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.

audit on hospital management of bronchial asthma

Medical audit is a new concept in developing countries like Pakistan. We carried out this retrospective study on bronchial asthma. The purpose was to see if care given to patients with asthma meets the accepted international standard or not. During this audit several deficiencies were found. Documentation in notes about signs indicating severity of asthma was very poor. Peak flow recording in the notes was also very deficient. There was no documentation in notes whether inhalers technique of the patients has been checked or not. This audit shows that care given to asthma patients is far from satisfactory and we clearly need to improve in order to reach the accepted international standards