Dispatch from India
I spent last week in Bihar, an area of Northern India near Nepal. The best way to describe the journey is in pictures.Our small team visited villages along the Ganges to the east of Patna, tracing the path of patients from seeking care to diagnosis to treatment to compliance to wellness. We met with patients, providers, field officers (think of them as care managers), chemists (pharmacists), and labs. Here's what we experienced:The villages had hand pumped water supplies, electricity and 4G cellular connections. Cows and goats were a part of many households.A unique telemedicine program from World Health Partners (WHP) provided access to experts, connecting each village to trained clinicians in urban areas. We participated in such a consultation.We visited patients in their homes to hear their stories. All of us were touched by Pooja, a 25 year old new mother who spent 70,000 rupees (about $1000) on unnecessary medical care due to a misdiagnosis. She had to sell her land and her cow to pay for healthcare. We've started ago fund me to help rebuild her life.We reviewed medical records and imaging studies, which in India are maintained by patients and families. In this photo, I'm reviewing the records of a TB patient who is feeling better after treatment, but appears to have a negative initial chest X-ray.We visited a local lab which offered a menu of diagnostic tests ranging in price from $.70 to $...
Conclusion: Sarcoidosis cannot be reliably differentiated from tuberculosis based on cytomorphology alone. A combination of clinical features, endosonography, cytology and microbiology is required for accurate diagnosis. PMID: 32476956 [PubMed - in process]
In this study, we present three cases of testicular infarction and discuss their clinical characteristics, imaging features and clinical management. PATIENTS AND METHODS: Three adult males with prolonged epididymitis presented with chronic unilateral testicular pain, tenderness, and palpable swelling, including left varicocele in one case and hydrocele in the other two cases. Patient's symptoms were not relieved after antibiotic therapy. We analyzed the diagnosis, management, and outcome of these three cases of testicular infarction resulting from prolonged epididymitis. This includes the clinical characteristics, feat...
We present the case of a 32-year-old Tunisian woman living in Belgium with a 5-year history of liver lesions. Her medical history is marked by two pregnancies, and pleural tuberculosis at the age of 23, treated by antitubercular agents. The lesions were incidentally discovered in 2013 on a CT scan during a workout because of postpartum fever. They measured 8, 28, and 11 mm, respectively, at segments 7, 5, and 6; based on both MRI and ultrasound, they were considered atypical. She was asymptomatic and put under surveillance with no precise diagnosis.
Conclusions: The morphological features of LNs based on endobronchial ultrasound-guided transbronchial needle aspiration can play a role in predicting malignancy. PMID: 32405434 [PubMed]
Patients with clinically suspected tuberculosis are often treated empirically, as diagnosis - especially of extrapulmonary tuberculosis - remains challenging. This leads to an overtreatment of tuberculosis and...
ConclusionsAbdominal TB is common in India and can mimic ovarian malignancy, and hence, high degree of suspicion needed. The isolation of AFB is the gold standard for diagnosis of pulmonary tuberculosis but has a low yield in abdominal TB. Ultrasound-guided procedure is reasonable as an initial procedure. As much time can be lost in working up these patients through multiple diagnostic algorithms using ascitic tap, USG biopsy and then an operative procedure, diagnostic laparoscopy could be considered early in the work up. It is a simple, time-saving and cost-effective way of establishing a diagnosis sooner with least complications.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in adults is an essential tool for investigating mediastinal and hilar lymphadenopathy. It is now integral to the diagnostic and staging algorithm for lung cancer , as well as the diagnosis of other malignancies, lymphoma and non-malignant granulomatous conditions, such as sarcoidosis and tuberculosis. The comparable diagnostic yield, along with decreased complications, has reduced the requirement for previously standard surgical biopsy sampling [2, 3].
A 45-year-old female who underwent evaluation for abdominal discomfort and dysuria was found to have multiple left “renal calculus” on ultrasound examination and referred to us. Her current blood biochemical workup were normal and urine microscopy revealed sterile pyuria. A plain radiography revealed an extensive lobular calcifications in the left renal bed suggestive of a classical putty kidney sign of end stage renal tuberculosis (Figure 1). Contract enhanced computed tomography showed non excreting,densely calcified left kidney (figure 2A,B).