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
Building upon prior studies, this rigorous evaluation confirms the utility of adjunctive aripiprazole as a strategy for improving prolactin and managing prolactin-related adverse effects in premenopausal women with psychosis.
Serological tests for syphilis BRITISH COOPERATIVE CLINICAL GROUP Scope of Study In 1971 the British Cooperative Clinical Group undertook a survey of the procedures in use in the laboratories where serological tests for syphilis were carried out for the venereal diseases clinics of Great Britain, and replies were received relating to 158 clinics and 68 laboratories (Table I). TABLE I Distribution of 68 laboratories and 158 clinics Area No. of laboratories No. of clinics England Multiclinic laboratories 21 96 Single clinic laboratories 33 33 Total 54 129 Wales Scotland Total 6 14 8 15 68 158 The survey covered 129 venereal diseases clinics in England (54 laboratories), fifteen in Scotland (8 laboratories), and fourteen in Wales (6 laboratories). Of the 129 clinics in England, 96 were served by 21 laboratories (termed for the purpose of this study 'multi-clinic laboratories') and the remaining 33 clinics did not share their laboratory with any other clinic. Some considerable degree of centralization was apparent in so far that no less than 47 of the English clinics were served by four laboratories (Bristol, Manchester, Liverpool, and Wakefield), while eight clinics were served by two laboratories in Scotland (see Appendix). Size of participating clinics The hours per week operated by the participating clinics are presented in Table II, which shows that
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