Gingivobuccal cancers usually fail locoregionally. Soft tissue infiltration and extracapsular spread of nodal disease influence disease-free survival.

Extrapulmonary drug-resistant tuberculosis (DR-EPTB) poses a formidable diagnostic and therapeutic challenge.Besides associated with high morbidity, it is a major financial burden for the patient and the health system. In spite of this, it has often been neglected as it does not “pose” a visible public health threat. We study clinical profiles, treatment outcomes, and factors associated with unfavourable outcomes among DR-EPTB patients under programmatic settings in New Delhi, India, and evaluate how this could impact TB elimination. A retrospective analysis of all DR-EPTB patients registered at three nodal DR-TB centres in Delhi in 2016 was carried out. Of the 1261 DR-TB patients registered, 203 (16%) were DR-EPTB, with lymph nodes (118, 58%) being the most common site, followed by bone (69, 34%). Nearly 29% (n = 58) experienced adverse drug reactions with severe vomiting (26, 13 %), joint pain (21, 10%) and behavioral disorder (15, 7%). History of previous TB treatment was observed in a majority of the cases (87.7%). Nearly one-third of DR-EPTB cases (33%) had unfavourable treatment outcomes, with loss-to-follow-up (n = 40, 58%) or death (n = 14, 20%) being the most common unfavourable outcomes. In the adjusted analysis, weight band 31–50 kilograms (aRR = 1.8, 1.2–3.4) and h/o previous TB (aRR = 2.1, 1.1–4.8) were mainly associated with unfavourable outcomes. TB elimination efforts need to focus on all forms of TB, including DR-EPTB, leaving no one behind, in order to realise the dream of ending TB.

timely diagnosis of paucibacillary tuberculosis (tB) which includes smear-negative pulmonary tB (ptB) and extra-pulmonary tB (eptB) remains a challenge. this study was performed to assess the diagnostic utility of stool as a specimen of choice for detection of mycobacterial DnA in paucibacillary TB patients in a TB-endemic setting. Stool samples were collected from 246 subjects including 129 TB patients (62 PTB and 67 EPTB) recruited at TB hospital in Delhi, India. Diagnostic efficacy of stool IS6110 PCR (n = 228) was measured, using microbiologically/clinically confirmed TB as the reference standard. The clinical sensitivity of stool PCR was 97.22% (95% confidence interval (CI), 85.47-99.93) for detection of Mycobacterium tuberculosis in stool samples of smear-positive PTB patients and 76.92% (CI, 56.35-91.03) in samples from smear-negative PTB patients. Overall sensitivity of PCR for EPTB was 68.66% (CI, 56.16-79.44), with the highest sensitivity for stool samples from patients with lymph node TB (73.5%), followed by abdominal TB (66.7%) and pleural effusion (56.3%). Stool PCR presented a specificity of 95.12%. The receiver operating characteristic curve also indicated the diagnostic utility of stool PCR in TB detection (AUC: 0.882). The performance characteristic of the molecular assay suggests that stool DnA testing has clinical value in detection of tB.Tuberculosis (TB), a global health problem, is caused by Mycobacterium tuberculosis (Mtb) and has two ways of clinical manifestation. Apart from the common pulmonary TB (PTB) manifestation, extrapulmonary TB (EPTB) is identified as a major concern and contributes significantly to the disease burden worldwide. According to the World Health Organization (WHO), 10 million people fell ill with TB in 2018 1 . Although new strategies for diagnosis and treatment over the past decade have led to decline in death rate, it remains inadequate to reach the milestone of the WHO "End-TB" goal 1 . Apart from the diagnostic and treatment difficulties faced in the eradication of PTB, timely diagnosis and treatment of EPTB is considered a bigger challenge. This is due to the diverse, non-specific and paucibacillary presentation of EPTB at remote body sites and requirement of a longer treatment regimen 2 . In 2018, an increase in EPTB incidence was reported in India 3 , which is also considered as a TB high-burden country by the WHO. A probable explanation for this rise can be in part due to access to better diagnostic tools that highlight the fact that EPTB burden may have been underrepresented over the years. Thus, accurate and rapid diagnostic tests for PTB and EPTB are key to limit the spread of the epidemic.In India, diagnosis of TB is done by the Revised National Tuberculosis Control Program guidelines that follow the WHO recommendations ( Fig. 1). At present, although the diagnosis of PTB by sputum-smear direct microscopy is considerably established, the diagnosis of smear-negative PTB and EPTB poses serious challenges due to paucibacillary nature of the specimen. Diagnos...

The study compares potential of transcript signature and IGRA to diagnose LTBI. It is first of its kind study to screen household contacts (HHCs) in high TB burden area of India. A transcript signature ( FCGR1B, GBP1 , & GBP5 ) is identified as potential biomarker for LTBI. These results can lead to development of point-of-care (POC) like device for LTBI screening in a high TB burdened area.

The disease, fistula in ano, which is considered to be a minor ailment, has high morbidity. Besides fistulectomy; the father of surgery, Sushruta, has also described its treatment in his text Sushruta samhita by kshar sutra method considering it as nadi vrana (wound with tract). The aim of the study was to compare the effectiveness, hospital stay, post operative pain between fistulectomy and kshar sutra procedure. 30 patients underwent fistulectomy and 30 patients underwent kshar sutra procedure according to the inclusion and exclusion criteria of study. Post operative assessment of pain was done using VAS score, fecal incontinence, gas incontinence, wound healing, follow up complaints and recurrence. Mean hospital stay and recurrence was more in fistulectomy procedure and duration of healing of fistula was more in kshar sutra ligation procedure and there was significant difference in pain on 1 st , 2 nd and 3 rd post operative day. Kshar sutra procedure is safe, feasible and effective. In Ksharsutra procedure immediate post operative pain was much less with early discharge from the hospital, complete healing of wound was delayed with decreased morbidity, as compared to open method of fistulectomy.