Pulmonary tuberculosis, caused by Mycobacterium tuberculosis, is a significant public health issue, especially in developing countries, affecting millions of people every year. Despite the development of many antitubercular antibiotics and increased awareness of preventive methods, it is still a major cause of mortality worldwide. Vitamin D, a micronutrient known to have a major role in bone and calcium metabolism, has also shown its immunomodulatory effects to suppress mycobacterial growth. We conducted a systematic review and meta-analysis of the available evidence to explore the association between vitamin D levels and tuberculosis. We performed a systematic search for articles from inception to May 2021 in multiple databases. We included 26 studies in our qualitative synthesis and 12 studies in meta-analysis or quantitative synthesis. In our meta-analysis, we used a random-effect model to calculate the odds ratio (OR) of vitamin D deficiency in tuberculosis patients compared to the healthy controls. On pooled analysis, we found that the odds of the participants having vitamin D deficiency was 3.23 times more in tuberculosis patients compared to the healthy group (OR=3.23, CI = 1.91-5.45, p<0.0001). Thus, we concluded that there is an association between low levels of vitamin D and tuberculosis infections. We suggest conducting longterm prospective cohort studies in tuberculosis endemic countries to better understand the causal relationship between vitamin D deficiency and tuberculosis.

Cardiovascular disease, including ischemic heart disease, is one of the most common causes of death and disability in both sexes. The traditional concept of ischemic heart disease as a “man’s disease” is debunked. Yentl syndrome is used to describe the underdiagnosis of ischemic heart disease in females and its associated effects. This article reports a 48-year-old female presented to the emergency department with acute epigastric discomfort. Her initial diagnostic tests did not reveal any abnormalities, and she was discharged. Subsequently, after four days, she again visited the emergency department with chest pain, the evaluation of which furthermore revealed no abnormalities. However, we admitted her. After 40 hours of hospitalization, her evaluation revealed anterior wall ST elevation myocardial infarction, and she underwent emergent reperfusion via coronary catheterization. This combination of atypical signs and symptoms and chances of delayed manifestations in the diagnostic investigations provides evidence for a need for thorough assessment in a female with chest pain.

COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 has been occurring in waves due to emergence of different strains. During second wave of COVID pandemic in Nepal, largely caused by Delta variant, due to rapid rise in cases, existing hospitals and health facilities were overwhelmed. As a result, telemedicine was expanded to help reduce strain on the healthcare system and meet unusually high demands. A team of physicians with the support from the local government provided hospital level care for patients at home in rural district of Dang in Nepal. This research analyzes implementation of this model of care and outcomes based on review of patient records and treatment guidelines. Within a month, from May 5 to June 13, 2021, a total of 102 patients received care at home. While most patients had mild to moderate disease, 12.8% of patients had severe disease. Telemedicine usage was highest among the 40-59 years age group, with overall recovery rate of 85.3%. The patient satisfaction survey revealed that majority, 86.5% were happy with the medical care they received. This home hospital care model has shown excellent clinical outcomes and high patient satisfaction even in resource limited setting.