1993-2018 ,u ,p vkj lh % iPphl o’kZ&vla[; vk’kk,a Nhrc : Twenty Five Years-billion Hopes • Cannot leave work (overlapping work hours with medical facility • • • • working hours Dif iculties with transportation/distance to clinic Do not like attitude of medical workers Do not want to ind out that something is really wrong Do not trust medical workers 38. What is tubercular meningitis? What are the chances of dying due to TBM? Tubercular meningitis (TBM: tubercular involvement of brain covering) is still one of the common infections of central nervous system (CNS) and poses signi icant diagnostic and management challenges, more so in the developing world. Despite modern antituberculosis treatment (ATT), 20% to 50% of patients still die, and many of the survivors have signi icant neurological de icits. About 10% of patients who have tuberculosis develop CNSdisease. TBM is a serious CNS infection associated with signi icant mortality and high morbidity among the survivor. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to reduce mortality and morbidity is by early diagnosis and timely recognition of complications and institution of the appropriate treatment strategies. However, still the most challenging aspect is early diagnosis with certainty. 39. If TB is treatable? It is curable but despite treatment, pleural adhesions, shrinking of lungs due to ibrosis, pneumonia, weakness, bronchiectasis (permanent destruction of walls of airways in the lungs) and cor pulmonale (heart problem arising due to long standing diseased condition of lungs) are the known complications after pulmonary Koch's (TB) in a non-responsive/resistant case. 40. Whether miliary tuberculosis is dif icult to diagnose? Miliary TB still remains a perplexing disease that continues to confuse the most experienced clinicians and is a diagnostic and therapeutic challenge. Mortality from this disease has remained high despite effective therapy being available. Delay in diagnosis and consequently, delayed initiation of speci ic anti-tuberculosis treatment appears to be FORENSIC INVESTIGATION | 41