Drug Resistant Tuberculosis The mortality rate of people suffering from pulmonary diseases that is diseases related to the lungs was about 50%.But with the advent of anti –tuberculosis drugs in year 1950’s a passage towards prevention was opened to the world .But a considerable and continuous effort together with a superlative supply of drugs was vital for a chance of cure. But, due to paucity of resources in impoverished countries, an increasing incidence of tubercle bacteria resistant to most effectual drugs known as multi-drug resistant tuberculosis has been on an increase. The sanatoria that came to existence in the 19th century provided a domicile where patients were treated away from home and this did trim down the incidence of tuberculosis in the community. Through the 1930’s artificial pneumothorax which refers to filling of air in the pleural cavity and thoracoplasty confiscating of upper ribs were some surgical effort meant to provide prevention and the surgical method continued for 30 years until drugs were recognized as a potential preventive. Thus by the end of 1950’s drug therapy erased sanatoria beds as treatment at home became a possibility. Soon community based treatment took over as sanatoria were not compliable to attend spur in the number of patients health visitors were trained to ensure the compliance of patients to there treatment regime .DOT or direct observed therapy seeing the patients swallowing their medication was practiced by these health visitors. Streptomycin formulated in USA in the year 1944 was the first explicit anti- tuberculosis drug. But soon the drug faded in its function as bacteria developed resistance the European scientist came up with papaminosalycillic acid (PAS) in the late 1940’s .a combination of both the drugs prohibited and protected individual against the fatal tuberculosis.Isoniazid which exterminates the actively dividing tubercle bacilli when combined with PAS and Streptomycin treatment length was cut down to 18months Finally in the 1960’s Rifampicin was a breakthrough as the drug eliminated the slow dividing bacteria that lead to reoccurrence. Regrettably the achievement for drug treatment of tuberculosis has been the agency for the materialization of drug resistance. A patient due to poor conformity and pitiable medical supervision may intake only a single drug instead of the combination resulting in drug resistance. Thus it implies defiance to impact of isoniazid and rimampicin at the same time it may or may not be resistant to first line agent. 1 During the year 1985-1994, 63 surveys of resistance to antituberculous drugs showed the highest percentage 48.0% in Nepal, 33.8% in Gujarat, India, New York City accounted for 30.1%and in quick succession were Bolivia with 15.3% and 14.5% in Korea 2In the year 1997 cases of TB totalled to 7.96 Million , infectious pulmonary disease accounted for 44% that is 3.52 million cases and 16.2 million added to the already active cases of the disease .The global burden of tuberculosis remains gargantuan as an impact of impoverished management especially in areas like south-eastern Asia, sub-Saharan Africa and east Europe.80% of Tb cases were found mainly in five south east Asian countries.3 Tuberculosis has quite high incidence in refugee populations the Health objective 2010 stated that in order to prevent disease, disability and death from theses communicable ailment a co-coordinated strategy to understand ,detect control and ultimately prevention is vital .The approach manly covers four target namely observation or close watch with functional feedback, education and providence of infrastructure requirements and finally deterrence followed by detaining reoccurrence were looked on as the cornerstone for success of the approach. It is further stated that community cooperation is indispensable for preventing communicable diseases.Survelliance which is imperative for harnessing communicable diseases like tuberculosis is possible only through cooperation of many in the community. The community healthcare provider, laboratories, hospitals report timely for implementation of preventive measures with increase in immigration the need for a preventive therapy and DOT
has amplified4 .The Drug resistance has jeopardizing effect on human health worldwide. The Preventive largely includes a patterned and concise chemotherapy (SCC) based on inexpensive and non-toxic first –line drugs a creditable SCC can also be very handy in containing drug resistance even when it has reached the epitome of epidemic. In a nutshell the strategy for containing drug resistance is (i) Extensive execution of SCC (ii) Improvement in the quality of resistance testing and surveillance and (iii) Meticulous induction of the second – line drugs after a reliable assessment of the expenses , efficiency with viability5.The global impact of drug resistance a report commissioned by the open society institute and Harvard medical school says that drug resistance TB is a manifestation of the global neglect for tuberculosis control. Further the human rights argue that fighting tuberculosis is a global responsibility. The most hopeful solution to drug resistance is based on DOTS program which refers to a simple procedure rather a therapy in which the patient must be seen so as to ensure that they swallow their medication under the supervision of a medical supervisor, this prevents drug resistance budding as it should ensure that monotherapy is avoided Areas with high drug resistance have had DOTS success rates up to 95%.But leading tuberculosis experts have been quick to emphasize that in areas of strong DOTS programs for regular tuberculosis drug resistance should not be able to develop ,therefore a dual program is needed . To address the problem of drug resistance tuberculosis a working group on DOTS plus was established. The working group assesses the global drug resistance crisis and established the green light committee to ensure proper use of drugs at low cost. The green light committee includes members of WHO, Harvard medical school and centres for disease control. DOTS plus must be implemented where DR -TB is present and DOTS program must be expanded to reach all areas of the globe .Another emphasis is that DOTS-plus must be implemented only where DOTS is already a strong program to prevent further drug resistance resulting from inadequate infrastructure. Otherwise, strains of tuberculosis resistant to second and third line drugs may develop .And the world will face a calamity in which a curable disease will be take form of a incurable ailment simply due to disorganization ..6
References:1. http://www.priory.com/cmol/TBMultid.htm 2. http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=8994791&cmd= showdetailview&indexed=google 3. http://jama.ama-assn.org/cgi/content/abstract/282/7/677 4. http://www.lincoln.ne.gov/City/HEALTH/hp2010/Immcom.pdf 5. http://www.sciencemag.org/cgi/content/abstract/295/5562/2042 6. http://web.mit.edu/murj/www/v06/v06-Features/v06-f4.pdf
A Dollhouse by Henrik Ibsen A forte of symbolism
Henrik Ibsen a Norwegian playwright, poet and theater director is often referred to as “Father of modern drama” His writings can be tagged as a flag off to realism drama; his writings more or less revolved around the essence of human freedom. He felt societal norms condition individuals’ behavior towards family and community and this inurn doesn’t give him a chance for self fulfillment. Many a times his writings became a critic centrifugal, controversies always went hand in hand with his works. Ibsen in his works highlighted the stress that modern society exerts ans its excruciating consequences.
A Doll’s house
A dollhouse is one of the social dramas written between 1867-1899.It is an avid arbiter of the constrains of Victorian society. Ibsen highlights the maladies of human relationship being weighed down by social conventions. Ibsen also successfully exposes the mediocre attitude of society towards women in 19th century infact the total gamut of the institution of marriage is put under the scrutiny. The doll house was thus criticized as a play giving prominence to the female liberties but Ibsen argued that his sole aim was to project the importance of liberty of individual beyond the female independence; his protagonist Nora was a depiction of any person harnessed with rules and regulations of society, he felt the person behind the woman was overlooked. The dollhouse as the name suggest at the very first glimpse illustrates a typical Victorian household where Nora is just like a doll an item of adornment for torvald to enhance his living room and to embellish his bedroom. Like is a doll hose all is fake, thus also Nora fakes her marriage her happiness trying to fabricate a life though she is bitter about but wants the society to know is better off. But at the end of the play she understands the worth of her freedom and walks out from the bondage of torvald’s, Dollhouse hence
opening the doors of mankind towards liberal thinking and self attainment. Ibsen, all throughout the play has utilized words and phrases as symbols to sustain the realism factor in the play. What are symbols? A symbol is sign that has further meaning. Symbols in literature camouflage an array of meanings that the writer uses to bring about his concept, with a tactful presentation of language. Symbolism and A dollhouse Henrik Ibsen’s a doll house is often considered as a forte of symbolism for his remarkable use of symbols engrossed in his vocabulary and idioms. The use of symbols was consecrated to compliment Ibsen’s realism. The very first introduction to symbolism in Ibsen’s play is the title “A dollhouse” through which he tries to convey the ersatz in life of people who lead pretending to be happy all glittering like a dollhouse presenting a picture perfect life while disguising there predicament’s. The Victorian house set up in a chic yet not cheap ambience comes out symbolic of the ways people to use to swathe there fissured out relationship, as even in noras and torvalds marriage where she is no equals he calls her by names like “little squirrel” little lark” little women “the phrase “little” symbolic of noras diminutive status in the eyes of torvald and the pet names suggesting that she is quite similar meant for his entertainment. The discrepancies existing in the status Quo of man and woman in Victorian society is clearly visible in the home setting as trovald has a study room a sanctum of his male authority and contemplations assemble and nora is not permitted and remains confined to the living room”with china objects and Bric-a –bac” as similar to pretty décor to enhance and enchant.
Trovald uses nora as a contrivance for his carnal desires he asks her to dress in provoking outfits to dress up in Capri’s perform the” tarantella.” And Nora goes all the way to satisfy even though her inner self doesn’t consent .Her effort are a clear paradigm of her struggle to keep her marriage intact. But in spite when its trovalds turn to stand up for nora he reputes her and takes the side of society as he weights the values of society more to the love of his wife.
This in turn “opens the door” for nora symbolizing her freedom from the “dollhouse” created by trovald. She walks from the fake world to a free world opening the doors for individual freedom form the precincts of society .that holds individual independence second to society. The transition form “Christmas” to “New year” in noras life Ibsen tries to symbolize the transition” Christmas “symbolizing salvation for nora as Christmas is for everyone one around the world and the ”New Year” a fresh start for nora without the jurisdiction of trovald . She walks out of the dollhouse to a unconstrained, unfettered, self-reliant world were she can be the human not the doll.