Nontuberculous mycobacteria (NTM) represent an increasingly significant cause of pulmonary and extrapulmonary infections, but are sometimes misinterpreted as tuberculosis (TB) owing to overlapping clinical and microbiological characteristics. Conventional diagnostic approaches, such as Ziehl-Neelsen staining and culture in a Mycobacterial Growth Indicator Tube (MGIT) system, are constrained by extended incubation times, are insufficient for accurate species differentiation, and are limited by prolonged incubation periods. Recent molecular and genomic advances have transformed NTM diagnostics by enabling rapid, specific, and high-resolution identification. Line probe assays (e.g., GenoType Mycobacterium CM/AS assay) and multiplex PCR have enhanced the ability to distinguish between NTM species such as Mycobacterium absessus, M. fortuitum, and M. avium complex and M. tuberculosis complex, which is essential for proper treatment and epidemiological mapping. Among newer proteomic platforms, matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry has emerged as a transformative, cost-effective technology capable of identifying Mycobacterium species directly from culture isolates through protein fingerprinting. It provides rapid, reproducible, and highly discriminatory identification between closely related species. Next-generation sequencing (NGS) and whole genome sequencing approaches now offer unprecedented insight into species identification, strain typing, and drug-resistance prediction, complementing traditional culture-based susceptibility testing. Newer techniques such as metagenomics NGS (mNGS), targeted NGS (tNGS) multilocus sequence typing, and mycobacterial interspersed repetitive unit-variable number tandem repeats (MIRU-VNTR) genotyping facilitate subspecies-level resolution and real-time outbreak surveillance. Moreover, molecular beacons, insertion sequence analysis, and repetitive sequence-based polymerase chain reaction (Rep-PCR) enhance detection sensitivity even in paucibacillary samples. The integration of genomic data with automated diagnostic system promises earlier intervention, accurate species delineation, and improved patient outcome.

Non-tuberculous mycobacteria (NTM) are environmental opportunistic pathogens causing chronic pulmonary disease. NTM pulmonary disease (NTM-PD) and bronchiectasis exhibit a bidirectional pathogenic relationship that is particularly under recognized in South Asian regions with high tuberculosis (TB) burden. This review article covers most of the current evidence on the epidemiology, clinical spectrum, pathogenesis, therapeutic advances of NTM-associated bronchiectasis. A well-structured literature search was conducted across PubMed, Web of Science, Scopus, and Google Scholar for articles published within from 2008 to 2025. These studies were specifically focused on NTM -associated bronchiectasis for host pathogen interactions, diagnostic strategies, and treatment outcomes. The prevalence of NTM related bronchiectasis especially with species like Mycobacterium avium complex and Mycobacterium abscessus which were more frequent pathogens all over the world. Its diagnostic dilemma with TB remains widespread due to limited lab capacity and lack of exact species identification, which leads to late or wrong diagnosis. Integration of molecular diagnostic tools, inclusion of NTM within national TB programs, and establishment of regional reference laboratories are essential to improve early detection, targeted treatment, and disease surveillance for bronchiectasis.

Background Tuberculosis (TB) is an airborne bacterial infection caused by Mycobacterium tuberculosis. It continues to pose a major threat, India bore the highest TB burden accounting for 27% of global cases in 2022. The emergence of drug resistance, especially primary medications such as isoniazid (INH), hinders treatment and containment efforts. Genetic alterations in the katG and inhA genes are the main contributors to INH resistance, resulting in high and low levels of resistance, respectively. Objectives This study investigates the genetic mutational patterns of INH resistance in TB cases, focusing on their prevalence and association with demographical, geographical, and clinical features.  Methods A cross-sectional prospective study was conducted in our tertiary care center located in eastern Uttar Pradesh (UP), India, from June 2022 to May 2024. A total of 6,954 highly suspected TB cases, including pulmonary and extra-pulmonary samples, were evaluated. After fluorescence microscopy, line probe assay (LPA) was used to analyze 1,998 (28.73%) sputum-positive samples for katG and inhA mutations, which confer INH resistance. Results Among 1,998 sputum-positive samples tested with LPA, valid results were obtained for 1,993 cases. Of these, 131 (6.57%) showed INH resistance, with high-level INH resistance detected in 102 (77.86%) cases, predominantly linked to katG MUT1 (S315T1) mutations. Low-level resistance was identified in 29 (22.14%) cases, primarily associated with inhA MUT1 (C-15T) mutations. Among INH resistance cases, females were significantly younger than males (mean age 28.49±14.16 vs. 40.65±16.03; p-value<0.001), but male cases were higher than female (86[65.64%] vs. 45[34.35%]; p-value=0.039). However, age distribution was comparable between high and low-level INH resistance. Geographically, Gorakhpur emerged as a hotspot for high-level resistance 40/102 (39.21%), while Deoria had the highest prevalence of low-level resistance 9/29 (34.48%). Conclusion Our study identified the prevalence of katGmutations in high-level and inhA mutations in low-level INH resistance in eastern UP, India. This highlights the need for region-specific public health strategies, including better joint management of comorbidities and enhanced diagnostic capacity to address the burden of drug-resistant TB in this high-prevalence region.

The emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) complicates control efforts. We investigated the prevalence and genetic patterns of pre-XDR and XDRTB, by employing second-line line probe assays (SL-LPA). This prospective cohort study was conducted at the Intermediate Reference Laboratory, from November 2023 to May 2024. We screened 1253 samples via Genxpert followed by florescence microscopy, and mutational/resistance analysis via the GenoType MTBDRplus/FL-LPA (first line-line probe assay) and MTBDRsl/SL-LPA for the mutation patterns. We identified 355 rifampicin drug-resistant TB isolates, 260 of which were smear positive samples obtained for FL-LPA and SL-LPA. Finally, 255 MDR/RR-TB patients were analyzed and 73(28.62

Introduction:Drug-resistant tuberculosis (DR-TB) poses a significant public health threat, with molecular diagnostics playing a pivotal role in understanding the genetic mechanisms of resistance. This study focuses on the patterns of genetic mutations observed in DR-TB cases, with the aim to identify key mutations associated with resistance to rifampicin (RIF) and isoniazid (INH). Methodology:A total of 6,954 non-duplicate clinical samples were obtained from individuals of all age groups, categorized as TB and DR-TB, from seven linked districts between June 2022 and May 2024. The samples were transported under cold chain conditions to an intermediate reference laboratory. TB was confirmed using fluorescence microscopy, and 1,998 sputum-positive samples were analyzed using line probe assay for characterization of genetic mutations. Results:Among the analyzed cases, a total of 136 cases of DR-TB were identified. This included 57 cases (41.92%) of multidrug-resistant TB (MDR-TB), 73 cases (53.68%) of INH monoresistance, and 6 cases (4.4%) of RIF monoresistance. The analysis revealed a high prevalence of rpoB MUT3 (S531L) mutations in 52 cases (82.25%), which is associated with RIF resistance. In high-level INH (katG gene mutation) resistance noted in 83 (63.35%) cases, katG MUT1 (S315T1) was predominant, while low-level INH resistance (inhA gene mutation), inhA MUT1 (C-15T) mutation, was found in 29 (22.13%) cases. Maharajganj and Deoria reported the highest prevalence of rpoB MUT3 (S531L) mutations, while Kushinagar and Sant Kabir Nagar exhibited higher rates of katG MUT1 (S315T1) mutations. Other regions showed notable distribution of rpoB, katG, and inhA gene mutations. Conclusion:The high prevalence of mutations such as rpoB MUT3 (S531L) and katG MUT1 (S315T1) highlights the need for integrating molecular tools into routine workflows to identify genetic mutations. District-specific mutations emphasize the influence of local epidemiological factors on resistance patterns, necessitating region-specific interventions. Continuing research into regional resistance trends are vital to addressing the global DR-TB burden effectively.

Globally, drug-resistant tuberculosis is major public health issue. Multidrug-resistant tuberculosis (MDR-TB), especially resistant to first line drugs (isoniazid [INH] and rifampicin [RMP]), is one of the serious health concerns in India. As per annual India TB report 2022, 2.7% of total TB patients were infected with MDR-TB. Line probe assay (LPA)/GenoTypeMTBDRplus technique based on polymerase chain reaction is a rapid method for the detection of RMP and INH simultaneously. This cross-sectional prospective study includes 405 samples from suspected TB patients from 30.12.2021 to 13.05.2022. Samples were received from linked districts with Intermediate Reference Laboratory (IRL) for fluorescent microscopy (FM) and LPA testing through proper cold-chain under NTEP program and then subjected to FM. Only smear positive sample were subjected to LPA as per manufacturer instructions. Out of 405, a total of 261 samples were smear positive (64.4%). Among 261 samples processed for LPA, 255(97.7%) showed valid result and 6(2.3%) were found invalid. In LPA result, 227 (89.01%) were susceptible to both INH and RMP, 9(3.5%) had MDR-TB, 18(7.05%) shows INH mono resistance and 1(0.3%) shows RMP mono resistance. Patients with MDR-TB were prominent in younger age group (Mean±S.D; 29.6±5.7 vs. 36.6±17.8 years, p value = 0.004). Prevalence of MDR-TB cases is higher in our study than cases reported in annual TB report (2022) of India. LPA is proved highly accurate in rapid detection RMP resistant/MDR-TB cases. Early diagnosis may potentially enable earlier commencement of appropriate TB drugs and the reduction of transmission of MDR-TB and may possibly leading to the complete eradication of TB in India.

Antimicrobial Resistance (AMR) is a condition which occurs, when pathogens evolve and no longer respond to antibiotics, making infections more difficult to treat and leads to death. Apart from the truth that antibiotics have increased the life expectancy of human, AMR is a serious threat. AMR is a major public health threat declared by World Health Organisation (WHO) since 2014. During the different waves of the pandemic, patients with Coronavirus Disease-2019 (COVID-19) infection caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) accounted for the majority of hospital admissions, frequently necessitating an antibiotic upon admission. Among hospitalised patients with COVID-19 infection, a major cause of mortality was mainly due to secondary infections, which was due to overuse of antibiotics and poor infection control procedures which may lead to rapid emergence of Multidrug Resistance (MDR). Before COVID-19 pandemic, AMR was estimated to kill around 700,000 people yearly that are predicted to increase upto 10 million by 2050. Before COVID-19 pandemic, there was lower incidence of hospital associated infections across world. AMR was surprisingly prevalent in patients with bacterial co-infections during the first 18 months of the COVID-19 pandemic. The latest update as per WHO guidance for antibiotic stewardship, which does not recommend antibiotic therapy or prophylaxis for patients with mild/moderate COVID-19 unless signs and symptoms of a bacterial infection. Now, the researchers must consider secondary bacterial infection rate, MDR isolation rate, and high mortality among COVID-19 with secondary infection. This shows the urgent need for surveillance, reinforcement of infection control practices and strict antimicrobial stewardship to combat increasing AMR.

BACKGROUND:Primary gastric lymphoma is uncommonly reported in India. We retrospectively analyzed their data in a northern Indian teaching hospital.METHODS:During a 12-year period (2000-2012), endoscopic and surgical biopsies were assessed for gastric neoplasm. Gastric biopsies from normal-looking areas, rapid urease test, and Helicobacter pylori serology were done, with 2 of 3 tests positive being considered diagnostic. We aimed to study (i) the frequency of primary gastric lymphoma among gastric neoplasm patients, (ii) its clinical profile, (iii) the diagnostic procedures needed, and (iv) the frequency of H. pylori infection among them.RESULTS:Thirty out of 324 (9.2%) patients (age 56 years, range 25-72, 73.3% male) with gastric neoplasm had primary gastric lymphoma. Presentations included dyspepsia (n = 9, 30%), gastric outlet obstruction (n = 7, 23.3%), upper gastrointestinal bleeding (n = 5, 16.7%), dysphagia (n = 4, 13.3%), malignant ascites (n = 3, 10%), and others (n = 2, 6.7%). H. pylori infection was confirmed in 7 (23.3%), 12 (40%), and 21/29 (72.4%) patients by rapid urease test and histopathology and positive anti-H. pylori IgG serology, respectively. By 2 tests, H. pylori was detected in 12 (40%) patients. Though in 60% primary gastric lymphoma was diagnosed on endoscopic biopsy, in 40%, surgical resection was required. The endoscopic and surgical diagnosis groups were comparable in age (53.4 years vs. 52.7 years), sex (male 77.8% vs. 66.7%), H. pylori infection (38.9% vs. 16.7%), presentation with dyspepsia (38.9% vs. 16.7%), organic symptoms (61.1% vs. 83.3%), and the need for repeated endoscopic biopsies before diagnosis (12.% vs. 33.3%).CONCLUSION:Primary gastric lymphoma is not uncommon (9.2%) in India, often missed on endoscopic biopsy and is associated with H. pylori infection (40%).

India has made a bold promise to eradicate Tuberculosis (TB) by 2025 five years ahead of the global target. Although, one-fourth of the global burden with highest new cases of TB is shown by the country. So yet, no comprehensive analysis has been published on India’s National Tuberculosis Elimination Program (NTEP) (2017-2025). The current review details the advanced diagnostic methods like Fluorescence Microscopy (FM), culture, nucleic acid amplification test (Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and True Nucleic Acid amplification Test (TrueNAT)) and line probe assay as well as the role and network of Mycobacterial culture and Drug Sensitivity Testing (C and DST) laboratories in national scaling-up of evidence-based policies and facilities, which is a critical component in India's fight against TB. The material of this study was mostly obtained from policy and program making documents of World Health Organisation (WHO) and annual TB reports of India. India’s TB annual report 2021 says that only half of the patients were successfully treated in the period of conventional longer care regimens. The interventions to achieve the factors related patient’s care have been implemented through universal drug sensitivity testing through C and DST laboratories, which has driven therapy with a shorter regimen, newer medications, and social protection. In one hand, the comprehensive monitoring scheme through C and DST laboratories for TB including all possible drug-resistance cases and other hand, patient’s systemic treatment through shorter, more reliable, and safer first- or second-line drug regimens are all necessary milestones to achieve the goal of our government for abolition of TB in India by 2025.

This paper emphasizes the anti-inflammatory effects of Alhagi Camelorum. Most of the diseases are caused by a continuous swelling, including cancer. There is hence a need to neutralize inflammation. A. Camelorum, a medicinal plant, has been historically utilized as a remedy in Ayurveda and other systems of folk medicine. Thus, several techniques were utilized by Wister rats to examine A. Camelorum anti-inflammatory properties. The plant material was crushed into a coarse powder in a grinder after drying and stored at a room temperature for further investigation. The powdered plant material of A. Camelorum was subjected to successive solvent extraction (hexane, petroleum ether, chloroform, and methanol) in soxlet extraction method. Different extracts were analyzed using a traditional procedure to evaluate the various physicochemical properties. The HPTLC report is included to the file. It was discovered that the methanol and chloroform drug extract contained flavonoids (good anti-inflammatory properties) when quercetine was used as a marker. Topical gel of methanol and chloroform drug extract of A. Camelorum were prepared with Carbopol 934, hydroxypropyl methylcellulose (HPMC) and carboxymethyl cellulose. These gel formers have been created, tested, and gel chosen, which showed good propagation and consistency, to get the right consistency of the gel formulation. Gel containing methanol drug extract FM2 and FM10 formulation showed highest in-vitro release which were selected and subjected to carrageenan induced rat paw edema method. Our study reveals the anti-inflammatory effects of methanol extract of A. Camelorum were found to be significant.

Prognosis of a COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is determined by how the host and virus variant interact with each other.The second wave was spreading at a breakneck pace in India, eventually and became a "tsunami by spreading of delta (B.1.617.2) variant.To determine the cause of this condition, randomly chosen positive SARS-CoV-2 samples were sequenced for the detection of variants responsible for this miserable situation.We have found mainly delta variants in clinical samples.Surprisingly, first time two delta plus (AY.1) and one kappa (B.1.617.1)variants of SARS-CoV-2 were also reported on July 2, 2021 from our centre of Uttar Pradesh.Unfortunately, among these, two non-vaccinated cases, person infected with delta plus and another with kappa variants had loss of their life admitted in ICU COVID-19 ward with severe conditions.Remaining, one case infected with delta plus was recovered who had already taken the vaccination of both doses.This finding suggests that SARS-CoV-2 genome variations have a substantial influence on COVID-19 outcome, resulting in an increase in reproduction number (R 0 ) in the second wave.However, our findings point to a possible role for vaccination against the more lethal double-mutated delta plus variant.This primary report also opens a door towards large-scale gene sequencing of SARS-CoV-2 samples in order to develop precautionary measures against subsequent waves.

Background: Esophageal cancer remains one of the deadliest cancers with an overall 5-year survivalrate estimated to be less than 18%. Squamous cell carcinoma of the esophagus is the predominanthistology in the cervical esophagus and upper and middle thirds of the thoracic esophagus, whereasadenocarcinoma predominates in the distal esophagus. Lymph node involvement and the number oflymph node metastases are important prognostic factorsMaterials and Methods: 30 patients of mid and lower thoracic esophageal carcinoma treated between2008 to 2014 were studied retrospectively. Histopathological profiles were analysed mainly in terms ofpattern of lymph node involvement.Results: 26 cases were squamous cell carcinoma and 3 were adenocarcinoma while 1 case waspathological complete response after neoadjuvant treatment. 22/30 were moderately differentiated.24/30 had lymph node involvement where T3N1 was the commonest stage as 50% had achieved thisstage. Mediastinal group of lymph nodes were involved in 23 cases upper abdominal lymph nodeswere involved only in 1 case while cervical lymph nodes were not involved in any case. Amongmediastinal group paraesophageal, paratracheal lymph node involvement was the commonest followedby subcarinal and recurrent laryngeal group of lymph nodes.Conclusion: Squamous cell carcinoma is still the commonest variety prevailing in this region. Majorityof the cases present in advanced stage with lymph node involvement. Mediastinal group of lymph nodesare involved in majority of the cases hence precise clearance of this group is of utmost importance toprevent local recurrence and prolonged survival.

MRSA (methicillin-resistant Staphylococcus aureus) is a prevalent cause of infection in hospitals and at community level.It causes bacteraemia, pneumonia, endocarditis, skin and soft tissue infections and bone and joint infections.Although its prevalence has started declining before the pandemic of COVID-19, but extensive use of antibiotics and long-term hospitalization during infection have increases the risk of secondary bacterial infection including MRSA.As a result, occurrences of co-infection and super-infection are on the rise.MRSA is responsible for collateral damage among patients with COVID-19 infection.In this review, recently published comprehensive studies have assessed the MRSA co-infection among hospitalised COVID-19 patients through PubMed, Scopus, Google Scholar, and the WHO COVID-19 databases.According to recent studies, it was found that MRSA co-infections are on the rise among COVID-19 patients which has increased the mortality rate.Improved diagnostic capabilities of laboratories and reducing the necessity of antibiotic that can be helpful in reducing the MRSA co-infection in these patients.Sanitation and preventive measures and strict infection control policies can reduce the burden of MRSA infection.

Background and objectives: Hepatitis C virus (HCV) is a causative agent of hepatitis C disease of the liver. We have analysed the major risk factors including demographic, clinical and genotypic distribution among HCV seropositive patients and their distribution in Uttar Pradesh, India. Methods: This study was conducted by a questionnaire-based proforma, filled in Hepatobiliary Clinic, Department of Medicine, King Georg's Medical University, Lucknow, from 2014 to 2017. Demographic, clinical and laboratory data were recorded. Seropositivity was demonstrated through an anti-HCV IgG ELISA kit. Positive patients were further examined for HCV RNA by RT-PCR. Results: A total of 31,440 patients attended the hepatobiliary clinic. Among these, 310 (0.99%) patients were confirmed for HCV infection and there was no significant difference between males and females (50.3% vs. 49.7%). Previous surgery (49.0%), dental extraction (41.0%) and roadside shaving (38.1%) were the major risk factors for HCV infection. We also observed that previous surgery 143/154 (92.9%) in female and roadside shaving 118/156 (75.6%) in male was the commonest factor for HCV, however; dental extraction was comparable among male and female (65 [51.8%] vs 62 [48.2%], P value = 0.818). HCV RNA genotype 3 (81.6%) was the most frequent followed by 3a (11.3%), 3b (5.8%), 1 (0.7%) and 4 (0.7%). In the district-wise analysis, frequent cases were included from Lucknow with previous surgery and dental extraction as the commonest risk factor. Interpretation and Conclusions: Previous surgery among female and roadside shaving among males are the commonest risk factors for HCV. This study suggests a powerful and strict guideline, to avoid HCV infection.

Chronic inflammation and long-term tissue injury are related to many malignancies, including gastric cancer (GC). Helicobacter pylori (H. pylori), classified as a class I carcinogen, induces chronic superficial gastritis followed by gastric carcinogenesis. Despite a high prevalence of H. pylori infection, only about 1–3% of people infected with this bacterium develop GC worldwide. Furthermore, the development of chronic gastritis in some, but not all, H. pylori-infected subjects remains unexplained. These conflicting findings indicate that clinical outcomes of aggressive inflammation (atrophic gastritis) to gastric carcinogenesis are influenced by several other factors (in addition to H. pylori infection), such as gut microbiota, co-existence of intestinal helminths, dietary habits, and host genetic factors. This review has five goals: (1) to assess our current understanding of the process of H. pylori-triggered inflammation and gastric precursor lesions; (2) to present a hypothesis on risk modulation by the gut microbiota and infestation with intestinal helminths; (3) to identify the dietary behavior of the people at risk of GC; (4) to check the inflammation-related genetic polymorphisms and role of exosomes together with other factors as initiators of precancerous lesions and gastric carcinoma; and (5) finally, to conclude and suggest a new direction for future research.