Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this ‘how we did it’ paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

To reduce TB deaths in resource-limited settings, triaging at diagnosis can identify those with immediate need for comprehensive assessment and inpatient care. n This type of differentiated TB care model was successfully implemented in Tamil Nadu, India, without additional stress on the health system. n Half of the patients referred as a result of triaging were very severely undernourished, which implies a need for capacity-building of inpatient care facilities in clinical management of very severe undernutrition in adults.nThe identification of predictors of not being triaged and comprehensively assessed will inform ongoing and future improvements to the care model.

Objectives: Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. Materials and Methods: The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Results: Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. Conclusion: GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.

Recently we passed through the covid-19 pandemic. We were eagerly wait for the covid-19 vaccine but after development of vaccine, what benefits we get? In the era of vaccine we want to give our inputs. During the covid-19 pandemic, every person was waiting for the vaccine. They were alert for each step of vaccine trial updates. They were hopping that once vaccine comes, it will make magic and the world will be free from the covid-19 virus which did not happen. If vaccine is powerful why second or third wave occurred? There are various cases of reinfection of the covid-19 to humans even after successful vaccination completion. One of the leading covid vaccine production company chief executive officer Was infected with Covid-19 even after successful vaccination. we conclude that vaccines solely are not effective and contact precautions and herd immunity is also important. We conclude that vaccines solely are not effective and contact precautions and herd immunity is also important. We are not against the vaccines; we are against to mentality which think that vaccine end the covid-19 pandemic. Keep one thing in our mind, that virus will never be dead, somewhere they are alive. When they get chance to mutate them self, they will make their new variants and come again.