Tuberculosis conundrum-current and future scenarios:A proposed comprehensive approach combining laboratory,imaging,and computing advances

Tuberculosis(TB)remains a global threat,with the rise of multiple and extensively drug resistant TB posing additional challenges.The International health community has set various 5-yearly targets for TB elimination:mathematical modelling suggests that a 2050 target is feasible with a strategy combining better diagnostics,drugs,and vaccines to detect and treat both latent and active infection.The availability of rapid and highly sensitive diagnostic tools(Gene-Xpert,TB-Quick)will vastly facilitate population-level identification of TB(including rifampicin resistance and through it,multi-drug-resistant TB).Basicresearch advances have illuminated molecular mechanisms in TB,including the protective role of Vitamin D.Also,Mycobacterium tuberculosis impairs the host immune response through epigenetic mechanisms(histone-binding modulation).Imaging will continue to be key,both for initial diagnosis and follow-up.We discuss advances in multiple imaging modalities to evaluate TB tissue changes,such as molecular imaging techniques(including pathogen-specific positron emission tomography imaging agents),non-invasive temporal monitoring,and computing enhancements to improve data acquisition and reduce scan times.Big data analysis and Artificial Intelligence(AI)algorithms,notably in the AI subfield called“Deep Learning”,can potentially increase the speed and accuracy of diagnosis.Additionally,Federated learning makes multi-institutional/multi-city AI-based collaborations possible without sharing identifiable patient data.More powerful hardware designs-e.g.,Edge and Quantum Computing-will facilitate the role of computing applications in TB.However,“Artificial Intelligence needs real Intelligence to guide it!”To have maximal impact,AI must use a holistic approach that incorporates time tested human wisdom gained over decades from the full gamut of TB,i.e.,key imaging and clinical parameters,including prognostic indicators,plus bacterial and epidemiologic data.We propose a similar holistic approach at the level of national/international policy formulation and implementation,to enable effective culmination of TB’s endgame,summarizing it with the acronym“TB-REVISITED”.

Symptom overlap between schizophrenia and bipolar mood disorder: Diagnostic issues

Although the Kraepelinian classification paradigm is widely used, observations of overlapping boundaries among the symptoms associated with bipolar disorder and schizophrenia are beginning to challenge this dichotomy. The objective of this research was to explore the symptoms of individuals diagnosed with schizophrenia and with bipolar mood disorder in order to determine the frequency of symptom overlap. One hundred patients of a psychiatry ward were divided into two main groups based on their diagnosis—schizophrenia or bipolar mood disorder. Chi-square analyses were used to determine whether the symptoms measured in this study differed between individuals diagnosed with schizophrenia and those diagnosed with bipolar mood disorder. The results suggest that both positive/manic symptoms and negative/depressive symptoms are present in individuals diagnosed with schizophrenia and with bipolar mood disorder and, consequently, they do not present a reliable means of differentiating between these two groups. These findings have many implications for the ways in which mental illness is conceptualized and classified. Treatment efforts and interventions may be enhanced if a more dimensional approach to diagnosing mental illness is utilized.