Introduction: This review aims to assess published cases of multifocal tuberculous spondylodiscitis (MTS) with whole-spine involvement, examining current concepts, management strategies, and providing evidence-based recommendations. Methods: A systematic review of case reports and series on MTS with full spinal involvement was conducted across databases, including PubMed, Google Scholar, and Web of Science, up to 2023. Data on patient demographics, clinical presentation, predisposing factors, spinal and extra-spinal locations, imaging findings, diagnostic methods, biochemical markers, management approaches, complications, and outcomes were collected and analyzed. Fourteen reports, representing 16 patients, met the inclusion criteria. Results: Radiologically, central lesions were present in all cases, with additional patterns including axial/anterior lesions in 62.5% and paradiscal involvement in 37.5%. Extensive spinal involvement was observed in the cervical, dorsal, lumbar, and sacral regions in all patients, and 68.75% had associated axial skeleton involvement (e.g., sternum, ribs, pelvis). Anti-tuberculosis (TB) therapy was administered to all patients, with treatment durations varying from 8 to 18 months. Surgical intervention was required in 56.25% of cases, primarily for spinal cord compression and progressive deformities. Follow-up data indicated that 93.75% of patients achieved pain resolution, and 68.75% experienced neurological recovery, with no recurrence observed at follow-up intervals of up to 4 years. Conclusion: Effective management of MTS involving the entire spine requires thorough clinical evaluation, tailored anti-TB chemotherapy, monitoring for drug resistance, and judicious surgical intervention when necessary. Routine use of whole-spine magnetic resonance imaging is essential for detecting multifocal lesions and guiding comprehensive treatment strategies to improve patient outcomes.
ABSTRACT A crescentic (“semilunar”) cap‐like pus–fluid level seen across CT/MRI sequences in a polymicrobial (bacterial‐fungal) brain abscess which may aid preoperative recognition when interpreted alongside clinical context and DWI/ADC.
BACKGROUND:Considerable diversity in cardiology training and credentialing pathways exist within the Asia-Pacific. We aimed to map these variations and report similarities and disparities with a view to understanding needs in cardiology curricula development in the region. METHODS:A 42-item online questionnaire was distributed to credentialed cardiologists serving as representatives from various regions within the Asia-Pacific, allowing obtainment of region-specific data as of December 2023. Responses were derived from a total of 23 regions. RESULTS:All regions required specialist qualification to practise cardiology. Overall, 69.6% have a single training pathway, while 21.7% and 8.7% have two or three pathways, respectively. Majority (91.3%) had structured cardiology training curricula with assigned supervisor and regular assessments. The majority (91.3%) required mandatory training in internal medicine prior to cardiology. The total training duration inclusive of medicine and cardiology varied across regions (range 3-8 years) with 26.1% lasting 5 years and 43.5% lasting 6 years. All programmes had mandatory clinical cardiology training; 82.6% had interventional cardiology, 73.9% had electrophysiology, 73.9% had cardiac imaging training. However, 47.8% of regions had no training in cardiac computerized tomography (CT) and 56.5% had no cardiac magnetic resonance (CMR) imaging. 73.9% required mandatory research for board certification. In addition, 95.1% had an exit exam at completion of training (local in 95% cases). Board certification was mandatory for general cardiology practise in 69.6% of regions. Separate subspeciality fellowships were mandatory in 73.9% of regions. CONCLUSIONS:Significant regional variations in cardiology training and credentialing pathways exist, presenting opportunities to harmonize and improve training metrics regionally. Key message What is already known on the topic? Cardiology training within the Asia-Pacific region has considerable variation in terms of duration, curriculum, training, and exit requirements. What this study adds? This study outlines the similarities and differences of cardiology training between different countries within the Asia-Pacific region. How this study might affect research, practise or policy? Results from this study provide insights that may inform the development of harmonized and contextually appropriate cardiology curricula in the Asia-Pacific region. Establishing common standards for cardiology training could facilitate a more uniform and coherent curriculum across Asia, ensuring consistency in trainee competencies and clinical practise.
