Sternal swelling presenting as tuberculosis: a case report

Abstract Background Tuberculosis continues to be a worldwide public health problem. Despite the noted gradual decline in tuberculosis case rates in the UK, clinicians should still be aware of these unusual presentations. Sternal tuberculosis is an uncommon form of extrapulmonary tuberculosis and it can initially be a diagnostic challenge for paediatricians. These lesions can present with nonspecific signs and symptoms that may mimic malignancy. Case presentation We present a case of a 3-year-old African descent girl with a sternal swelling that was confirmed to be Mycobacterium tuberculosis complex DNA on gastric aspirate. The child had additional radiological investigations that corresponded accordingly. She was started on quadruple antituberculosis therapy with good outcome. Conclusion Tuberculosis sternal abscess is as rare finding, especially in developed countries where tuberculosis is not endemic. Tuberculosis may not always present with pulmonary symptoms in children. There should be a high suspicion of tuberculosis, especially in immigrant population presenting with unusual presentations. Our aim is to increase awareness around atypical presentations of tuberculosis in children. Although, tuberculosis is endemic to underdeveloped countries, clinicians should still be aware of presentations in view of current global migration.

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Isolated Pancreatic Tuberculosis Mimicking Pancreatic Cancer: A Diagnostic Challenge

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/7871503 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Abhishek Bhurwal ◽

Muhammad Masoodul Haq ◽

Sunil Sapru ◽

Matthew Tortora ◽

Dhanasekaran Ramasamy

Keyword(s):

Pancreatic Tumor ◽

Extrapulmonary Tuberculosis ◽

Rare Condition ◽

Abdominal Tuberculosis ◽

Needle Aspiration ◽

Diagnostic Challenge ◽

Prognostic Implication ◽

Pancreatic Tuberculosis ◽

Antituberculosis Therapy ◽

Persistent Abdominal Pain

Isolated pancreatic tuberculosis is an exceedingly rare condition, even in areas of the world where the disease is highly prevalent. Abdominal tuberculosis is a common form of extrapulmonary tuberculosis but involvement of the pancreas is very rare. We report a case of isolated pancreatic tuberculosis presenting as a pancreatic mass in a patient with persistent abdominal pain and jaundice. Clinically and radiologically, the mass mimicked a malignant pancreatic tumor with a vastly different prognostic implication and therapeutic approach. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) can provide valuable diagnostic information in this scenario. After the tissue showed evidence of acid-fast bacilli and the cultures showed growth of Mycobacterium tuberculosis, antituberculosis therapy was initiated. Conservative management is usually successful in alleviating symptoms and leading to a cure. The excellent response to ATT makes it imperative that these patients are diagnosed early and managed appropriately to avoid unnecessary surgery and associated morbidity.

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Chronic heart failure

Oxford Handbook of Cardiac Nursing ◽

10.1093/med/9780198832447.003.0010 ◽

2020 ◽

pp. 217-240

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Mortality Rate ◽

Adult Population ◽

Age Groups ◽

Severe Heart Failure ◽

Signs And Symptoms ◽

Developed Countries ◽

Clinical Syndrome ◽

The Uk

Heart failure is a complex clinical syndrome of signs and symptoms that suggest the ability of the heart to pump effectively has been impaired. It is distinguished by dyspnoea, effort intolerance, fluid retention, and poor survival. The prevalence of heart failure is around 1–2% in the adult population in developed countries, and 920 000 people in the UK have heart failure. The incidence of heart failure has decreased; however, the number of people newly diagnosed with heart failure has increased. This is thought to be largely due to an ageing population, improvement in the management and survival of people with ischaemic heart disease, and effective treatment of heart failure. The condition can occur in all age groups; however, the incidence and prevalence steeply increase with age. The average age at first diagnosis is typically 77yrs. Chronic heart failure (CHF) has a poor prognosis, the mortality rate for CHF being worse than for many cancers. It is estimated that 70% of those hospitalized for the first time with severe heart failure will die within 5yrs. However, this has been improving, with 6mth mortality rate ↓ from 26% in 1995, 15% in 2009, to 8.9% in 2016. This chapter will outline the aetiology, pathophysiology, and management of CHF, including considerations for palliative care.

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Incidence of Common and Rare Cancers in Ilorin, Nigeria

Notulae Scientia Biologicae ◽

10.15835/nsb10410263 ◽

2018 ◽

Vol 10 (4) ◽

pp. 453-459 ◽

Cited By ~ 2

Author(s):

Abass T. ANIFOWOSHE ◽

Olubukola A. OWOLODUN ◽

Bashirudeen O. OYINLOLA ◽

Kazeem ABDULGANIYU ◽

Robiat D. YUSUF ◽

...

Keyword(s):

Endocrine System ◽

Kaposi Sarcoma ◽

Public Health Problem ◽

Signs And Symptoms ◽

Developed Countries ◽

Environment Interaction ◽

Gene Environment Interaction ◽

Gene Environment ◽

High Prevalence ◽

Leading Position

Cancer is a public health problem worldwide, affecting all categories of persons. It is the second common cause of death in developed countries and among the three leading causes of death in developing countries. Due to its genetics and medical importance, study on its incidence is germane. In the present study, 74 different cancers of 2,246 (n = 891 male and n = 1355 female) cancer patients within the age of 1-105 in Nigeria were retrospectively reviewed using the data from University of Ilorin Teaching Hospital (UITH). The overall profile of the categories showed the leading position of breast cancer, followed by cancer of the digestive system (32.29% and 19.67%, respectively), while Kaposi sarcoma, endocrine system and brain cancers were among the rare or least recorded (<1.0% incidence rate). Furthermore, the trend showed a high prevalence during 2011 and 2015 (>13% and >11%) than any other year within the study, while the lowest incidence was recorded in 2016 (<6%). Predisposing factors like tumorigenesis, immune system, biological stressors as well as gene-environment interaction and low life expectancy could influence the risk of different groups of cancer. Therefore, future investigations should be targeted on risk factors related to those considered rare so as to provide useful information about possible signs and symptoms for diagnosis before it escalate.

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Clinical Peripheral Atypical Presentation of Tuberculosis in the Head and Neck Region in Asian Population —11 Years Experience and Review of Literature

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59a34262 ◽

2021 ◽

pp. 183-190

Author(s):

Mayur J. Gawande ◽

Rishabh R. Agrawal ◽

Parul Nimbalkar ◽

Rakshita Nitnaware ◽

Tannu Mishra ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Head And Neck ◽

Extrapulmonary Tuberculosis ◽

Neck Region ◽

Asian Population ◽

Signs And Symptoms ◽

Developed Countries ◽

Major Health Problem ◽

Head And Neck Region ◽

Organ Systems

Tuberculosis TB one of the major health problem in developed countries, with extremely high prevalence in Asian countries, mainly caused by "Mycobacterium Tuberculosis". Although pulmonary tuberculosis is the most common form of the disease, it also can occur in other organ systems such as lymph nodes, central nervous system, skeletal system, hepatic system, and gastrointestinal system, including the oral cavity. Extrapulmonary tuberculosis is an uncommon form of chronic infection that does not present typical signs and symptoms of pulmonary tuberculosis. Oral tuberculosis is an uncommon form and is often overlooked as it shows no path gnomic signs. This article presents our experience of unusual atypical tuberculosis in the Head and Neck region.

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Evaluation of Clinical and Laboratory Characteristics of Children with Pulmonary and Extrapulmonary Tuberculosis

Medicina ◽

10.3390/medicina55080428 ◽

2019 ◽

Vol 55 (8) ◽

pp. 428

Author(s):

Aygun ◽

Akcakaya ◽

Cokugras ◽

Camcıoglu

Keyword(s):

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Clinical Laboratory ◽

Extrapulmonary Tuberculosis ◽

Public Health Problem ◽

Developed Countries ◽

Resistant Bacteria ◽

Interferon Gamma Release Assay ◽

Important Public Health Problem ◽

Low Socioeconomic

Background and objective: Tuberculosis (TB) is an important public health problem in both developing and developed countries. Childhood TB is also an important epidemiological indicator in terms of forming the future TB pool. The diagnosis of TB is difficult in children due to the lack of a standard clinical and radiological description. We aimed to evaluate and compare the clinical, laboratory, and radiologic findings of childhood pulmonary and extrapulmonary TB. Material and Methods: The medical records of patients hospitalized with the diagnosis of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) between December 2007 and December 2017 were evaluated retrospectively. Results: There were 163 patients diagnosed with TB with 94 females (57.7%) and 69 males (42.3%). Seventy-three patients (44.8%) had PTB, 71 (43.6%) patients had EPTB, and 19 patients (11.7%) had both PTB and EPTB, called as disseminated TB. Ninety-six (58.9%) patients had tuberculin skin test (TST) positivity and 64 patients (39.3%) had interferon-gamma release assay (IGRA) positivity. Acid-resistant bacteria were observed in 34 (20.9%) body fluid samples and culture positivity was observed in 33 (20.2%) samples. Comparison of PTB, EPTB, and disseminated TB revealed that low socioeconomic status, TB contact, and low body weight were more common in disseminated TB, and TST positivity was more common in PTB. Conclusion: Malnutrition, low socioeconomic status, and TB contact were important diagnostic variables in our study and all three parameters were more common in disseminated TB. Tuberculosis should be considered in patients admitted with different complaints and signs in populations with high TB incidence and low socioeconomic status.

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Anti-meningococcal B vaccination in Italian adolescents: a cost-effective health opportunity

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.586 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Panatto ◽

P Landa ◽

D Amicizia ◽

P L Lai ◽

E Lecini ◽

...

Keyword(s):

Large Scale ◽

Public Health Problem ◽

Vaccination Strategy ◽

Cost Effective ◽

Dose Schedule ◽

Developed Countries ◽

Invasive Disease ◽

International Setting ◽

The Impact

Abstract Background Invasive disease due to Neisseria meningitidis (Nm) is a serious public health problem even in developed countries, owing to its high lethality rate (8-15%) and the invalidating sequelae suffered by many (up to 60%) survivors. As the microorganism is transmitted via the airborne route, the only available weapon in the fight against Nm invasive disease is vaccination. Our aim was to carry out an HTA to evaluate the costs and benefits of anti-meningococcal B (MenB) vaccination with Trumenba® in adolescents in Italy, while also considering the impact of this new vaccination strategy on organizational and ethics aspects. Methods A lifetime Markov model was developed. MenB vaccination with the two-dose schedule of Trumenba® in adolescents was compared with 'non-vaccination'. Two perspectives were considered: the National Health Service (NHS) and society. Three disease phases were defined: acute, post-acute and long-term. Epidemiological, economic and health utilities data were taken from Italian and international literature. The analysis was conducted by means of Microsoft Excel 2010®. Results Our study indicated that vaccinating adolescents (11th year of life) with Trumenba® was cost-effective with an ICER = € 7,912/QALY from the NHS perspective and € 7,758/QALY from the perspective of society. Vaccinating adolescents reduces the number of cases of disease due to meningococcus B in one of the periods of highest incidence of the disease, resulting in significant economic and health savings. Conclusions This is the first study to evaluate the overall impact of free MenB vaccination in adolescents both in Italy and in the international setting. Although cases of invasive disease due to meningococcus B are few, if the overall impact of the disease is adequately considered, it becomes clear that including anti-meningococcal B vaccination into the immunization program for adolescents is strongly recommended from the health and economic standpoints. Key messages Free, large-scale MenB vaccination is key to strengthening the global fight against invasive meningococcal disease. Anti-meningococcal B vaccination in adolescents is a cost-effective health opportunity.

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Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems

BMJ Open ◽

10.1136/bmjopen-2020-044622 ◽

2021 ◽

Vol 11 (1) ◽

pp. e044622

Author(s):

Catherine Heeney ◽

Stephen Malden ◽

Aziz Sheikh

Keyword(s):

Qualitative Interviews ◽

Geographical Area ◽

Health Resources ◽

Round Table ◽

Developed Countries ◽

Care Quality ◽

Electronic Prescribing ◽

Study Results ◽

Electronic Health ◽

The Uk

IntroductionElectronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites.Methods and analysisQualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic.Ethics and disseminationThe Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)—an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process.

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Tuberculosis presenting as dacryoadenitis in the USA

BMJ Case Reports ◽

10.1136/bcr-2019-231694 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231694 ◽

Cited By ~ 1

Author(s):

Harry Ross Powers ◽

Mark Anthony Diaz ◽

Julio C Mendez

Keyword(s):

Correct Diagnosis ◽

Developed Countries ◽

Histopathological Analysis ◽

Orbital Mass ◽

Antituberculosis Therapy ◽

The Usa ◽

History Of ◽

Patient’S History ◽

High Degree ◽

Filipino Woman

A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis. She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient’s history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

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Overt acts of perceived discrimination reported by British working-age adults with and without disability

Journal of Public Health ◽

10.1093/pubmed/fdz093 ◽

2019 ◽

Cited By ~ 1

Author(s):

Eric Emerson ◽

Allison Milner ◽

Zoe Aitken ◽

Lauren Krnjacki ◽

Cathy Vaughan ◽

...

Keyword(s):

Public Health ◽

Negative Impact ◽

Policy Research ◽

Secondary Analysis ◽

People With Disabilities ◽

Public Health Problem ◽

Health Staff ◽

Cross Sectional ◽

Increased Risk ◽

The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

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Knowledge, Awareness and Perception on Malaria in Tribal Regions of Vadodara District, Gujarat (India)

Journal of Health Management ◽

10.1177/0972063419868580 ◽

2019 ◽

Vol 21 (3) ◽

pp. 406-416

Author(s):

Bindu Bhatt ◽

Janak P. Joshi

Keyword(s):

Malaria Control ◽

Control Measure ◽

Health Sector ◽

Public Health Problem ◽

Signs And Symptoms ◽

Well Being ◽

Clear Understanding ◽

Major Public Health Problem ◽

Health Seeking ◽

Tropical Regions

Malaria affects health and general well-being of many people in the developing world. In India also, malaria is a major public health problem. It continues to be a leading cause of morbidity and mortality in many tropical regions of the world, despite global efforts to eradicate the disease. To achieve the targets of reducing malaria prevalence and preventing malaria epidemic, it is essential to have active community participation. Therefore, clear understanding of the Knowledge, Awareness and Perception (KAPs) of a particular community can help in framing the policy of prevention and promotion of any malaria control measure. In this context, the decision makers in the health sector are recognizing the importance of community’s KAPs on malaria and, thus, is gaining stimulus as one of the methods for malaria control. KAPs, however, play an important role in the improvement of health and health-seeking behaviour of a disease-burdened group. This study, therefore, investigates a local community’s KAPs on malaria in tribal areas of Vadodara District. The KAP investigates the community’s understanding of malaria transmission, their recognition of signs and symptoms, their treatment-seeking behaviours and community preventive measures and practices.

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