on smear positive pulmonary samples and
has been approved by WHO for that purpose.25
It can also
detect resistance to both Rifampin and Isoniazid unlike the
Xpert test; sensitivity and specificity being 98.1% and 98.7% for
Rifampin and 84.3% and 99.5% for Isoniazid.26
Though these are already a great improvement on the
widely used tests they can still be improved and investment is
needed.
To develop and implement new and better technologies for
DNA extraction and concentration methods.
Analyze the cost benefit aspects.
3.6. Adenosine deaminase
Adenosine deaminase testing, which has been in use in some
developing countries, has been abandoned now. It has been
found to have higher sensitivity than conventional tests when
performed on pleural fluid samples.16
3.7. Nose technology
It was documented that in ancient Greece, TB could be diag-
nosed by strong odors emitted from specimens. This was also
favored in Roman times and by traditional Chinese healers.
More recently there are reports suggesting that African pouch
rats can be trained to identify TB cases by smelling sputum.27
Instrument-based technologies using Electronic Noses28
have been developed and neural patterns were established
by exposure to a series of known TB-positive and TB-negative
samples and once such a pattern predictable of the disease is
established, it is programmed into the device. They have the
potential to be highly sensitive, portable and be able to screen
samples in a few minutes. The drawbacks being, it maybe
unstable over time, vulnerable to interference from water
vapor and background odors, and variation may occur be-
tween instruments requiring calibration.
Some of the widely used tests and those approved by WHO
are listed in Table 1.29,30
4. Conclusions
The future for TB diagnostics is bright with the tests like Xpert,
Hain and liquid cultures in use in many parts of the world and
many other advances in their late stages of evaluation. There
is the presence of large amount of funding and there is also a
huge challenge in translating these technological advances
into the public health settings. Initial studies show that these
advances are highly accurate in the normal setting but more
research is required to assess their performance in TB affected
children, MDR TB, HIV co-infection and with different types of
extrapulmonary TB.31
An ideal test, as also stated by the STOP
TB partnership, would have
~100% sensitivity and specificity
Be affordable
Have a quick turn around time of possibly 2 h
Be fully automatable with internal controls
Have a closed system to minimize contamination
Require minimal specimen processing
As of now existing tools like LED microscopy, Xpert, Hain
and liquid cultures should be scaled up as they are now more
affordable and accessible, even in India.
Conflicts of interest
All authors have none to declare.
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Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.05.008