Cytomegalovirus (CMV) infection is frequent after kidney transplantation, typically occurring within the first 100 days post-transplant. This prospective, multicenter study aimed to estimate the frequency of CMV disease beyond 100 days post-transplant and demonstrate the usefulness of virological diagnosis during this period. Of 48 kidney transplant recipients with suspected CMV disease, 17% had positive CMV viremia, and 6% had confirmed CMV disease. The 3 cases of CMV disease presented with high viral loads, viral syndrome associated with tissue-invasive disease. For the 45 patients without confirmed disease, virological diagnosis allowed the identification of other etiologies, mainly infectious or iatrogenic. Although infrequent beyond 100 days, CMV disease can occur and be severe, justifying virological screening in the presence of suggestive signs. Differential diagnosis with other causes remains paramount.

Pulmonary Tuberculosis is caused by bacilli mycobacterium tuberculosis and known to infect human race since the dawn of history and archaeological evidence has traced its association in neolithic times. Tuberculosis is the most common infectious lung disease in India with significant mortality and morbidity. Tuberculosis can cause diverse thoracic presentations ranging from nodules, consolidations& cavitation, mediastinal adenopathy, pleural effusion to diffuse endobronchial disease presenting like bronchial asthma. Due to diverse presentations, diagnosis is many times delayed due to lack of suspicion by treating general physicians and rational treatment not offered in time. In spite of awareness by government organizations and considered as a ‘global health issue of concern’ by the World Health organization, tuberculosis is still considered as a social stigma. Destroyed lung is described in literature and known as a complication of pulmonary tuberculosis. Destroyed lung is defined as combination of pleural and parenchymal lung destruction with cavitation, bronchiectasis, loss of lung volume and mediastinal herniation to diseased side. In this case series, we have reported two cases with history of pulmonary tuberculosis in the past and received adequate anti-tuberculosis treatment. Both were having residual chronic lung disease and symptoms causing significant impact on quality of life with recurrent hospitalization, hospital visits and cost of care. One patient has a history of delayed diagnosis and ATT was started after maximum lung destruction due to a tuberculous process that has already occurred. In this patient tuberculosis was cured but residual lung damage or sequel presenting as destroyed lung. In the second case, tuberculosis was diagnosed in adequate time but the patient has defaulted due to adverse events of ATT and he has taken medications as per his own tolerance. Neither adherence nor compliance was acceptable in the second case and resulted in a partially treated case of pulmonary tuberculosis. Ongoing lung destruction in the second case would be the cause for destroyed lungs in absence of irrational medicines in today’s era of good quality ATT. Destroyed lung is preventable with early diagnosis, prompt evaluation with microscopy and nucleic acid amplification tests and treatment with universally available, acceptable and affordable free ATT as National guidelines. 'Destroyed lung' are having a significant impact on quality of life and health expenditure and are considered as ‘radiological stigma’ of Tuberculosis. Radiological classifications of tuberculosis are less used now, and, it can be justified in grading of disease severity and aggressive treatment planning. Radiological classifications also help in predicting complications such as ‘destroyed lung’ during evolution of advanced pulmonary tuberculosis disease which can be prevented with timely diagnosis and use of rational treatment with good clinical and radiological outcome.

In this review article, it is emphasized that adopting advanced molecular diagnostics is essential for modern UTI management, offering a more comprehensive, accurate, and rapid approach compared to traditional methods. Standard urine culture’s limitations include low sensitivity and failure to culture certain microorganisms, leading to undiagnosed cases and increased morbidity. Advanced molecular techniques, like multiplex-PCR and pooled antibiotic susceptibility testing have been shown to reduce empiric treatments and negative outcomes significantly. And advanced molecular methods like metagenomics (mNGS) offer comprehensive pathogen detection without prior knowledge of target organisms, improving diagnostic yield. These methods also detect antibiotic resistance genes, aiding in precise treatment strategies and improving patient outcomes. Adopting advanced molecular diagnostics is essential for modern UTI management, offering a more comprehensive, accurate, and rapid approach compared to traditional methods. These technologies are vital in improving patient care and combating antibiotic-resistant infections.

Complicated appendicitis is a complication of acute appendicitis, which is defined as perforation of the appendix, with abscess or mass formation. The management of complicated appendicitis was initially with conservative treatment with intra-venous antibiotics, with percutaneous drainage of abscess reserved for patients with abscess formation. The recent trend has seen a movement towards immediate appendectomy with laparoscopic appendectomy being the preferred surgical option. As there is no definitive consensus on the management of complicated appendicitis, we have conducted this mini review to look at the treatment option for complicated appendicitis in adults and children.

Acute appendicitis in the elderly is a difficult condition to diagnose and treat due to its atypical clinical presentation, the co-morbidities that these patients have and the risk of developing complications like perforation. The diagnosis involves the use of imaging modalities like computerized tomography and the treatment is by performing an appendectomy. Laparoscopic appendectomy is slowly becoming the gold standard in the surgical treatment of acute appendicitis in the elderly. We have conducted this review article to look at the diagnosis and management of acute appendicitis in the elderly. The role of laparoscopic appendectomy in the surgical treatment of acute appendicitis in the elderly is also investigated.

Background: Although there were several clinical studies regarding the effectiveness of sitagliptin, there were dearth of studies on the prescription patterns and practices among clinicians. Methodology: This cross-sectional study included 19 statements with multiple responses in a pretested questionnaire format to gather and understand the current prescription practices, clinical observation and preferences for managing diabetes with a special reference to the clinical use of sitagliptin in Indian settings. The survey respondents were specialists with expertise in managing diabetes. Results: According to 49% of clinicians, the preferred drug combination for managing diabetes with hemoglobin A1C (HbA1C) levels >9% is dipeptidyl peptidase 4 inhibitors (DPP4i) + metformin + glimepiride. The majority of clinicians (89.92%) recommended sitagliptin as the preferred gliptin for cardiovascular (CV) protection in diabetic patients. Approximately 38% of clinicians considered established cardiovascular outcome trials (CVOT) and CV benefits as decisive factors in prescribing sitagliptin as a first- or second-line therapy for diabetic patients. Around 72% of clinicians preferred sitagliptin + dapagliflozin as an oral antidiabetic (OAD) combination for type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD). Approximately 42% of respondents reported sitagliptin + metformin as the preferred OAD combination, prescribed as a single pill, for uncontrolled T2DM patients with HbA1c levels >8%. Conclusion: The study highlighted the prescription trends favoring sitagliptin-based therapies in the management of diabetes, with potential cardiovascular benefits and as first- or second-line OAD therapy. The respondents also emphasized the significance of personalized approaches, such as the sitagliptin + dapagliflozin combination, for T2DM patients with CKD.