Rate of Treatment Failure among Tuberculosis Patients

Rate of Treatment Failure among Tuberculosis PatientsABSTRACTTreatment failure in patients with pulmonary tuberculosis (PTB) poses a great danger to the globose effort in see of tuberculosis. This study evaluated prevalence of treatment failure among PTB patients at a tertiary care pedagogics hospital in Pakistan. in series(p) patients of vilification positive PTB patients man suppu grazed between February 2011 to October 2013 at the directly observed therapy (Tuberculosis) unit of our hospital were enrolled for the study. Sputum specimens were accumulate from each patient at entry for mordant Fast Bacilli microscopic examination and repeated at the end of 2nd (in folk I cases only), 3rd (in category II cases only), 5th and 7th calendar month of treatment. Of the 144 patients recruited, 124 patients consisting of 53 (42.74%) males and 71 (57.26%) females aged 14-85 years completed the study. Ninety three (75 %) of the patients were New (category I) at entry mend 31 (25%) w ere Retreatment cases (category II). Among 124 smear positive patients at baseline, 22 (17.74%), 6(4.84%) and 6(4.84%) patients remained positive after 2nd (in category I patients only) and 3rd (in category II cases only), 5th and 7th month of treatment respectively. In conclusion, there is considerable treatment failure rate (4.84%) among our smear positive TB patients and this poses a great danger to healthcare personnel and close contacts in the community.Key words Pulmonary tuberculosis, prevalence, treatment failure.INTRODUCTIONAbout two billion or nearly a third of the worlds macrocosm is infected with Mycobacterium tuberculosis.(1) The global prevalence of TB was an estimated 14 million, with 9.4 million incident cases and 1.3 million deaths among human immunodeficiency virus-negative cases for the year 2009. (2) Eighty-five percent of the 9 million large number infected with TB each year live in the developing countries. (2) Whereas more women of child bearing age die of T uberculosis than from all causes of enatic mortality combined.(3) TB incidence has tripled in high HIV prevalence countries in the last two decades with a slight decline in 2009. Globally, in people living with AIDS, one out of every four deaths is due to TB globally 380,000 people died of HIV associated TB in 2009. Persons co-infected with TB and HIV are 20-30 times more likely to develop active TB disease than persons without HIV. Globally, 440,000 MDR TB cases were estimated in 2009 (8). on that point are 27 high MDR TB burden countries contributing 86% of the MDR TB case burden. Pakistan falls on number 4 among these high MDR TB burden countries.(2) Currently Pakistan stands 5th amongst the 22 high TB burden countries which account for about 81 % of all estimated TB cases around the globe. (4) Pakistan contributes about 63% of tuberculosis burden in the eastern Mediterranean Region. According to WHO, the incidence of sputum positive TB cases in Pakistan is 97/100,000 per year and for all types it is 231/100,000 or around 420,000 new cases each year. The prevalence of the disease is untold higher and is estimated at 373/100,000 population or 670,000 cases.(5) TB is responsible for 5.1 percent of the heart national disease burden in Pakistan. The feign of TB on socio economic status is substantial.(6) Sputum smear-positive patients are the most potent sources of infection and, without chemotherapy, have poor outcomes, as about two-thirds of them die within 2-3 years of developing disease. (Ten years case fatality rate of HIV negative untreated smear positive pulmonary tuberculosis is 70%, while that for smear negative cases is 20%). (7)Non-completion of treatment has serious consequences, including ongoing infectiousness and development of medicine-resistant Mycobacterium tuberculosis. The problem of resistance results from treatment that is inadequate, often because of an irregular drug supply, improper regimens, or poor compliance. Drug resistance is a potential threat to tuberculosis-control programs throughout the world. (8)Materials and methodsThe study was carried out in a tertiary care teaching hospital inPakistan. The research proposal was approved by the Ethics and Review Committee of the hospital. Informed consent was obtained from the patients. The hospital has a TB clinic which is back up by the National Tuberculosis Control broadcast Pakistan. Laboratory services for sputum microscopy and the drug regimens are provided according to National Tuberculosis Control Programme protocol.Consecutive patients who presented at the TB clinic of the hospital with smear positive pulmonary tuberculosis were enrolled. Sociodemographic data such as age, sex, marital status and occupation were recorded. Patients of age less than 5 years were excluded.Before enrolling into the study, the patients were well informed about the consequences and potential predictors of treatment failure such as treatment compliance. Pretreatment sputu m specimens were collected from each patient for acid fast bacilli (AFB) examination. Patients were categorized as New cases (category I) and Retreatment cases (category II) on the basis of history of previous anti TB treatment. All patients were followed up to completion of eight months TB treatment. Sputum examinations were repeated at 2nd month (in case of category I only), 3rd month (in case of category II only), 5th month and 7th month of treatment. Data were entered and analyzed using SPSS 16.0 version.ResultsA total of 144 patients were recruited during the study period (between February 2011 and October 2013). Twenty patients were every transferred out or lost to follow up. One hundred and twenty four patients who completed their treatment at the centre were evaluated. There were 93(75%) New cases (category I) and 31(25%) Retreatment cases (category II). There were 71 (57.26%) females and 53(42.74%) males aged between 14 and 85 years. Majority of the patients (47.58%) were a ged above 45 years with 6 patients above 80 years. Table 2 shows the age group distribution of sputum positive pulmonary TB patients on entry.Repeat sputum AFB results in study participants are presented in write in code 1. Of the 124 patients who were sputum positive at baseline, 6 (4.84%) patients were AFB smear positive after 5 months therapy revealing the prevalence of treatment failure in these patients. Our study showed that TB affects mainly the middle and elderly age in our environment (47.58% of the patients managed were above age 45 years). This finding is also observed in some studies from the substantial countries (9), While in developing countries it affects mainly the young age group. (10) One reason may be the changing circumstances in the less develop countries and further large scale studies may highlight the issue. Greater percentage of our study population was females which again is different from studies in our region. (10,11) Treatment failure rate among our patients was 4.84%. Though this is lower tthan reported in many studies we still need to further improve it (The cure rate of tuberculosis among Category I patients in our study was more than the cure rate reported by studies from Bangalore (65.7%) and Tamil Nadu (75%). (12,13) The World Health Organization guidelines have recommended achieving cure rate of 85%. The smear positive TB patients pose a significant risk to members of the public, close relatives, and health care staff who treat these patients. They are the focus for infection control measures, and contact investigations. This type of patient must be isolated because of risk of transmitting microbes. Treatment failure increases the risk further. These are the cases where there are much chances of drug resistance including multidrug resistance and extended drug resistance. ((((All 3 failure patients who underwent DST testing had MDR-TB, while 3 of 22 of relapse patients and 0 of 5 remissness patients tested did. While the se DST results were only available for three failure patients and, therefore, not representative, these data and those from other studies suggest that MDR risk is not uniform among retreatment subgroups, with increased prevalence of MDR among patients with initial treatment failure. (14-16) Drug resistance is a global health concern and resolutionive programmatic therapy of the smear positive cases is one of the cornerstones in its prevention. Facilities for rapid detective work of rifampicin resistance are being do available throughout the country which can help in early detection of drug resistant cases. Physicians gnarly in TB management need to be involved in its programmatic management and timely referrals for testing resistance in appropriate cases. Taken together, these findings computer backup use of DST in all retreatment patients, earlier DST testing in those with clinical and microbiological indications of impending treatment failure, and use of second-line drugs for retreatment of patients with initial treatment failure until DST results are known.(17) Recently, total drug-resistant tuberculosis has been described in which some patients with TB infection were completely unresponsive to all TB drugs. This is a big blow to the global effect in control of TB. On the other hand, additional burdens of isolation and stigmatization on the patients are enormous. (18) Noncompliance to treatment, deficient patient knowledge/health education, drug quality, and other comorbidities like diabetes mellitus and HIV infection had been identified as major predictors of treatment failure in patients with TB. These factors were not considered in our study participants. According to observations made in many countries, only directly observed therapy is capable of improving treatment outcomes. (19-22) The effectiveness of the DOTS strategy is also confirmed by our own studies.In conclusion, there is still considerable treatment failure rate among TB patients managed in our tuberculosis clinic. There is need for provision of facility for sputum close for detection of patients with drug resistant TB cases. Policies on the management of tuberculosis need to be reviewed and strengthened in order to reduce open TB cases in the community.

Students at Risk and the Digital Divide :: essays papers

Students at Risk and the Digital DivideAs the world advances in technology, there be many benefits and disadvantages. In the school systems, students pull ahead from having use of more technology. Then there are schools that have this technology and schools that dont. There are classes that have it and classes that dont. There are students in the same class that have access to various forms of technology and others that dont have that luxury. There is not a definition of students at risk, precisely rather common characteristics (a) children/youths from families living in poverty, (b) children/youths with different backgrounds (e.g., experiences, education, and origins), (c) children/youths of color, and (c) children/youths from limited English-speaking families (Davis & McCaul, 1990). Low achievement, poor attendance, low economic status, and attendance at schools with large rime of students living in poverty contribute to the likelihood of not earning a high school diploma . But students at risk are also characterized as students who are likely to leave school without the necessary skills to succeed academically, socially, or vocationally in todays society. These students become victims in the sense that the likelihood of reaching their bountiful potential is diminished. The digital divide is a problem that these students at risk face. It is a divide among household computer and internet access by campaign/ ethnicity, income, education, location, and disability. The purpose of this research paper is to analyze the inequities that exist with respect to childrens educational technological opportunities (Means, 1997).Relationship between Poverty and Students at RiskThere is a link between poverty and students at risk. The Office of the United Nations High Commissioner for Human Rights (2005) defines poverty is defined as a human condition characterized by the sustained or chronic deprivation of the resources, capabilities, choices, security and po wer necessary for the enjoyment of an adequate standard of living and other civil, cultural, economic, political and social rights. 1 billion children live in poverty, which are 1 in 2 children in the world. The price these children pay for being born poor is enormous. Carta (1991) cites several sources indicating that low-SES (socio- economic status) children living in inner cities are much more likely to have educationally damaging circumstances as part of their life experiences than are higher SES children. The dangers these children could suffer include prenatal exposure to drugs and AIDS, low birth weight, poor nutrition, lead exposure, and personal injuries and accidents.

What Love Is Not :: essays research papers fc

When I was Thirteen, I couldnt wait until I was 16 so that I could drive. Once I was sixteen I couldnt wait until I was eighteen. I cute to be considered an adult. When I reached the age of eighteen, I couldnt wait to turn twenty-one. I wanted to be able to drink and gamble, legally. I am now twenty-two years old, and I wish that I could be a child again. I look back and feel that I grew up too quickly. I think the reason that I grew up so quickly, was due to the fact that I was friends with people who were older than myself. And just like the four-year-old male child in the short story Araby by James Joyce, I wanted to be pass judgment by someone older than myself. The young boy from Araby, wanted to be accepted by an older girl who he thought he loved. Although (in reality) the young boy does not truly love this girl he becomes deeply obsessed with her. Which would take a shit cost him his childhood if it werent for his realization.Some people experience their whole lives a nd never discover what love really is. And the young boy from Araby hasnt either. Communication is a vital part of loving someone, and this is something that the young boy cannot do. The young boy demonstrates this when he encounters the older girl who is his so-called love. At last she spoke to me. When she addressed the first words to me I was so confuse that I did not know what to answer (Joyce 28). This shows the boys inability to communicate with the girl. He cannot even hold a simple conversation with the girl. When you love someone you get down to be able to tell someone how you feel, or at least be Williams 2able to communicate how you feel through body language. similar flirting. If you do not, or cannot, let that person know how you feel, it is not called love. It is called an obsession. Most people obsess over things that they cannot have. One thing that the young boy cannot have is the older girl. All he can do is obsess over her. He obsesses over to the point that he is almost stalking her. The boy illustrates this to us every morningEvery morning I lay on the floor in the front parlour watching her door.

The Culture and Music of Puerto Rico Essay -- culture Cultural History

The Culture and Music of Puerto RicoIn the first decade of American rule, Puerto Rican husbandry was influenced drastically by its status as a US possession. Although the political and economic aspects of American influence were very significant, American rule also had a great impact on Puerto Rican culture. This is expressed through the culture of Puerto Rican music both on the island and in the United States. Puerto Rican music not only became an important cultural icon, but also helped to determine the new identity element of the Puerto Rican both on the island and the mainland.Under Spanish rule, Puerto Rican music had been shaped by the prejudices of their oppressors and the divisions between the peasant class and the upper class elites. Many people argued everywhere what was true Puerto Rican music and culture, and the more powerful members of Puerto Rican society controlled the music that represented the island. For this reason, under Spanish colonization, the occupying co untry recognized the most refined and European-sounding music, the danza. However, the music of the cast dget classes also served as a means to declare an identity separate from the Spaniards. In this way, Puerto Rican music at this time had the influence of both Europe and its own native culture. According to Glasser, it is likely that in this way the vals, the mazurka, and other European dances penetrated much of the Puerto Rican countryside and were absorbed, with some modifications, into the jibaro repertoire. (Glasser 26) In other words, the refined European style that was constrained onto them by Spain and other types of music became part of Puerto Rican music, and part of their culture. Puerto Rican music and culture further developed when the United States ... ...uence. In addition to this, Puerto Rican music demonstrates that although there was immaterial influence, the Puerto Rican identity still grew strong. This is demonstrated by the various protest songs, and the st rong ties between musicians on the island and on the mainland. In the face of early US colonization, Puerto Rican culture came under the same conflicts as it did under Spanish rule, and reacted much in the same way. While US intervention may have masked the behavior of true Puerto Rican music and culture, the lives and the works of the Puerto Ricans themselves showed that it is possible both to accept new cultural themes and to struggle to preserve ones native culture at the same time.Works CitedGlasser, Ruth. My Music is my Flag Puerto Rican Musicians and Their New York Communities 1917-1940. University of California Press, Los Angeles, 1995.

2001 - A Metaphorical Odyssey :: 2001 Space Odyssey Essays

2001 - A Metaphorical Odyssey Myths are created for the purpose of conveying a message with an interesting medium with which to do so. Many cultures use myths to teach their unfledged about the past. Through time, however, these myths become impractical due to discovery. This is when a new myth must be introduced to take the place of the obsolete one. Stanley Kubrick shaped 2001 A Space Odyssey as a new myth to crack the archaic view of space, by using a hero, a dilemma, and a new manifestation to fuel his cause. Every myth has a character that breaks the mold of the ordinary. In Homers The Odyssey, Odysseus is the character that broke the mold of the other mortals. He displayed character traits that superseded those of his crew mates. more than in the same fashion, Bowman breaks the mold of the astronauts aboard the Discovery. He and Poole are share duties aboard the Discovery, but he demonstrates a higher level of idea by sensing and interpreting what is happe ning before him. He is the one that realizes exactly what HAL is doing, and he puts a stop to it. He sees problems, analyzes them, and then proceeds to distribute the cause in the most efficient manner possible. He uses his character traits of intelligence, persistence, and adroitness to overcome the dilemmas put in front of him. By using his intelligence, he realizes that HAL has figured him out, and he must find a way to get back into the discovery in order to survive. In using persistence, Bowman does non give up when it seems that HAL has won the battle. Instead he takes the rough way in, and he then disables HAL. Bowman shows how adroit he is with dilemmas by handling the stallion HAL situation with calm and intelligence. While on the mission, Bowman is faced with many dilemmas. The first dilemma, is that he is in the dark about the purpose of the mission. He has solo been supplied with the vital information that he will need to perform routine operations unti l the site of the mission is reached. HAL is responsible for informing him when the place has been reached and time is respectable to complete

How the Continuity of Experience Could Disprove Materialism :: Philosophy Philosophical Papers

There seem to be three distinct hesitations ab bring out continuity. (1) Is experience continuous? (2) Is the corporal ball continuous? And (3) Are the physical events of the brain which give rise to experience continuous? Finding answers to these questions that can be integrated without contradiction is a challenge in itself. But beforehand we ask whether our answers contradict, we must respond to the questions. The most ambitious and unwieldy of these questions is without a doubt the second, regarding the continuity of the physical world. This question is the realm of philosophers alone, and it has been debated since the beginning of thought. Heraclitus thought the world was in a constant state of continuous change, while Parmenides thought time an illusion, laid out eternally and unchangingly. Today this debate has become cognize as that between the conventional theory of time and the block theory of time. (1) New names for the two camps, however, have provided no n ew answers, and the debate seems interminable. If the question of whether time in the physical world flows at all cannot be answered, it is certainly impossible to determine whether it flows continuously. Philosophy must here bow out to some degree and let psychology have its turn at bat. Aristotle writes Whether, if soul (mind) did not exist, time would exist or not, is a question that whitethorn fairly be asked for if there cannot be some one to count there cannot be anything that can be counted... Aristotle is wise enough not to prove to answer this question, but instead simply states that the answer depends on whether time exists countably in the absence of a perceiver. (2) Thus the ball is thrown very premature in the game into the hands of psychologists and neurobiologists, and the question thus is transformed into the first of the three, regarding experience. William James advocated a model of experience with continual mental states, the stream of consciousness. He writes Consciousness, then, does not appear to itself chopped up in bits. Such words as chain or train do not describe it fitly as it presents itself in the first instance. It is nothing jointed if flows. A river or a stream are the metaphors by which it is most naturally described. He explains that even when gaps seem to appear in the moments when we are aware of our awareness, such as when a loud noise surprises us, even there exists some sort of mental state and thus a continuity of experience.

Soccer :: essays research papers fc

Procedures 1. The team that wins the coin toss whitethorn choose to kick sour or defend the polish of its choice. 2. All players must be on their own half of the field before the kickoff takes place. 3. Defensive players must be outside the center circle, at least ten yards away from the ball, for the kickoff. Players 1. Each team has up to eleven players one is the goalkeeper. The other players are known as defenders, midfielders, and forwards, or strikers. 2. In major competitions, a team may not use more than three substitutions in a game. In other competitions up to five may be used. 3. A substitute must be summoned onto the field by the referee and must enter the field at the center course of action after the player she/he is replacing has left the field. Equipment 1. The ball is round, covered in leather or in leather like material, and is between 27 and 28 inches in circumference. It must weigh 14 to 16 ounces and have 14 pounds of air pressure. 2. Players dress in team shi rts, shorts, shin guards, and socks. Shoes may have studs if they are rounded, no longer than .75 inch, and no less than .5 inch in diameter. Goalkeepers often wear elbow and kneepads and gloves. The goalkeeper wears different colored like than his teammates. 3. Any equipment deemed dangerous to players may not be worn. This includes, earrings, glasses, necklaces, bracelets, watches, and casts and braces that the referee considers dangerous. Modifications 1. Soccer is played on various sized fields wwith competitions ranging anyplace from 3 on 3 players through 11 on 11. Offside, and Goalkeeping Offside A player is offside if he/she is closer to the opposite words goal line than the ball is, unless the player is still in his/her own half of the field or at least two opponents are closer to the opponents goal line. Offside is determined by the players position at the moment of the pass, not at the moment he/she receives the pass. A player is not offside when he/she receives a ball that, bounces off a defender who had possession of the ball, comes at him directly from a goal kick, recessional kick, or throw in was deflected by the goalkeeper, or was shot at the goal and bounces off a defender. Nor is player offside when he/she is in line with a defender a&8308&26740&8293&28525