Conclusions: RT-PCR assay is a simple, rapid, and accurate molecular diagnostic method to detect RR-TB and Hr-TB. However, further validation is needed on a large scale to improve the assays.

Tuberculosis (TB) continues to be a global public health emergency responsible for approximately 1.3 million deaths annually. Enduring the existing TB challenges, the emergence of “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), a similar respiratory infection threatened the success of TB control over the past few years. Contemplating the irreversible damage of the human immunodeficiency virus (HIV), one of the leading immune-suppressive conditions, a similar or worst expected with this synergism: TB-HIV-SARS-CoV-2. Therefore, an integrated approach is much demanded before the impending revolution, "Next Global Pandemic". The advancement of molecular diagnostic techniques, blood transcriptomics uncovered the importance of studying the cross-talk between host and pathogens. RNA-sequencing is a high-throughput sequencing technique allowing detailed characterization of gene expression profiles. With the impact of SARS-CoV-2 on host immunity, pathogen-derived biomarker identification is more disease-specific and constrains individual variations faced during host biomarker identification. However, several technical hurdles are encountered during the study of intracellular pathogens like Mycobacterium tuberculosis. The development of advanced RNA-sequencing techniques to tackle the issues targeting the host and pathogen interactions is in their infancy and restricted to in-vitro studies. Few studies on serum exosomal RNA-sequencing of active and latent TB patients enlightened the path of TB biomarker discovery urging the necessity of more studies. Thus, this review will explicitly discuss the existing TB diagnostic tools to understand where we stand in TB diagnosis and the recent advancements in blood transcriptomics emphasizing the importance of targeting the pathogen-derived biomarkers as a potential source for future diagnostics.

Pancreatic pseudocysts persisting beyond six weeks needs decompression, specially when they are larger than 6cm and symptomatic. Cysto-gastrostomy is the treatment of choice. This may be done by open, laparoscopic or endoscopic methods. Endoscopic cystogastrostomy has the least morbidity. Ultrasound guided aspiration causes lesser morbidity but has a higher incidence of recurrence. We compare six patients with pseudocysts treated by aspiration and cystogastrostomy; open, laparoscopic and endoscopic.

Chronic pancreatitis may cause disabling pain not responding to oral analgesics and/or drainage procedures. Although pancreatectomy is a definitive treatment, it carries a significant morbidity and mortality. Celiac plexus ablation is beneficial, although it is a temporary method for pain relief. While bilateral splanchnicectomy provides a more permanent pain relief, it is a difficult procedure requiring thoracotomy and results in significant morbidity. Thoracoscopy is an attractive alternative to perform splanchnicectomy. The results of a case series on video assisted thoracoscopic sympathectomies performed at the university surgical unit, Peradeniya, Sri Lanka from January 2011 to June 2013 was analyzed to evaluate the surgical technique and to quantify the efficacy of pain relief. Operating time, blood loss, intraoperative complications, conversion to open surgery, pre-operative and post-operative pain assessment using visual analogue scale score (VAS) were recorded. Seven patients who underwent video assisted thoracoscopic splachnicectomy were analyzed. All had an acceptable operating time (6omin), no measurable blood loss, no conversions to open surgery, no intercostal drainage, early mobilization and feeding. All had an average VAS of 8-10 pre-operatively. This reduced to a VAS of 1 or no pain in all, on post-operative day one, at one and six months. The few who experienced mild pain needed occasional use of paracetamol or diclofenac sodium. Non required narcotic analgesics. Bilateral thoracoscopic splanchnicectomy is a safe, effective and more attractive alternative as it carries a minimum morbidity, mortality and provides an excellent relief of chronic agonizing pancreatic pain.

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