On average, the isoniazid (INH) resistance rate is approximately 10% and the rifampin resistance rate is approximately 1%, with lower numbers in countries with good TB programs and higher numbers in the countries with poor TB programs.
Pathophysiology: Humans are the only known reservoir for Mycobacterium tuberculosis. TB is transmitted by airborne droplet nuclei, which may contain fewer than 10 bacilli. Exposure to TB occurs by sharing common airspace with a patient who is infectious. When inhaled, droplet nuclei are deposited within the terminal airspaces of the lung. Upon encountering the bacilli, macrophages ingest and transport the bacteria to regional lymph nodes.
The bacilli have 4 potential fates: 1. They may be killed by the immune system. 2. They may multiply and cause primary TB. 3. They may become dormant and remain asymptomatic, or 4. They may proliferate after a latency period (reactivation disease). Reactivation disease may occur following either 2. or 3. above.
Frequency:
In The US: Beginning in 1985, a resurgence of TB was noted. The increase was observed primarily in ethnic minorities and especially in persons infected with HIV. TB control programs were revamped and strengthened across the United States. After peaking at 25,287 (1993), the number of reported cases began to fall again. In 2001, 15,989 cases of TB were reported to the US Centers for Disease Control and Prevention (CDC). An estimated 10-15 million people have latent infection. Among foreign immigrants, 74% of cases reported in 1998 were related to 7 countries: 1. Vietnam 2. Philippines 3. India 4. China 5. South Korea 6. Mexico 7. Haiti Foreign born persons account for a steadily increasing proportion of all reported TB cases.
Internationally: An estimated 20-33% of the world's population is infected with M tuberculosis. Countries with the highest prevalence include Russia, India, Bangladesh, Pakistan, Pakistan, Indonesia, Philippines, Vietnam, Korea, China, Tibet, Hong Kong, Egypt, most Sub Saharan African countries, Brazil, Mexico, Bolivia, Peru, Colombia, Dominican Republic, Ecuador, Puerto Rico, El Salvador, Nicaragua, Haiti, Honduras, and areas undergoing civil war (e.g. Balkan Countries). Countries in Eastern Europe have an intermediate prevalence. Costa Rica, western and northern Europe, the United States, Canada, Israel, and most countries in the Caribbean have the lowest prevalence.
Mortality / Morbidity: The case fatality rate for TB was 50% for untreated patients before the advent of antibiotic therapy. Deaths worldwide are are estimated at 3 million per year. In United States, the mortality rate dropped from 12.4 deaths per 100,000 population (1953) to 0.6 deaths per 100,000 population (1993); this is approximately 7% per newly identified case.
Multidrug resistant during tuberculosis (MDR-TB) cases have a higher reported mortality rate. Patients with underlying diseases predisposing to active TB also have higher morality rates. Morality of untreated congenital TB is 50%. TB can mimic congenital syphilis or cytomegalovirus (CMV) infection.
Race: Based on 1990 CDC data, case rates were 10 times higher for Asians and Pacific Islanders; 8 times higher for non Hispanic blacks; and 5 times higher for Hispanics, Native Americans, and Native Alaskans, as compared to non Hispanic whites. However, race may not be an independent risk factor. Risk is best defined on the basis of social, economic, and medical factors.
Sex: Despite the fact that TB rates have declined in both sexes in the United States, certain differences exist. TB rates in women decline with age; in men, they increase with age. Men are more likely to have a positive tuberculin skin test. The reason for these differences may be social rather than biological in nature.
Age: In the 1997 CDC data for the United States, more than 60% of cases occurred in persons aged 25-64 years. The age specific risk was highest in persons older than 65 years. Infection in infants and young children (up to 5years) always indicates recent transmission. If left untreated, it may result in life threatening meningitis or disseminated disease, Elderly patients may not have typical signs and symptoms of infection because they may not mount a good immune response. In elderly patients, an active tuberculosis infection may present as an non resolving pneumonitis.
For two of the past two Presidential elections, the Democrats have miserably failed to produce a viable candidate who could sway the entire United States. Instead of complaining about how bad the next three years will be, Democrats now have the opportunity to produce a viable ?front runner.? It really shouldn't be that hard to find a candidate who can identify with the American people.
However, it seems the democrats have lost touch with many large regions of the country. This past election was big money versus big money. There was so much double talk, that it became difficult for the average voter to see much of a difference between George W. Bush and John Kerry. ?America's Heartland? and the ?Bible Belt,? couldn't identify with a Massachusetts lawyer.
Shame on the ?two party system,? if this is the best you can find. Some of us were forced to vote third party, and resign ourselves to the fact that the American people lost in the last election. The smaller parties also struggle to find viable candidates, but their biggest issue is financial backing.
Shame on the Presidential election process; with the Electoral College still in place, the popular vote really means nothing. Very little action has been taken to change this system, even after the Presidential election in 2000. If this were changed, the American people would really control who is elected.
Why is this system still in place? In fact, the people are considered too simple to elect their own President. We are a democratic republic and not a pure democracy. There is room allowed for special interest groups to alter every legislative action by funding our elected representatives in government.
However, let's get back to finding the best candidate for the job. Right now, there have been many names tossed around. Here is a short list of Democratic hopefuls for 2008.
U.S. Senator Hillary Rodham Clinton of New York: Hillary is not saying she will run, but I'll bet anything she is watching the polls; including a recent AOL poll, where to my surprise, she didn't do very well. She will probably stay out of it, unless her popularity improves.
Why is Hillary unpopular? Somehow, it seems odd that the American people are not ready for a strong female candidate. I am surprised at how many women don't want her to run. If women rallied around Hillary, she would win by a landslide.
? Copyright 2005 ? Paul Jerard / Aura Publications
Both Ibrahim Lodhi & Paul M. Jerard Jr. are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Ibrahim Lodhi has sinced written about articles on various topics from Religion, Nutrition and Pets. Dr. D.S. Merchant Resident MedicineGold Medalist (Anatomy & Histology). Ibrahim Lodhi's top article generates over 90500 views. to your Favourites.
Paul M. Jerard Jr. has sinced written about articles on various topics from Leadership, Yoga Practice and Anger Control. Paul Jerard is director of Yoga teacher training at Aura in RI. He's a master instructor of martial arts and Yoga. He teaches that along with fitness. He wrote: Is Running a Yoga Business Right for You? For Yoga students who want to be a teacher.. Paul M. Jerard Jr.'s top article generates over 165000 views. to your Favourites.