Rate of Treatment Failure among Tuberculosis Patients

Rate of Treatment Failure among Tuberculosis Patients ABSTRACT Treatment failure in patients with pulmonary tuberculosis (PTB) poses a great danger to the global effort in control of tuberculosis. This study evaluated prevalence of treatment failure among PTB patients at a tertiary care teaching hospital in Pakistan. Consecutive patients of smear positive PTB patients managed between February 2011 to October 2013 at the directly observed therapy (Tuberculosis) unit of our hospital were enrolled for the study. Sputum specimens were collected from each patient at entry for Acid Fast Bacilli microscopic examination and repeated at the end of 2nd (in category I cases only), 3rd (in category II cases only), 5th and 7th 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 while 31 (25%) were 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. INTRODUCTION: About two billion or nearly a third of the world’s population 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 HIV-negative cases for the year 2009. (2) Eighty-five percent of the 9 million people infected with TB each year live in the developing countries. (2) Whereas more women of child bearing age die of Tuberculosis than from all causes of maternal 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). There 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 much higher and is estimated at 373/100,000 population or 670,000 cases.(5) TB is responsible for 5.1 percent of the total national disease burden in Pakistan. The impact 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 untre ated 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 drug-resistant Mycobacterium tuberculosis. The problem of resistance results from treatment that is inadequate, often because of an irregular drug supply, inappropriate regimens, or poor compliance. Drug resistance is a potential threat to tuberculosis-control programs throughout the world. (8) Materials and methods The study was carried out in a tertiary care teaching hospital in  Pakistan. 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 supported by the National Tuberculosis Control Programme 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 sputum 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. Results A total of 144 patients were recruited during the study period (between February 2011 and October 2013). Twenty patients were either 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 aged 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 figure 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 developed countries (9), While in developing countries it affects mainly the young age group. (10) One reason may be the changing circumstances in the less developed 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 default patients tested did. While these DST results were only available for three failure patients and, therefore, not representative, these data and those from other studies suggest that MDR ri sk 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 effective programmatic therapy of the smear positive cases is one of the cornerstones in its prevention. Facilities for rapid detection of rifampicin resistance are being made available throughout the country which can help in early detection of drug resistant cases. Physicians involved in TB management need to be involved in its programmatic management and timely referrals for testing resistance in appropriate cases. Taken together, these findings support 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 culture 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.

In what ways is A view from the bridge like a Greek tragedy? Essay

In what ways is A view from the bridge like a Greek tragedy? Introduction In this essay I will be explaining in what ways "A View from the Bridge" is like a Greek tragedy by exploring what Eddie's tragic flaw is and how it influences his actions, sending him on a path of self-destruction that eventually leads to his tragic downfall. I will also be explaining which of the other characters and key events in the play have the biggest impacts on Eddie and his downfall. In the opening scene of the play, the audience is shown the setting of the play, which is the harbour area of Brooklyn near the Brooklyn bridge. When it shows Eddie with Beatrice and Catherine their use of dialogue initially suggests to the audience that they get along well and that there is a general 'happy family' atmosphere. The scene gives the audience the impression that Eddie is a good man who seems perfectly happy with his life since he has the dignity of a job that he likes and the love of his family. The audience also find out that Eddie is not related to Catherine which is an important fact to remember about him. Even though Eddie is not Catherine's real father he is still extremely over-protective of her, which suggests he may feel a bit too strongly for her and it is this love which is in fact the tragic flaw that eventually leads to his downfall. But this unlawful love does not come out into the open until it is sparked off by a metaphorical catalyst in the form of Beatrice's cousin Rodolpho. The first hints of this love that are given to the audience are when they see Eddie's obsession with the way Catherine dresses, for example when she comes in wearing a new dress and he says: " I think it's too short " He then goes o... ...uld be going on, perhaps a little. It didn't even cross her mind that she was a potential 'rival' to Beatrice; 'He said you was jealous?' Heidegger enveloped badman2k3's structuralism hypothesis. When Catherine falls in love with Rodolfo, Eddie cannot stand this, and does everything in his power to stop it, as his subconscious desires tear him apart slowly. He even calls the immigration bureau and risks his respect (which means so much to him) for her. I feel that both Eddie and Catherine were partly to blame for the tragic end of their relationship and in general. However, Catherine gained her confidence and independence a little more toward the end of the play. Eddie's possessiveness and dominance over Catherine suffocated her into staying a 'baby', but I feel she could/should have been more self- aware, especially of the situation around her.

Benifits of Walking

â€Å"Benefits of Walking† Walking provides a wide range of benefits, some of which are more obvious than others. The obvious benefits of walking include the benefits to the individual from physical fitness and mental health improvements. A less obvious benefit is the way in which getting more people walking more often can help to generate a stronger local community, which in turn will contribute to happier and healthier neighborhoods. Every channel you turn to, every magazine you flip through, and every sports store you go to, shows the concept of exercising.Most people think of exercise as too much work. They make excuses like I don’t have enough time, or I’ll do it later. The purpose of this essay is to persuade my listeners to get out their walking shoes and start reaping the benefits of a healthy life and start walking. First we will discover how walking benefits our bodies, second uncover how easy it is to incorporate walking in to our daily lives, and thir d reveal the only equipment that one needs to take the first step putting one foot in front of the other.For many of us we are always finding ways to get out of exercising. Either we are too busy or we are putting it off until we have more time, but actually we never get the time to exercise and we just see ourselves jumping from a size 6 to a size 12. Well I have help for you. We were all born with 2 arms and 2 legs, so let’s put those legs to the use they were intended. Walking is one of the easiest forms of exercise and provides many health benefits.Regular walkers have fewer heart attacks and strokes, have lower blood pressure, and have higher levels of healthy HDL cholesterol than couch sitters do. In one study of women, a regular walking program did just as much in the heart-protection department as more vigorous exercise did. Thirty minutes of walking a day makes your muscles more sensitive to insulin. That allows glucose to do its duty inside your cells rather than pi le up in your bloodstream and cause other havoc.Even just a 5-minute walk cuts down on cigarette cravings. It engages your brain's emotion centers, unleashing mood-enhancing hormones that decrease cravings and take your mind off that cigarette. And establishing a walking habit proves to you that you have the discipline to stick with your stop-smoking plan. Physical activity nourishes brain tissue and stimulates its production of neurons, synapses, and blood vessels. Some studies have found that walking can counter faltering memories in people over age 50.Anyone who has come back from a walk in a different frame of mind than they went out with can attest to this. Studies back up that walking benefits your mood and may even ward off depression and anxiety. Not only can a walk perk you up when you need it, but also it helps improve the quality of your sleep, so you're more energetic all day long. Walking regularly can lower your risk of arthritis, macular degeneration, and even cancer by an astonishing 50% compared with people who don't exercise. Walking has the highest compliance rate of any exercise.

Online IT Degree Programs Make Career Changes Easy Essays

Online IT Degree Programs Make Career Changes Easy Essays Online IT Degree Programs Make Career Changes Easy Essay Online IT Degree Programs Make Career Changes Easy Essay Essay Topic: Easy As many career fields suffer from layoffs and downsizing, those in the computer industry have largely escaped. Programmers, support staff, designers and more are still in high demand in many companies. If it’s time to turn in your present career for something that offers more stability and marketability, an online IT degree might be right up your alley. Going online for an IT degree, an online MBA or even a Masters in Education can be an incredibly wise choice to make. This is especially so if you are presently employed and would like to keep it that way. Just about any online degree, be it in nonprofit management or computers, will allow the flexibility you need to work during the day and learn at night. For those seeking on online IT degree, the road won’t necessarily be â€Å"easy,† but this platform certainly does make it more convenient to earn the credentials it often takes to succeed in this field. So, what can you expect from online courses? The answer, in a nutshell, is just about everything you’d experience in a classroom setting, minus the commute. Depending on the school and exact structure of a class, you are likely to have: Homework – This will be a part of any online degree program. In most cases, classes will have a set professor that oversees online lectures, homework and even special projects. Some programs even hook students and teachers up via closed chat rooms for lectures and other learning opportunities. Tests – Don’t expect to slide out with an online IT degree from any accredited program without being tested. As it is with any college course, performance standards will be put in place that students must attain to gain credits. An online IT degree can open doors on a career that is fairly stable in these times. If your present job is shaky, it might be time to consider retraining in a setting that’s convenient and more flexible than you likely think.

GT3 essays

GT3 essays Specific Purpose: I wish to provide several facts about the 2004 Porsche 911 GT3. Thesis: The 2004 Porsche 911 GT3 is a high-performance sports car for sports car purists. The 2004 Porsche 911 GT3 is a high-performance sports car for sports car purists. Its a sports car for the sports car purist because its got everything you need, and nothing you dont. The 2004 Porsche 911 GT3 is a car that has been acclaimed as the Porsche for purists. A purist is someone who holds the performance of his or her car above all. A purist doesnt care about: A purist only cares about pure performance and performance in general. The GT3 differs from the other 911 models significantly. It is the product of half a century of Porsche involvement in motorsport. Porsches racecar engineers designed this vehicle with track use in mind. In order for a car to be successful on the track, if needs several key ingredients. It needs to be fast and agile. The GT3 meets these requirements with so much ease. In order it be fast and agile - The GT3 is a lightened version of the 911 Turbo. The back seat has been removed. The heavy AWD drive train has been replaced by much lighter RW drive system. The Interior was redesigned for a more simplistic look, and they used lightweight components to make up the equipment. All of these combine together for a terrific display of weight reduction, and the lighter the car, they less work the engine does to accelerate it. - In order to be fast. The 911 GT3 boasts a 3.6-liter, six-cylinder horizontally opposed engine, rated at 380 (SAE) horsep ...

Life as a Police Officer Research Paper Example | Topics and Well Written Essays - 2500 words

Life as a Police Officer - Research Paper Example This essay will discuss life as a police officer. Qualifications for Police officers Police officers tackle a vast array of issues on a daily basis hence the need for specialized units within the police department. Some of the specialized areas include homicide, traffic, rape, police air wing, special emergency response teams and dog squads, among others. However, police officers are expected to respond to a wide spectrum of situations; even those outside their specialized units, especially in low crime areas as fewer police officer are employed in such areas. In order to qualify as a police officer in the US, one must fulfill a number of requirements, which are based on civil service regulations (DeLattre, p. 27). According to the US Bureau of Labor Statistics, a potential police officer must be a US citizen, at least 21 years of age, have a clean record (no previous convictions), possess a valid driver’s license and have a minimum high school diploma or equal educational cre dential. However, independent police departments across the country may require more than these basic prerequisites before admitting one into their police force. For instance, some require applicants to have some college education, as well as a psychological profile. For instance, the Philadelphia police department requires applicants seeking officer 1 status to have at least a college education (Willis, p. 18). In addition, in order to qualify as a police officer, one must undergo a reading test where recruits are required to have the ability to read at least ninth grade level. This test is often administered through the Nelson-Denny Reading Test. Physical fitness is of paramount importance in police officers as it is the end factor as to whether or not criminals are caught when in the field. A physical fitness test is performed to confirm that police recruits are physically fit. Here, recruits are required to run for 300 miles, do bench press-ups and sit-ups (DeLattre, p. 33). Off icer Training and actions Once all these requirements are ascertained, recruits undergo psychological evaluation by licensed state psychologists before being admitted to a police training academy where recruits undergo 12 to 14 weeks of training on effective ways of performing police duties such as using firearms, self defense techniques, apprehension techniques, risk assessment and responding to emergencies. At the police academies, recruits also receive basic education on the law. Officer training advocates for among other things, police officer safety, whether a crime is in progress or a civilian becomes a victim; officers’ safety is paramount. Officers’ safety is essential as it enables them to make rational decisions and enhances the performance of their response functions (Levitt, p. 45). When out of the training academies, police officers come to the realization that the principles they learn in academies are quite different from real life experiences in their v arious allocated departments. Different departments have different sets of policies and customs. However, the universal principles of the police force trump those of individual departments. Police officers often encounter hardships after completing their training programs in

The Island of Plenty by Johnson C. Montgomery Essay

The Island of Plenty by Johnson C. Montgomery - Essay Example The present research has identified that Johnson C. Montgomery was the attorney general in the city of California and former member of an organization situated in America. The organization was popularly known as Zero Population Growth, and it was extraordinarily effective in fulfilling its targets and goals through the assistance of Montgomery. He later ventured in literature and was able to write an exceptionally captivating book that got the attention worldwide. The book was called ‘The Island of Plenty’ and its review appeared first in the Newsweek magazine in the year 1974. The article was clear in the assertion of its points, and consequently got some criticisms from a section of the populace who felt that it was deceitful. The article was titled My Turn on the Newsweek magazine before it was later renamed The Island of Plenty. The author of the book supports the idea that America should isolate herself from helping other countries, until the time they had enough su stainable resources. Montgomery argues that the isolation is necessary for America to concentrate in solving their internal problems first. The writer has used rhetorical devices such as alliterations, assonance, cacophony and onomatopoeia in this piece. The writer uses alliteration in to emphasize that the growing populace is the main reason why there is food shortage in the world, ‘the problem is that there are too many people-many too many’. The repetition is on the word ‘many’, which has been repeated severally in the sentences. Through this use of the rhetorical devices, he has managed to emphasize the point of an immense populace causing famine. ‘We owe to our children- and to their children’s, children’s, children’s, children’s’ is a sentence the writer is emphasizing on the importance of planning to take care the future of our children. Montgomery succeeds to show his point the use of alliteration to show the readers the importance of having a well-planned future for the younger generation. Therefore, he presents the alliteration well in a manner that brings understanding to the reader. Assonance Assonance is the repletion of a similar sound in a sentence to emphasize on a theme to that of an article being read. The sentence ‘Ample food and resources exist to nourish man and all other creatures to indefinitely into the future’, successfully show how America is well equipped with resources that feed their citizens. Irony The writer