ABSTRACT
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.
ABSTRACT
The objective of the study was to determine the frequency, types, presenting symptoms and management options in patients with bleeding disorders in the local obstetric and gynaecological practice. This was a descriptive study of one year duration conducted at the Pakistan Atomic Energy Commission General Hospital, Islamabad. Types of bleeding disorders in decreasing order of frequency were HELLP syndrome in 27.7% [n=5], gestational thrombocytopenia in 22% [n=4], Von Willbrand disease in 16.66% [n=3], Glanzmann's thrombesthenia in 11.11% [n=2], autoimmune haemolytic anaemia in 11.11% [n=2], post-transfusion purpura in 6% [n=1] and factor V deficiency in 6% [n=1]. HELLP syndrome and gestational thrombocytopenia were the commonest bleeding disorders in pregnant patients and Von Willebrand disease is the the commonest bleeding disorder in gynaecological patients with menorrhagia