Multiple chest wall tuberculous abscesses.

Tuberculosis (TB) usually involves the lungs and hilar lymph nodes. Musculoskeletal TB occurs in 1%-3% of patients with TB, while chest wall TB constitutes 1%-5% of all cases of musculoskeletal TB. The present case reports a twenty six year old immunocompetent patient with multiple chest wall tuberculous abscesses along with multiple ribs destruction, in absence of active pulmonary TB or intrathoracic lymphadenopathy. Chest wall TB though rare, should have a high degree of suspicion in multiple destructive bone lesions, especially in patients from regions where TB is endemic. Plain chest x-ray postero-anterior (CXR-PA) view revealed osteolytic rib lesions with overlying opacities; fine needle aspiration cytology (FNAC) was not helpful. Computerized tomography (CT) of thorax and histopathology of the biopsied unhealthy tissue from the cavity were consistent with the diagnosis of TB. Oral antitubercular therapy (ATI) was given for 12 months, following which the chest wall abscesses and rib lesions healed.

Detection of chronic obstructive pulmonary disease using spirometric screening.

This study was carried out in the Respiratory wing, department of Medicine, Bangabandhu Sheikh Mujib Medical University to evaluate the efficacy of spirometric screening for the detection of chronic obstructive pulmonary disease (COPD) in Bangladeshi population. A total number of 400 participants were included in the study [60.50% male and 39.50% female, aged (M+/-SD) 48+/-7.54 years]. Free spirometry was offered to them. Among them 200 were smokers with a smoking duration of 17.07+/-7.50 pack-years and 200 non-smokers. Spirometric screening yielded diagnosis of COPD in 12.50% (50/400); of them 2.75% (11/400) was non-smoker compared to 9.75% (39/400) smoker (x2=17.92, p=<0.001) as diagnosed by spirometry following Global Initiative for Chronic Obstructive Lung diseases (GOLD) criteria. Using operational severity criteria adopted from GOLD, mild obstruction was found in 36% (18/50), moderate obstruction in 50% (25/50) and severe obstruction was found in 14% (7/50) of all subjects. The hall mark symptom of COPD, exertional dyspnoea was seen in only 4.3% (17/400) of subjects, nonspecific symptoms like cough and sputum were found in 10% (40/400) and 9.3% (37/400) respectively. Physical signs like abnormal breath sound and rhonchi were found in 3.3% (13/400) and 2.3% (9/400) respectively. Our study observed that spirometry was an effective and easy method for detection of COPD in risk group population like smokers and thus promotes smoking cessation efforts to reduce the burden of COPD in the community.