Tuberculous dactylitis is an unusual form of osteoarticular tuberculosis involving the short tubular bones of hands and feet, which is uncommon beyond six years of age. We report the case of a fifteen-year-old adolescent boy who was diagnosed with tuberculous dactylitis, involving contralateral hand and foot. His diagnosis was delayed due to lack of suspicion of this rare entity. The report also examines the diagnostic difficulties faced by clinicians in arriving at an appropriate diagnosis.

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Background: Battling against tuberculosis (TB) is still a major challenge in India, despite measures undertaken by the government and medical fraternity. Delay in diagnosing tuberculosis is a challenge, causing hurdle in the prevention of spread of the disease.Methods: This retrospective study analysed the samples by geneXpert assay. Samples (n=403, from 359 children) included pulmonary (sputum and gastric aspirate, 359), extrapulmonary (lymph node aspirate (LNA), 41) cerebrospinal fluid (CSF, 03) pus from the lesion at the elbow joint (01).  Only sputum was analysed for 315 children, both sputum and LNA for 41.Results: Mean age of patients was 9.08±2.85 years, range 3-15 years. There were 221 (61.56%) males and 138 (38.44%) females. Fever (71, 19.78%), fever with cough (87, 24.23%), fever with weight loss (41,11.42%) were the main symptoms.  There were three patients with high fever, headache and seizures with neck rigidity, clinically diagnosed as Tuberculous meningitis. There was history of contact with Tuberculosis in 15 (4.18%) patients. Mean ESR was 112.09mm/1st Hr±56.05 (range 54 -750 mm/1st Hr). Mantoux test was positive in 270 (75.42%). Chest X-ray was normal in 33 (9.19%); consolidation in 189 (52.65%), mild pleural effusion in 94 (26.18%) mild pleural effusion associated with consolidation in 43 (11.98%) were reported. Positive GeneXpert assay (106 samples, 27.39%; sputum (87, 24.23% %), pus (01), CSF (03), LNA (15, 57.69%) was reported in 87 patients.  Results were obtained ≤36 hours, mean 2 hours± 2.34 (range 6- 36 hours).Conclusions: GeneXpert is an effective tool for rapid detection of tuberculosis. Present study supports its inclusion in the battery of routine investigations. It can revolutionise the scenario in prevention and management of tuberculosis.

Aim: To study the clinicodemographic profile, outcomes, and post-COVID change in glycemic control among treated COVID-19-infected patients with poorly controlled or well-controlled diabetes mellitus (DM). Methods: Adult COVID-19-infected patients who tested positive with rapid antigen test or RT-PCR admitted were included in this prospective observational study. Patients were divided into well-controlled and poorly controlled diabetes group based on HbA1c values at admission. Telephonic follow-up and HbA1c estimation was done after three months. Clinical and laboratory investigations performed were compared between both groups. Hazard ratios (HRs) for mortality risk in both well-controlled and poorly controlled COVID-19 patients with DM was done by Cox proportional hazard models. Results: Out of 260 patients, 140 (53.84%) and 120 (46.15%) were poorly and well-controlled diabetics respectively. One hundred sixty-three patients (62.69%) were male, and the mean age was 52.67 ± 15.69 years. Severity, duration of hospital stay, steroid duration, insulin requirement and mean HbA1C, both at admission and after three months, were significantly higher in poorly controlled group than the well-controlled group ( P < 0.005). With increase in age, the HR for all-cause mortality increased by 1.15 times (95% CI, 1.05–1.25; P = 0.0025) in well-controlled than poorly controlled group, whereas with increase in FBS at admission, the HR for all-cause mortality increased by 1.03 times in poorly controlled than well-controlled group (95% CI, 1.01–1.06; P = 0.0044). Conclusion: Our results show that well-controlled blood glucose levels or improved glycemic control are associated with a better outcome in patients with COVID-19 and pre-existing type 2 diabetes mellitus.

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