Suchergebnisse

Background: The emergence and spread of DR and MDR-TB threat global TB control. The susceptibility patterns of M. tuberculosis isolates against anti-tuberculosis drugs informs an important aspect of TB controls and surveillance and analysis of local rates of TB drug resistance helps in the detection and monitoring of the extent of DR and MDR strains, indicating the quality of TB control in the country. Methods: A cross sectional study was conducted to find out antibiotic susceptibility pattern of Mycobacterium tuberculosis in pulmonary tuberculosis patients at national tuberculosis center. All the samples were stained by auramine fluorochrome method; processed by NaOH Ogawa Method; primary cultured; subcultured in 2% Ogawa media; cultured in drug LJ media and finally results observed and interpreted. Here Drug susceptibility test was done on M. tuberculosis isolate from each patient by Proportion method as standard protocol. Results: Ethambutol (66.10%) was found to be the most effective anti-TB drug according to the susceptibility test followed by RMP (60.33%), SM (59.66%) and INH (41.69%) against M. tuberculosis. Among 45 isolated untreated patients, primary drug resistance was observed in 20%, to two drugs in 17.77%, to three drugs in 11.11%, to four drugs in 6.66% and primary Multi-drug resistant in 22.22%. Among 250 isolated from previous treated patients, acquired resistance to one drug was found in 23.60%, to two drugs in 12.40%, to three drugs in 16.40%, to four drugs in 18.80% an acquired Multi-drug resistant in 37.20%. Among 250 treated 68.40% (n=171) were relapse,18% ( n=45) were chronic, 7.6% (n=19) were follow-up, 3.2% (n=8) were defaulter, and 2.8% (n=7) were treatment failure. MDR-TB was found the highest in chronic cases (64.44%) followed by follow-up case (47.36%), treatment failure cases (42.85%), relapse cases (27.48%) and default cases (12.5%). A statistical analysis reveals significant relationship between prior history of treatment and the development of drug resistance. However, no significant relationship between age and sex with the emergence of drug resistance isolates. Conclusion: MDR-TB was found the highest in chronic cases (64.44%) followed by follow-up case (47.36%), treatment failure cases (42.85%), relapse cases (27.48%) and Default cases (12.5%). Key words: multi drug, relapse, resistant, sensitivity, tuberculosis DOI: 10.3126/jnhrc.v7i1.2277 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 33-41

This paper on preventive programs for mental disease provides 'an orientation to what we know how to do, what we now hope we are doing, and what we are likely to be doing in the next few years.' Primary prevention (reduction in rate of people becoming diseased) includes such problem areas as general paresis and other organic psychoses, emotional deprivation, parent education, counseling, eugenic sterilization, security (financial, etc.), preventive analysis, and leadership and morale building. There are no programs of secondary prevention (reducing duration of extent of unhealthy states) for psychogenic diseases, but 'we can anticipate that such attempts (prevention of relapses) will be made during the coming years.' The prevention of the consequences of advanced disease and problems of disability and rehabilitation are discussed. D. Wolsk.

SummaryOld Patrons and NewIn societies where patronage occurs it is found in all social strata; it does not disappear with the suppression of rural poverty. This article deals with the various ways in which patronage may manifest itself during and after the execution of local development projects. It is argued that the agency which executes the project will itself often be assigned the role of patron; that the disruption of traditional local power relationships may lead to new political alliances at the regional and national level; and that, even if patronage is suppressed locally, the institution will continue to exist in the wider society. Recourse to it will therefore remain unavoidable if the community wants to obtain new facilities which it cannot pay for itself. For this reason it is held that the agency which executes the project should not withdraw after the completion of the work but should remain and continue to play the role of patron to the community. In this way, two goals may be accomplished: 1) a local relapse into the old social structure (i.e. the emergence of a new local boss) can be prevented, and 2) allowance is made for the fact that at the regional and national level patronage still discharges important functions.

A survey of recidivism leads to the conclusion that 'approximately 3/4 of those committed to jails and workhouses have been previously committed.' This raises questions about the reformative success of prisons. Also, all such studies show considerable % who did not recidivate. No one knows whether this is due to prison training or in spite of it, but the fact that 20-40% of offenders do not repeat indicates something is effective in altering conduct. Especially is this the case when we note that a negative selective process filters out the more desirable risks, leaving the higher risks for the prison to work with. The high, degree of failure is related to the composition of the prison pop. There are 3 pop. segments: (1) The psychologically disturbed. Many such persons are treated in mental hospitals and their relapse rate is high there. The same is true when they are released from prisons. (2) The unskilled and uneducated person, otherwise 'normal,' who needs sufficient skill to earn a living. Frustration and defeat are the re - lease experience of these persons. Recidivism is a likely result. (3) The psychologically 'normal' person who identifies with an antisocial way of life is an equally low risk. They wait only to get out and resume their customary way of life. Recidivism is a high probability here. H. M. Trice.