Skeletal tuberculosis as an extrapulmonary entity is uncommon accounting for less than 7% cases [1]. Tubercular involvement of the sternum is rarer even in countries where tuberculosis is highly prevalent [2]. We herein report an unusual case of tuberculous osteomyelitis of sternum with acute presentation as a swelling over anterior chest wall.An eleven year old girl presented with one week history of chest pain and swelling over anterior chest wall. There was history of progressive weight loss and low grade intermittent fever for one month. She was BCG vaccinated and there was no history of contact with tuberculosis in the family.On examination, the child was febrile, with thin built, and weighed 35 kgs (<50th percentile). Local examination showed diffuse swelling over manubrium. The swelling was highly tender and fluctuant. There was no redness, localised rise of temperature or any venous prominence over the swelling. There was no lymphadenopathy. Systemic examination revealed dullness over bilateral lower chest with decreased breath sounds on corresponding areas. Other systems were found to be normal.Investigations revealed hemoglobin of 10.4gm/dl, erythrocyte sedimentation rate was elevated to 40 mm in 1st hour. Tuberculin test was strongly positive measuring 20 x 20 mm with negative HIV test. Chest x-ray showed bilateral pleural effusion. Computed tomography of the chest showed permeative destruction (lytic areas) of sternum along with extrapleural collection tracking all along the anterior mediastinum and encroaching on anterior clear space on sagittal views (Fig 1). Collection was extending anterior to the sternum into parities and there was evidence of mediastinal and hilar lymphadenopathy along with areas of pleural reaction (thickening in the left hemithorax) along the costal pleura (Fig 2). There was enlargement of subcarinal group of lymph nodes. Fat planes anterior to mediastinum under collection were maintained. Aspirate from swelling over manubrium sterni revealed positive culture for Mycobacterium tuberculosis and positive Zeil Neelsen staining for acid fast bacilli.The child was started on antitubercular treatment with four drugs viz isoniazid, rifampicin, ethambutol and pyrazinamide. The child showed dramatic improvement within a month of institution of treatment. The pain and swelling subsided. She was switched over to continuation phase with two drugs isoniazid and rifampicin. Abstract:Primary tubercular osteomyelitis of sternum presenting as an acute swelling over chest is an extremely rare presentation in pediatric population. We herein report such a case which was diagnosed by CT scan showing lytic lesion and aspiration revealed positive culture for Mycobacterium tuberculosis. Child improved with antitubercular treatment.Tubercular osteomyelitis, Sternum

Background: Globally, in 2015, 1 million children died on first day of their life. The neonatal mortality rate is declining less rapidly than the mortality rate for children between 1month and 5 years of age. Thus, contribution of the neonatal mortality to the under-five deaths is increasing. Usually as average income of a country increases, it leads to decline in child mortality yet some countries in the fast lane for global economic growth such as India have been in the slower lane for child mortality reduction.Methods: This study was conducted at Sri Aurobindo Medical College and PG Institute, Indore from October 2015 to March 2017 for period of 18 months. Total of 800 live new-borns were included in this study by simple random technique. The statistical analysis of data was done using SPSS for Windows (Version 20.0) software. The correlation of gestational age with new-born foot length and new-born chest circumference was analysed by applying correlation and regression analysis.Results: Foot length is significantly correlated with both gestational age and birth weight with p value of < 0.05 and highly positive correlation coefficient. Chest circumference is significantly correlated with both gestational age and birth weight with p value of < 0.05 and highly positive correlation coefficient.Conclusions: This study tried to identify anthropometric parameter (foot length and chest circumference) which allows for rapid evaluation of the infant for gestational age and provide at risk infants with timely care.

Background: Sepsis is one of the most common causes of morbidity and mortality in the newborn. Early diagnosis and treatment is vital to improve outcome. Neonatal sepsis in newborn is characterized by paucity of signs and symptoms and is due to invasion and spread through the body of non-pathogenic/ pathogenic & Gram positive / negative organism. It is subtle disease, the general characteristic of bacterial infection in neonatal period are influenced more by response of the infant than the causative organism. The present study was therefore carried out to determine the usefulness of C-reactive protein (CRP) for evaluation of neonatal sepsis in tertiary care hospital.Methods: Neonates with clinical suspicion of sepsis were prospectively studied out from June 2006 to January 2008. Blood was obtained from each subject recruited for the qualitative estimation of CRP. Blood culture was used as gold standard for diagnosis of NNS.Results: Of 50 neonates studied, 34 (68%) had positive CRP while 31 (62%) had positive blood culture. The sensitivity, specificity, positive and negative predictive values of CRP were 90.32%, 42.10%, 71.79% and 72.72% respectively.Conclusions: The qualitative method of estimating CRP which is cheap and rapid has moderate sensitivity, specificity and negative predictive value.

INTRODUCTIONContemporary world is the world of science and technology. With the latest advances in technology the survival rate of extremely low birth weight newborns has increased. Extremely low birth weight newborns are defined as having birth weight less than 1000 grams. Apart from aggressive resuscitation and management of tiny infants, other factors that have contributed to the improved survival are widespread use of antenatal steroids and liberal surfactant replacement therapy, different types of ventilation, better control of nosocomial infections and early enteral feeding strategies.1-3 Although extremely low birth weight infants (ELBW, birth-weight < 1000g) represent approximately 1% of live births, their length of stay in the neonatal unit can be protracted exacting a heavy burden on hospital resources.Several studies have looked at the trends of mortality and morbidity of ELBW infants. In the last 20 years, survival of these ELBW infants has increased, but the incidence rates of the main neonatal complications remain unchanged. The survival rate of ELBW newborns worldwide is 10%. When the figures come to developing countries like India the neonatal mortality rate is 26% and ABSTRACT Background: The Aim of this study was to see the effect of gender and gestational age on early morbidities and mortalities of extremely low birth weight neonates. Methods: It was cross section retrospective. This retrospective study over a period of 5 years from June 2009 to May 2014 in a tertiary level teaching hospital. All the ELBW neonates admitted during the study period were recruited. Moving in a retrospective manner we collected previous case records relevant to our study from the institute and then categorized our data on the basis of gestational age and gender, then we compared and analysed our data on the basis of incidence of mortalities and morbidities and the effect of gender and gestational age on it. Results: Out of 115 ELBW neonates 61(53%) were born at ≤ 28 weeks, 26 (22%) were born between 29 to 31 weeks and 28(24%) babies were born at 32 to 37 weeks. The most common maternal risk factors responsible for ELBW deliveries were Pregnancy induced hypertension 27 (23%) followed by premature rupture of membranes 20 (17%). Out of short term outcomes HMD (66%), Apnea (71%), hyperbilirubinemia (53%) and sepsis (54.7%) were most common comorbidities. There was no effect of gender on any short-term morbidity and mortality of ELBW newborns. There was a significant higher incidence of hyaline membrane disease, hypoglycemia and neonatal sepsis in ELBW neonates born before 28 weeks of gestational age as compared to born after 28 weeks. 50% of the neonates survived below 28 weeks of gestation. Conclusions: Our study shows the high incidence of short-term neonatal morbidities. ELBW neonates born before 28 weeks of gestation had higher morbidity.

Central nervous system tuberculosis represents approximately 10% of extra pulmonary tuberculosis. However, spinal tuberculous arachnoiditis is a rare complication of CNS tuberculosis that can result in severe peripheral neurological deficit. We are reporting a case of 7-year-old male child of disseminated tuberculosis (pulmonary and spinal arachnoiditis) with nutritional anemia. We aim to illustrate the difficulties in the diagnosis and management of this potentially curable disease by reviewing the literature.