The incidence of tuberculosis (TB) infection in multiple organs outside the lungs is of particular concern. We present the case of a 48-year-old woman with a history of pulmonary TB who had a gradual loss of consciousness in one day, worsening shortness of breath, and a cough with green phlegm two weeks before admission. She had been undergoing five days of TB treatment with the drug-sensitive TB treatment regimen. The genital examination revealed a whitish mass in the paraurethral area, which impaired her urination. Blood gas analysis showed respiratory acidosis, and a chest X-ray suggested pulmonary TB and concurrent community-acquired pneumonia. She was diagnosed with extrapulmonary tuberculosis (EPTB) in the central nervous systems and urogenital sites. To treat her lifethreatening EPTB, she received crystalloid infusions, oxygen supplementation, ampicillin-sulbactam (converted to meropenem the next day), an oral fixed-dose combination antituberculosis therapy, pyridoxine, N-acetylcysteine, ursodeoxycholic acid, Curcuma, bisoprolol, proton pump inhibitor, and antiemetics. Additionally, she was inserted with a urethral catheter and a nasogastric tube to assist her urination and nutritional intake. Our facility was a subdistrict hospital and had a limited capacity for diagnosing and treating EPTB due to a lack of advanced intensive care units, blood and sputum cultures, and laboratory panels. After her two-day hospital admission to ICU for stabilisation, she was referred to a higher-level hospital with more advanced pulmonary treatment overseen by a multidisciplinary team. Our resource limitations highlight the importance of being well-informed about evidencebased primary EPTB management strategies.
Tuberculosis, Central Nervous System

Autopsy practice is often limited due to the risk of infection transmission and family objections. As an alternative, virtual autopsy (virtopsy) is proposed, which uses minimally invasive radiology techniques such as postmortem CT scan (PM-CT) and PM-MRI. However, there is a scarcity of literature comprehensively summarizing this topic. Therefore, this review article discusses the advantages and limitations of virtopsy in developing countries during the COVID-19 pandemic, along with ethical issues and a proposed algorithm for postmortem imaging. Virtopsy improves the sensitivity (93%) and specificity (83%) of diagnoses and offers several advantages, such as faster identification, good foreign body detection, three-dimensional reconstruction, and non-invasiveness. Limitations include difficulty in determining infection status and assessing internal organ characteristics, operator dependence, insufficient legal basis, and high costs. During the COVID-19 pandemic, this article compiles twenty-one studies from 2020 to 2022 that used virtopsy to investigate 191 cases of COVID-19 infection resulting in death. The studies were conducted in various countries, with only two developing countries [Brazil (n = 3) and India (n = 1)] reported to have used it. Most of the studies used PM-CT, while others used postmortem ultrasound, PM-MRI, and PM chest X-ray. Virtopsies were mostly performed within 24 hours. The age range of the deceased individuals investigated using virtopsy was between 11 and 99 years old, with males being predominant. Virtopsy was mostly used for triage or screening for conventional autopsy (CA) as well as adjuvant/complement to CA. In summary, virtopsy has potential benefits for developing countries during and after the COVID-19 pandemic, making it a valuable investment despite its limitations.
Magnetic Resonance Imaging

Background: Poor sleep and excessive fatigue among workers can reduce well-being and physical fitness. However, not many studies have mentioned how sleeping deprivation among night-shift healthcare workers impacted their work performance in multiple aspects. Method: We conducted an evidence-based case report (EBCR) of a night shift nurse who was worried about the impact of her sleep deprivation on her work performance in the future due to prior history of needle-stick injuries. We aimed to determine whether sleeping deprivation caused by regular night shifts leads to decreased work performance among night-shift healthcare workers by formulating a clinical question. Evidence was searched systematically using five major journal databases (Proquest, EBSCO-Host, PubMed, ScienceDirect, and Cochrane) and was assessed thoroughly using inclusion and exclusion criteria. Results: Eleven eligible studies were obtained with a medium level of evidence (III-IV), three systematic reviews with meta-analyses (SR-MA), three SR without MA, and five observational studies. All of them were analyzed and critically appraised using Oxford Evidence-Based Medicine and Joanna Briggs Institute tools. We found that reduced quantity and quality of sleep impacted all dimensions of work performance among healthcare professionals, be it in task performance (e.g., skill proficiency), contextual performance (e.g., communication skill and mental health issues), and patient and health worker safety (accident and medication error). It could also encourage counterproductive work behavior, such as absenteeism. Furthermore, sleep deprivation changes circadian rhythms, causing decreased information processing and affective recognition functions in some vital brain areas, ultimately affecting several work dimensions. Conclusion In conclusion, stakeholders need to adjust proper shift scheduling for health care workers, practice sleep hygiene, maintain physical fitness, and consume nutritional food, positively correlated to health and productivity.
Evidence-Based Medicine ; Health Personnel ; Sleep Deprivation ; Work Performance