Severity of COVID-19 in bacillus Calmette-Guérin vaccinated population

Purpose@#Considering the cross-protection reported for bacillus Calmette-Guérin (BCG) vaccination on viral respiratory infections, it has been proposed that it could reduce the severity of coronavirus disease 2019 (COVID-19). The objective of the current study is to investigate the association between the severity of COVID-19 with prior BCG vaccination in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. @*Materials and Methods@#Adult patients (18 years or above) with positive SARS-CoV-2 polymerase chain reaction admitted in July 2020 were included in this cross-sectional study. Patients were classified into non-severe, severe, and critical diseases. History of prior BCG vaccination and the presence of a BCG vaccination scar were recorded. @*Results@#Out of 103 patients, 64 patients with prior history of BCG vaccinations were compared with 39 patients without BCG vaccination in childhood. The median age was 55 years and 64 years in BCG vaccinated & non-BCG vaccinated patients (p-value=0.002). There was male predominance in both groups and frequent comorbid illnesses were hypertension and diabetes mellitus. Severe COVID-19 was found in 91 patients (88.3%) followed by non-severe disease and critical diseases i.e., 7 (6.8%) and 5 (4.9%) patients, respectively. No association of prior BCG vaccination with disease severity of COVID-19 was found in this study and mortality was 8.7%. Out of nine patients who expired only 2 (22.2%) had a prior history of BCG vaccination (p-value=0.01). Secondary infections were present in 26 patients and the majority had pneumonia. @*Conclusion@#The BCG vaccine has no impact on the severity of COVID-19 but could have a protective role with a low mortality rate in already infected patients.

Report: shattering a myth - whooping cough susceptible to antibiotics

Bordetella parapertussis is the causative agent of a milder form of pertussis or whooping cough. Little is reported about the antibiotic resistance patterns and mechanism of drug resistance of Bordetella parapertussis. The objective of this study has been to investigate antimicrobial resistance, distribution of integrons and presence of gene cassettes to quinolones [qnr] and sulfonamides [sul] among B. parapertussis strains' isolated from Pakistan. Thirty-five [35] samples were collected from various hospitals of Pakistan from children [median age 3 years] with pertussis-like symptoms, all were tested and confirmed to be B. Parapertussis. Resistance profile of Ampicillin, Cephalexin, Sulphamethoxazole, Chloramphenicol, Ofloxacin, Nalidixic acid, Gentamycin and Erythromycin were investigated through all samples. Majority of the isolates were found to be resistant to the afore-mentioned antibiotics except erythromycin. All isolates were resistant to quinolones phenotypically, but qnr genes were detected in only 25.7% [9/35] of isolates. On the other hand, 71.4% [25/35] isolates were resistant to sulfonamides phenotypically. From these 71% strains showing phenotypical resistance, 96% [24/25] were found to possess sul genes. Only two isolates were carrying class 1 integrons, which also harbored sul gene and qnr gene cassettes. It can be safely concluded that the phenotypic resistance patterns seemed mostly independent of presence of integrons. However, interestingly both integrons harboring strains were resistant to quinolones and sulfonamides and also possessed qnr and sul genes

Mortality in sepsis and its relationship with gender

Sepsis remains a leading cause of death across the world, carrying a mortality rate of 20-50%. Women have been reported to be less likely to suffer from sepsis and to have a lower risk of mortality from sepsis compared to men. The objective of this study was to determine the relationship between gender and mortality in sepsis, and compare cytokine profiles of male and female patients. This was a prospective case series on 97 patients admitted with sepsis. Clinical and microbiological data was gathered, blood samples were collected for cytokine [IL-10, IL-6 and TNFalpha] levels and patients were followed up for clinical outcome. There were 54% males and 46% females, with no significant difference of age or comorbids between genders. Respiratory tract infection was the commonest source of sepsis, and was more common in females [60%] compared to males [39%] [p=0.034]. Males had a higher mortality [p=0.048, RR 1.73] and plasma IL-6 level [p=0.040] compared to females. Mean IL-6 plasma level was significantly [p<0.01] higher in patients who died vs. who recovered. Our study shows that males with sepsis have a 70% greater mortality rate, and mortality is associated with a higher IL-6 plasma level

Human ophthalmomyiasis externa caused by the sheep botfly Oestrus ovis: A case report from Karachi, Pakistan

Ocular myiasis due to Oestrus ovis larvae infestation is an eye infection in humans. A case of ophthalmomyiasis externa in a young male from Karachi, Pakistan in winter (December 2012), without history of close proximity to domestic animals or visit to any rural area was reported. The condition is self-limiting and the disease is confined to the conjunctiva. The eye was locally anesthetized and washed with 5% povidine iodine solution. A total number of 27 first instar larvae of Oestrus ovis were removed with fine forceps. The patient received 0.5% moxifloxacin and diclofenac eye drops for one week. His eye was examined after one day, one week and one month and the recovery status was favorable. The present case raise the awareness among ophthalmologists regarding larval conjunctivitis as one of the causes of conjunctivitis and it can occur throughout the year in any season including winter. Moreover, it can occurr in any area either rural or urban with or without close proximity to domestic animals especially in subtropical regions with high parasitic burden.

BCG vaccination is associated with decreased severity of tuberculosis in Pakistan

Vaccination with Bacille Calmette-Guerin [BCG] is given at birth to protect against tuberculosis [TB] in Pakistan. The country ranks 6th amongst high-burden countries worldwide and has an incidence of 231/100,000 population. This was a cross-sectional multi-center hospital-based study. TB patients [n = 218] with pulmonary [PTB, n = 120] or extrapulmonary [ETB, 98] were recruited, and the presence of a BCG vaccination scar was documented. Cases were further classified into minimal, moderate and advanced PTB or less severe [LETB] or severe disseminated [D-ETB] disease. The association of age, gender and severity of TB infections with BCG vaccination of the individual TB cases was investigated. No difference was found of the BCG vaccination status of PTB and ETB cases, or in relation to age or gender. Patients under 29 years of age comprised the largest group. There were more females with ETB than PTB. The largest group within ETB comprised those with tuberculous lymphadenitis [LNTB, 39%]. A significantly greater number of LNTB cases had received BCG vaccinations than had those with pleural [unilateral] TB [p = 0.004], and tuberculous meningitis [p = 0.027] groups. Also, there were more immunized patients with pulmonary as compared with pleural disease [p = 0.001]. LNTB represents localized granulomatous disease and the observation of higher vaccination rates in this group suggests that BCG has protected against more severe forms of TB in this high-burden region.

Tuberculous and cryptococcal meningitis in a setting with high TB and low HIV prevalence

To compare the differences in presentation and outcome of patients with tuberculous meningitis [TBM] and cryptococcal meningitis [CCM]. Case series. The Aga Khan University Hospital, Karachi, from December 1995 to December 2005. Patients with a confirmed diagnosis of TBM or CCM were included in this study. The signs and symptoms, laboratory findings and other variables of patients were entered and analyzed by Statistical Package for Social Sciences [SPSS] Software version 14. We compared 16 patients of TBM with 11 of CCM. None of the patients with TBM were Human Immunodeficiency Virus [HIV] positive while 4 patients with CCM had HIV. The common initial signs and symptoms in patients with TBM were fever, altered mental status and headache; and in patients with CCM were fever, headache and cough. The mean CSF glucose level decreased according to the Medical Research Council [MRC] stage in TBM. The mean CSF RBCs, WBCs, glucose and protein in TBM were 2010/mm[3], 228/mm[3], 52.32 mg/dL and 289.48mg/dl respectively and in CCM were 178.54 mm[3], 529.54/mm[3], 32.63 mg/dL and 432.18 mg/dL respectively. TBM and CCM should be suspected in all cases that present with symptoms of chronic meningitis. Patients with TBM are more likely to have altered mental status and higher CSF RBCs; those with CCM are more likely to have headache, cough and higher CSF WBCs

Characteristics of patients with Guillain Barre syndrome at a terrtiary care centre in Pakistan, 1995-2003

To study the clinical presentation, hospital course and outcome of patients admitted with Guillain Barre Syndrome [GBS] to a tertiary care hospital in Karachi, Pakistan. The charts of patients conforming to International Classification of Diseases [ICD] code 9.0, for GBS, from September 1995 to January 2003 were reviewed. Clinical data was recorded on a standardized questionnaire, which included patients' age, sex, antecedent events, neurological signs and symptoms and ventilation requirement. The hospital course was analyzed, including nosocomial infections, therapy given and the functional status of patients, using the Rankin scale [0-6]. Standard SPSS 11.5 software [Windows] was used for data analysis. Thirty-four cases of GBS were admitted to the hospital during the study period, with an age range of 3 to 70 years. The mean age for disease onset was 35.2 years for female patients, compared to 30 years for males; the male/female ratio was 1.6:1.Gastrointestinal infections [12/22, 54.6%] were the most common antecedent event, followed by upper respiratory tract infections [9/22, 40.9%] and skin lesions [1/22, 4.5%]. Most patients developed GBS within one month of the preceding infection. Cranial nerve abnormalities [30/34, 88.2%], autonomic dysfunction [21/34, 61.8%] and respiratory failure requiring intubation [19/34, 55.9%] were also common. The median Rankin score of patients at admission, and at 30 and 60 days thereafter was 5, 4 and 3.5 respectively. The in-patient mortality was 1 of 34 [2.4%]. We found that GBS occurred at all ages and was slightly more common in males. Majority of patients had an antecedent history of infection and had severe disease on presentation. The patients were treated with either plasmapheresis or intravenous immunoglobulins and there was no significant difference in outcome in the two groups. Despite severe persistent disability, in-hospital mortality was low

Enteric fever in adult patients: clinical features, outcome and antibiotic susceptibility patterns

Enteric fever is one of the commonest causes of fever in our country. In majority of the cases, the diagnosis and treatment are based on suggestive clinical features alone, without confirmatory laboratory tests. We studied the clinical and laboratory features, sensitivity pattern of isolates and disease outcome in culture-proven cases of enteric fever in adult patients, with a view to highlight those features which would help general practioners in the diagnosis and empiric treatment of enteric fever in the community

Assessment of four mortality prediction models in intensive care unit patients with sepsis

Early recognition of sepsis and the rapid institution of therapy are absolutely essential for appropriate management of patients admitted to the hospital. Both score-generating clinical tools and clinical acumen are important for identifying the sick, while early intervention in acute deterioration is beneficial, before and after ICU admission. Several scoring systems have been devised which attempt to identify risk factors and predict outcome of different patient groups. The purpose of this pilot study was to assess the value of four mortality risk scoring systems, i.e. Mortality Probability Models [MPM] - admission, MPM -24 hours, Simplified Acute Physiology Score [SAPS] II and Acute Physiology and Chronic Health Evaluation [APACHE] II, in predicting outcome in patients admitted to the intensive care unit with sepsis. The expected outcome was calculated according to the specifications of each system and was compared to the actual outcome