{"presentation":{"slides":[{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":19.607843137254903,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

A. Drug Therapy <\/strong><\/span><\/span><\/p>\n"},"subContentId":"fc1bf093-ef8d-4212-a860-919ba4cd4def","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":7.619596949891068,"y":17.34611231101512,"width":81.69934640522877,"height":69.11447084233261,"action":{"library":"H5P.Table 1.1","params":{"text":"

\n\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t
Drug <\/strong><\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
2RHZE (Intensive phase) plus 10RHE (Continuation phase)<\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
<\/div>\n\n\t\t\t
Duration   <\/strong><\/div>\n\t\t\t<\/td>\n\t\t\t
Total treatment duration: 12 months (extendable to 18 months on a case-by- case basis) <\/td>\n\t\t<\/tr>\n\t\t
Referral <\/strong><\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
All presumptive spinal TB cases should be referred and managed in specialist centres<\/div>\n\n\t\t\t
with involvement of spinal orthopaedic surgeon, microbiologist\/infectious diseases<\/div>\n\n\t\t\t
specialist and spinal radiologist, as well as physiotherapists and orthotists. <\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n<\/div>\n"},"subContentId":"d5e9dfff-67d9-4ba9-b42d-04e1c1eeeecb","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":7.625272331154684,"y":86.39308855291577,"width":49.01960784313726,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
H = Isoniazid, R= Rifampicin, Z= Pyrazinamide, E= Ethambutol<\/span><\/p>\n"},"subContentId":"7dfea6fa-134e-4008-970d-fadda03e4822","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":75.16339869281046,"y":88.55291576673866,"width":20.697167755991288,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
INDEX-TB guidelines 2016<\/span><\/p>\n"},"subContentId":"b073994b-19a2-4d53-ac44-86f2e0990dfa","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.443790849673203,"y":6.490734341252699,"width":31.59041394335512,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
B. Surgical Intervention <\/strong><\/span><\/span><\/p>\n"},"subContentId":"29879278-0196-4019-bd68-58c595407e13","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.265141612200436,"y":23.80302375809935,"width":96.73202614379085,"height":73.43412526997841,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n\t\n\t\t\n\t\t\t\n\t\t\t
Neurological deficit<\/strong><\/span><\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
Without neurological deficit <\/strong><\/span><\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
<\/div>\n\n\t\t\t
1. Neural complications developing or getting worse or<\/div>\n\n\t\t\t
remaining stationary during the course of non-operative<\/div>\n\n\t\t\t
treatment (3\u20134 weeks)
\n\t\t\t2. Paraplegia of rapid onset, i.e. spine with<\/div>\n\n\t\t\t
mechanical instability
\n\t\t\t3. Severe neurological deficits
\n\t\t\ta) Flaccid paraplegia
\n\t\t\tb) Complete sensory\/motor loss for >6 months
\n\t\t\tc) Bowel or bladder incontinence
\n\t\t\t4. Painful paraplegia in elderly patients <\/strong><\/div>\n\n\t\t\t
<\/strong><\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
1. When diagnosis is uncertain and open biopsy<\/div>\n\n\t\t\t
is indicated
\n\t\t\t2. Mechanical instability of spine
\n\t\t\tSuspected drug resistance
\n\t\t\t3. Spinal deformity \u2013 severe kyphotic deformity<\/div>\n\n\t\t\t
at presentation (example >60 degrees)<\/div>\n\n\t\t\t
or progressive kyphotic deformity
\n\t\t\t4. Mass effect- dysphagia\/ stridor
\n\t\t\t5. Cold abscess- not responsive to repeated<\/div>\n\n\t\t\t
aspiration with ATT<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n"},"subContentId":"23ed24eb-58dc-4f24-91e6-df9466591541","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":15.11879049676026,"width":39.97821350762527,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Indications for surgery in spinal TB <\/span><\/strong><\/p>\n"},"subContentId":"80e83416-587a-4f76-8d27-412abdf5fea3","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.443790849673203,"y":6.496349892008639,"width":38.12636165577342,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Surgery improves neurological outcome <\/span><\/strong><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"abd49754-962d-41a2-b5c5-ebf207ab68df"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":12.958963282937365,"width":90.41394335511983,"height":41.03671706263499,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Large number of patients present late in disease course with severe neurological deficits - flaccid paraplegia, gross sensory deficit, prolonged weakness, bladder involvement and spinal cord signal changes demonstrated on MRI<\/p>\n\t<\/li>\n\t
\n\t
~90% of patients with complete loss of power or severe dysfunction experienced improvement to mild-mod dysfunction (walking with or without support) at 3 months after surgery.<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"704c61c4-913c-4dc9-8e7e-cc69ff1350b6","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":41.394335511982575,"y":82.07343412526998,"width":54.46623093681917,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sai Kiran NAS, Vaishya S, Kale SS et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine. 2007<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"5a272169-ceb6-4d18-9b8f-82591fdfad35","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.443790849673203,"y":6.490734341252699,"width":33.769063180827885,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
C. Complications and Sequelae <\/strong><\/span><\/p>\n"},"subContentId":"6d5b7808-7bb4-463b-89cc-d34874ccc4fd","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":75.16339869281046,"y":88.55291576673866,"width":20.697167755991288,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
INDEX-TB guidelines 2016<\/span><\/p>\n"},"subContentId":"2f4cf5f2-b27e-42d1-ba96-f9cb250bf187","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":12.958963282937365,"width":89.32461873638344,"height":73.43412526997841,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Early onset paraplegia<\/li>\n<\/ul>\n\n
a) Secondary to acute inflammation, good prognosis with treatment <\/p>\n\n
\n\t
Late onset paraplegia <\/li>\n<\/ul>\n\n
a) Reappearance of neural deficit after a disease-free period of at least 2 years in patients who
\n   completed ATT and achieved healed status
\n b) Progression of deformity in healed patients with mechanical compression
\n c) Rarely vascular
\n d) Generally good outcome with medical + surgical treatment.<\/p>\n\n
\n\t
Deformity<\/li>\n<\/ul>\n\n
a) Surgery should preferably take place during treatment with ATT for active TB infection. <\/p>\n"},"subContentId":"93a9b34d-c5d7-4041-a78b-a61eee18aae9","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":44.66230936819172,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuli and Kumar\u2019s Staging of Pott\u2019s Paraplegia <\/strong><\/span><\/p>\n"},"subContentId":"1cbee9a2-1a09-4725-99db-77eebfe461d2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":27.233115468409586,"y":90.71274298056156,"width":70.80610021786492,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Tuli SM . Tuberculosis of Skeletal System 2nd edn. Japee Brothers Medical Publications (p) Ltd: New Delhi 1996, p 220 <\/span><\/p>\n"},"subContentId":"3f0665bb-d6ce-4a81-8359-d7cf8dd38272","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":15.11879049676026,"width":91.50326797385621,"height":75.5939524838013,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t
1   <\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
Patient unaware of neural deficit, physician detects plantar<\/div>\n\n\t\t\t
extensor and\/or ankle clonus.<\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t\t
No support needed<\/td>\n\t\t<\/tr>\n\t\t
2<\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
Patient aware of deficit but manages to walk with
\n\t\t\tsupport, clumsiness of gait.<\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t\t
Walks with support<\/td>\n\t\t<\/tr>\n\t\t
3<\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
Paralysis in extension, sensory deficit less than 50%<\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t\t
Unable to walk<\/td>\n\t\t<\/tr>\n\t\t
4<\/td>\n\t\t\t \n\t\t\t
<\/div>\n\n\t\t\t
Paralysis in flexion\/ flaccid\/ sensory deficit more than 50%\/ sphincters involved.<\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t\t
Unable to walk, feel or control urine\/stools<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n"},"subContentId":"a9cfb772-1dec-42e2-8957-d80fbd882a7d","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":44.66230936819172,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Kyphosis <\/strong><\/span><\/p>\n"},"subContentId":"363010f6-53a4-4249-b7cb-cdeebffbe709","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":66.44738562091503,"y":88.64298056155508,"width":31.59041394335512,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
PC: Dr Swati Gupta, Dept of Radiology, MAMC Delhi <\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"7e23cd49-1133-4005-86dd-0b21b14e8aba","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.442363834422658,"y":12.992699784017278,"width":53.37690631808279,"height":73.43412526997841,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Most common deformity<\/p>\n\t<\/li>\n\t
\n\t
Occurs due to collapse of the vertebrae (anterior predominant involvement of spinal TB)<\/p>\n\t<\/li>\n\t
\n\t
Can interfere with lung function<\/p>\n\t<\/li>\n\t
\n\t
Surgically correctable<\/p>\n\t<\/li>\n\t
\n\t
40 or 60 degrees kyphosis cut-off may not be appropriate for all<\/p>\n\t<\/li>\n\t
\n\t
Lesser degree of deformity may be taken up for surgical correction provided surgical facilities and infrastructural requirements are met.<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"008734c0-f381-4830-8e1f-2028603778be","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":58.82352941176471,"y":19.43844492440605,"width":37.79956427015251,"height":60.47516198704104,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64a1800b07b87.png","mime":"image\/png","copyright":{"license":"U"},"width":921,"height":749}},"subContentId":"d6f4a801-a803-4d0a-a134-8ed963ebc4cd","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":44.66230936819172,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Cold Abscess <\/strong><\/span><\/p>\n"},"subContentId":"093337b8-35aa-433f-8b88-6ac7fee4b5ba","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":6.5359477124183005,"y":90.71274298056156,"width":31.59041394335512,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
PC: Dr Swati Gupta, Dept of Radiology, MAMC Delhi <\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"2ca78394-b880-40ec-85d1-e9f14dfde8dd","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.439531590413943,"y":13.015205183585312,"width":51.19825708061002,"height":71.27429805615552,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Can form on either side of spine, anteriorly or posteriorly<\/p>\n\t<\/li>\n\t
\n\t
Extends to involve loco-regional structures according to level of spinal lesion<\/p>\n\t<\/li>\n\t
\n\t
Pseudo-flexion deformity at hip<\/p>\n\t<\/li>\n\t
\n\t
May not heal with ATT, require drainage (USG or CT guided)<\/p>\n\t<\/li>\n\t
\n\t
Extended drainage using a pigtail is better than a single time aspiration, <\/strong>however the pigtail should not remain in-situ more than 2 weeks which might increase chance of sinus formation<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"52c810f1-1bb7-4b73-a106-99985de504e7","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":61.00217864923747,"y":17.278617710583152,"width":29.19424219565194,"height":52.69978401727862,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64a1809d09ecc.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":267,"height":244}},"subContentId":"de49c438-3854-41a8-8e7d-01d16f1512b1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":60.99934640522876,"y":73.5803455723542,"width":31.59041394335512,"height":17.278617710583152,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CT post contrast axial images showing peripherally enhancing collection in substance of left ilio-psoas<\/span><\/p>\n"},"subContentId":"37e943d7-7836-46e7-b77a-f166b9bcd31f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":19.607843137254903,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
D. Follow Up <\/strong><\/span><\/span><\/p>\n"},"subContentId":"e618fc52-5b4b-483e-8c75-0d58f723b656","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":77.34204793028323,"y":90.71274298056156,"width":20.697167755991288,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
INDEX-TB guidelines 2016<\/span><\/p>\n"},"subContentId":"b4009baf-baca-41bc-b741-3a31d487a0db","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":12.958963282937365,"width":47.930283224400874,"height":84.23326133909288,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Patients with neurological deficit require staging and grading of their deficit and close monitoring of neurological status<\/p>\n\t<\/li>\n\t
\n\t
Patients without neurological deficit should be assessed weekly for neurological signs<\/strong> <\/p>\n\t<\/li>\n\t
\n\t
Repeat X-rays<\/strong> of the spine every 3 months<\/strong><\/p>\n\t<\/li>\n\t
Repeat MRI<\/strong>
\n\t1. After 6 months, if there is suspicion of poor treatment response<\/strong> <\/span>(but is not required in most)<\/span>
\n\t2. At treatment completion (12 months)<\/strong><\/span> is prudent to assess good healing before discontinuation of therapy. <\/span>
\n\t3. Findings of quiescent burnt out infection which do not warrant continuation of ATT such as bony\/fibrous ankylosis or thin walled cysts without enhancement must be identified<\/span><\/li>\n<\/ul>\n"},"subContentId":"27739a4b-64d2-4755-bf99-9c8a82d246ad","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":53.37407407407407,"y":12.981468682505398,"width":42.48366013071895,"height":34.557235421166304,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
After completion of treatment, follow up every 6 months for at least 2 years<\/p>\n\t<\/li>\n\t
\n\t
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Management of Spinal TB

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