Morbidity &Mortality Affecting Humankind †Myassignmenthelp.Com

Question: Discuss About The Morbidity And Mortality Affecting Humankind? Answer: Introducation Tuberculosis (TB) is one of the major causes of morbidity and mortality affecting humankind worldwide. It is caused by bacterium, Mycobacterium tuberculosis that spreads through air from one person to another. It affects lungs and in extreme cases, affects other body parts and cause symptom like chest pain, chronic cough, fatigue, weakness, fever or weight loss. TB deaths are widespread contributing to 7% of most common deaths and first infectious disease becoming a major public health issue. There are also problems of late diagnosis and interrupted treatment being the cornerstone for TB widespread affecting millions of people. Control and prevention of TB are the priority areas to curb this major health issue. This essay aims to examine the causes of MDR-TB and genetic resistance and mismanagement of TB as the key contributing factors to high morbidity and mortality rates worldwide, and then asses the two effects, side effects of drug-resistant TB treatment, high Tb transmission rat es, emergence and major public health issue. TB is one of the major causes of death worldwide and greatly contributing to burden of disease due to mismanagement of TB medications and bacterial resistance to drugs. In 2015, 1.8 million people died from TB majorly in low and middle-income countries (95%). In addition, 10.4 people In addition, 10.4 million people fell ill with TB and estimated 480,000 cases developed MDR-TB. This shows that TB incidence has accelerated to four to 5% annually and likely to increase by 2020 (Zumla, George, Sharma, 2015). This evidence shows that TB Is going to be epidemic taking a heavy toll of life by 2030. It is important to study the causes of MDR-TB resistance to mitigate this major public health issue. There is an ineffective use of formulation of drugs, poor quality medicines, single drug usage, or bad storage conditions causing drug resistance. An also premature treatment interruption is causing this drug resistance and transmission to the population. It is difficult to treat MDR TB resistanc e as the treatment options are expensive and limited and the recommended medicines are not always available. People face adverse drug reactions that is difficult to be treated and as a result, MDR TB is developed. it has been reported that apart from multidrug resistant TB there is additional anti TB drug resistance that respond to few medicines in around 117 countries worldwide. Rifampicin and Isoniazid are considered powerful first line drugs for treating TB and MDR TB is treatable only with second line drugs, however, they are expensive, limited and highly toxic and genetic mutations. The main mechanism of this drug resistance is due to genetic mutation at the bacteria loses the ability to transfer genes through plasmids between organisms by horizontal transfer. There are other mechanisms of drug resistance where M. tuberculosis (TB) cell wall consisting of complex liquid molecules act as barriers and stop drugs from entering the cell. There are also inactivating and drug modifying enzymes TB genome that code for protein and has the ability to inactive drug molecules (Augustine Jain, 2014). These enzymes are acetylate, adenylate or phosphorylate drug compounds. There are also drug efflux systems in TB cell consisting of molecular systems that pump drug molecules actively out of the cell. There are also instances of spontaneous mutations that can occur in TB genome altering the proteins of the target cells by the drugs which make the drug of the bacteria resistant. The mutation takes place in the genes of the bacteria, changes conformation and as a result, unable to prevent the infection spread due to bacterial resistance. Mutation takes place in rpoB gene that code for bacterial RNA polymerase beta subunit (Prammananan, 2017). In TB, which are non-resistant rifampins binds to the RNA polymerase beta subunit and there is disruption of elongation step in transcription. When mutation takes place in the rpoB gene there is change in the Amino acid sequence and eventually beta subunit conformation changes. Therefore, rifampin is no longer able to prevent or bind transcription and bacteria become resistant. There are other mutations that occur in isoniazid (INH) that includes inhA, ahpC or katG genes (Van Deun, Aung, Hossain, 2015). In this mutation, there is apparent replacement of amino acid in the NADH binding site of InhA resulting in INH resistance that prevents the mycolid acid biosynthesis from which the bacterium uses for its cell wall. The m utation that occurs in katG gene results in the inability of enzyme catalase peroxidase to convert to INH that is the biologically active form. Therefore, INH becomes ineffective and as a result, the bacteria become resistant (Salinas, Armstrong, Silk, 2017). MDR-TB or RR -TB can occur in two main ways (Kasapo, Chimzizi, Simwanza, 2017). Firstly, the patient does not take my medicines as exactly as prescribed by the Healthcare professional. It can also happen if the patient is not taking the current drugs and make the bacteria resistant to more variety of drugs that is not recognized by the healthcare provider. In this condition, the resistance remains undiagnosed and referred to as acquired TB. Another reason of MDR-TB is the misuse of the drugs by the patients, as they do not complete the course or inefficiency of drug supply. MDR-TB resistance also occurs when there is mismanagement or misuse of anti TB drugs (Khrstrm, 2014). In this cases, those patients are included who do not complete their full drugs course or treatment or healthcare professionals prescribe the wrong treatment, dose or duration for taking drugs. There are also instances when drug supply is not in ample amount or of poor quality. This resistance causes high burden for TB resistance and a public health issue where around 30 countries are labeled as high burden. Apart from long treatment duration, limited treatment options, side effects and toxicity, there are psychosocial issues that affect patients and challenge the MDR-TB (Thomas, Shanmugam, Malaisamy, 2016). The systematic review results depicted that there are economic and psychosocial issues that challenges MDR patients. Therefore, there is require ment of innovative, feasible economic and psychosocial interventions that help the patients to cope up with MDR-TB with the illness, improve treatment outcomes and adherence and improve their quality of life. From the above discussion, it can be inferred that the main causes of MDR-TB are non-adherence to prescribed drugs and treatment, poor management, unavailability or lack of national programme. Apart from long treatment duration, limited treatment options, side effects and toxicity, there are psychosocial issues that affect patients and challenge the MDR-TB. There is also person-to-person transmission of TB. In most cases, TB is cured through a strict procedure that is six-month drug treatment regimen provided to TB patients with strict supervision and support. However, MDR-TB becomes resistant and gives least response to rifampicin and isoniazid being the most powerful anti-TB drugs. There is high burden of MDR-TB in around 30 countries developing resistance to two major drugs-rifampicin or isoniazidthat causes resistance. Therefore, there is need for treatment compliance, national programme and monitoring of patients response to taking medications. References Augustine, J., Jain, N. 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The WHO 2014 global tuberculosis reportfurther to go.The Lancet Global Health,3(1), e10-e12 https://dx.doi.org/10.1016/S2214-109X(14)70361-