MULTIPLE SCLEROSIS

Multiple Sclerosis

Multiple sclerosis is a Chronic neurological condition that causes disability and limit participation in young adults. Many of the patients of Multiple Sclerosis are of the ages of twenty to fifty, although it is possible for one to get the disease at an early as of two years and elder age of seventy-five years. Some medical practitioners think it is an autoimmune disease, but others disagree because they do not know any specific immune target of the disease. For this reason, they categorize it as an immune-mediated disease. This disease cannot spread from one person to the other, and for the reason it falls under the group of non-communicable diseases. Health practitioners do not regard Multiple Sclerosis as a fatal ailment since many of the patients learn to live with it and manage a normal life span (Sandra and Hans, 2012).

To glean how multiple sclerosis spreads and damages the brain, axon, cells and body, it is essential to study the basic structure of the central nervous. The central nervous comprises of the brain and spinal cord. The Central nervous system is full of nerve cells (neurons). These are the brain cells. The brain looks like a net work of cables rounded up to form a ball like structure. These cables like structures are the neurons (brain cells). Brain cells are different in diverse parts of central nervous system. The axon is an elongated strand comprising soma and myelin sheaths. The axon looks like a necklace of sausage like structures threaded together. Since it is part of the neurons in the brain white matter, tissue it is among the cells prone to Multiple sclerosis attacks. The soma has thin branch like protruding growing from it (dendrites). The axon of one neuron connects to dendrites of other neurons through a synapse (special connection of neurons). Signals travel through axon and pass to other neurons through neurotransmitters (chemical signals) moving across the special connection of nerves. The axon has a coating of a fatty layer of protein (myelin), which aids transmission of brain signals. Axon’s maintenance cells create and repair the myelin sheath. This is the basic structure of the brain (Steen, et al., 2013).

Multiple Sclerosis damages cells, brain, axon and body through drawing of white blood cells to areas of white matter. This results to an inflammatory response same as of the skin to pathogens that cause pimples. This causes the stripping of myelin from axon. This cause parallels to the myelin coating and soon transmission of nerve impulses stops or slows. Inflammation also kills brain maintenance cells. Once inflammation destroys myelin sheath and axon, it is no longer possible for nervous systems, which coordinate the body activities to take place. This is in turn causes disability of the body (Serafin, et al., 2013).

Nervous system, spinal cord, brain coating and myelin produce substances that attract B cells, which are a sub group of lymphocytes. B cells later produce antibodies when they are mature. Once B cells are in the brain, axon and spinal cord they produce toxic substances, which destroy oligodendrocytes (cells producing myelin). It is through the spread of B cells across the brain and spinal cord that Multiple Sclerosis spreads throughout the brain, axon and spinal cord. B cells regulate other lymphocytes, and it is for this reason they produce toxic substances to counter attack T cells found in the brain (Alastair and Alasdair, 2008).

Multiple sclerosis manifests itself in patients in either one of the four available courses. These are relapsing-remitting, Primary-progressive, secondary-progressive and Progressive relapsing Multiple sclerosis (Talbot, 2010). The four are either placid or severe depending on a patient. Relapsing–remitting is a condition that exhibits clearly defined attacks of worsening neurologic functions. These attacks are relapses, flare-ups, or exacerbation. These attacks occur in the form of the disease worsening after a period of latency. During the remission stages, no progression of the disease occurs. Doctors diagnose about eighty-five percent of Multiple sclerosis patients with relapsing-remitting Multiple sclerosis in the first diagnoses.

The second course of Multiple sclerosis is the primary-progressive sclerosis. Slowly worsening neurologic functions characterize the disease course from the onset without any relapses or remissions. Rate of disease progression varies with minor improvements and latencies. Health care specialists diagnose about ten percent of multiple sclerosis patients with this level of multiple sclerosis.

The third level of the disease is the secondary-progressive multiple sclerosis. After the relapse-remitting stage, many patients develop secondary-progressive multiple sclerosis. The disease in this level worsens steadily without flare-ups and remissions. In the past, about half the number of people diagnosed with remitting-relapsing multiple sclerosis developed this disease in a period of about ten years. No data is available to prove that these medications delay the progress of the disease.

The fourth stage of multiple sclerosis is the progressive-relapsing course. This is a very rare condition affecting about five percent of all multiple sclerosis patients. In progressive-relapsing course, one experiences steadily worsening disease from the onset, but with no clear attacks of worsening nervous system function. Some people experience a bit of recovery in this stage while others do not. The disease continues to progress without any remissions.

Doctors are yet to find exactly what causes multiple sclerosis, but there is interesting information suggesting that a person’s environment, genetics and viruses play a role in the spread of the ailment. Some doctors disagree with these findings while others support them as possible causes of the disease (Richman and Scrub, 2012).

Epidemiological data indicates interesting trends of multiple sclerosis. Different people and population groups have different prevalence of the condition. The disease is common in Scotland, Scandinavia and across the northern part of Europe. In USA, prevalence is higher in whites than among other racial groups. Studies show that some areas have higher multiple sclerosis prevalence than others. These studies also suggest that if one moves from an area with high prevalence to an area with low prevalence of the disease, the risk of acquiring the disease lowers with the risk associated with the new environment. This is the case if the movement occurs before puberty. This data implies that exposure to environmental agents before adolescence poses a threat of multiple sclerosis infection to a person. Both hemispheres of the earth experience high multiple sclerosis levels. This has led to the notion that multiple sclerosis is a disease of temperate climates. As a result, its prevalence increases with distance from the equator (Korteweg, 2011).

Some researchers believe multiple sclerosis is an inherited condition that runs through ancestry lines. These researchers believe there is more than one gene that increases the risk of acquiring this condition. Some argue that multiple sclerosis develops because one has an inborn genetic predisposition to react to environmental agents, which trigger auto immune responses. Auto immune responses refer to the error of genes, which manage to lack of differentiation between body genes and external pathogens (Steen, et al., 2013).

Other studies suggest the cause of the condition is viruses. Studies have suggested that several viruses such as Epstein-Barr, vermicelli zoster and hepatitis vaccine cause of multiple sclerosis. Doctors are yet to prove this study (Serafin, et al., 2013).

At times, multiple sclerosis may not show any symptoms; this makes it hard to detect whether one suffers from it or not. The specialist in such a case uses several strategies to diagnose the condition. These strategies include analysing medical history, brain examination and other test such as magnetic resonance imaging, evoked response techniques and spinal-fluid analysis. To diagnose multiple sclerosis a physician must first find evidence of damage in the central nervous system; then try to find evidence that this damage occurred at least a month apart then later rule out any other possibility for the damage. There is an international guideline, which specialists follow in carrying out the diagnosis. Doctors also use these techniques to assess second area damage in an individual (relapse) of Multiple Sclerosis, also referred to as clinically isolated syndrome (Miller, et al., 2009). An individual with this condition may or may not progress to the multiple sclerosis stage.

A medical history analysis is one of the techniques health specialists use to diagnose multiple sclerosis. In this test, the specialist takes a careful history and any past and present symptoms of multiple sclerosis. The doctor also gathers information such as age, birthplace, ancestry history and places an individual has travelled to find clues of the condition. The physician then performs several tests to assess the mental, speech functions, emotional, coordination, body balance and normal functions of other body senses (Franciotta, et al., 2008).

Magnetic resonance imaging is another method doctors use to diagnose multiple sclerosis. This is so far the best imaging technique that doctors can use to discover lesion (scarring) in the central nervous system. The technique can also differentiate new and earlier scars. However, despite the efficiency of this technique, health practitioners cannot rely solely on this method to diagnose sclerosis since there are other conditions such as cysts, which cause scarring in the central nervous systems. It is essential to realize that about five percent of people diagnosed with multiple sclerosis do not initially have lesions (Korteweg, 2011). Visual evoked techniques record the nervous system’s electrical response through stimulation of certain sensory transmission paths, such as auditory, visual and general sensory. Destroying myelin results to slowing of response, the evoked techniques give evidence for slowed sensory responses. Spinal fluid test is another technique doctors use to detect sclerosis. This method detects the level of certain immune system proteins and presence of oligoclonal bands (Serafin, et al., 2013). The bands that show an immune response within central nervous system are present in spinal fluids of about ninety percent of people with multiple sclerosis (Coles, et al., 2009). Health practitioners cannot rely on this method solely since there are other conditions such as migraine, cysts and malformations, which show similar results.

Health practitioners are yet to find a cure for multiple sclerosis. However, there are therapies, which slow down the disease. The aim of multiple sclerosis’ treatment is to control symptoms and help an individual keep up a normal life style (Hafler, 2013). Therapies available to patients include speech therapy, occupational therapy and support from other groups of people. Speech therapy helps people learn alternative ways of speech if they lose this vital sensory function. Occupational therapy is to help people make a living despite losing their sensory functions. Support group therapy helps a patient over come side effects of the disease such as depression (Darcy, 2012).

Recent studies show that early treatment helps patients delay disability, perhaps through decrease of injury to the nervous system. Treatment of Multiple sclerosis falls into two categories. The first group is the treatments that address symptoms management of the disease such as therapeutic treatments. The second group is of treatments, which change the course of the disease (Alonso and Hernia, 2008). The treatments that alter the course of disease do this via modifying a number of attacks and their severity. FDA has already approved six different multiple sclerosis products. The six are three interferon-beta products (Avonex, Betaseron and Rebif) and three unrelated products (Novantrone, Tysabir and Copaxone).

Betaseron was that first drug that FDA approved and marketed in USA. As with all beta interferon, this product shuts down inflammation of multiple sclerosis lesions through different mechanisms including repairing blood brain-barrier and reducing inflammatory process of lesions. Anovex slows down the rate of disability in relapsing-remitting multiple sclerosis and amount of accumulated multiple sclerosis damage. Rebif is same in structure to anovex. However, Rebif is effective in reducing the number and severity of disability and the number of new lesions (Franciotta, et al, 2008).

Copaxone treatment product differs from beta interferon in chemical composition. These products consist of a group of amino acids, which look like myelin. The drug acts through suppressing the immune system’s attack on myelin. It decreases the frequency and severity of attacks to a similar extent as Betaseron, but with a less effect on lesions. Doctors administer this drug daily to patient through subcutaneous injections. The product is effective for treating relapsing-remitting course of multiple sclerosis. Tysabir is another non-beta inferno product that doctors use to treat multiple sclerosis. This product blocks receptors on white blood cells from entering spinal cord and brain. Tysabir slows down the progress of disability. Novantrone is a non-toxic chemotherapy agent that slows multiple sclerosis progression and reduces relapses through suppressing activities of T Cells and B cells. This product is effective in treating almost all the courses of multiple sclerosis (Franciotta, et al., 2008)

Research shows that more than fifty percent of the world’s population are genetically incapable of developing multiple sclerosis regardless of their environments (International Multiple Sclerosis Genetics Consortium, 2009). The most susceptible areas are northern America and Europe. The two places determine regional variations in disease characteristics. Many of multiple sclerosis patients are women, with about seventy-five percent of all patients been women. Despite the many female patients research records that men have a sixty percent chance of being genetically susceptible. In the recent years, women have shown high response to environmental changes.

Research has also brought developments in diagnoses of the disease. Doctors used assumption methods to diagnose multiple sclerosis in the past. This often led to misdiagnosis and probably wrong medications. In the recent years, research has seen doctors adopt new strategies in diagnoses of the disease. One of the new strategies doctors use in modern diagnosis is the Multiple sclerosis diagnosis international guideline (Alonso and Hernia, 2008). This guideline guides doctors on the techniques and methods they are to use when testing patients for multiple sclerosis. This has contributed to the success of medical practices ion treatment of multiple sclerosis. Modern technologies such as evoked technology systems and Magnetic resonance imaging are able to detect symptoms even when the patient shows no visible symptoms (Serpell, Notcutt and Collin, 2013). Researchers have also provided us knowledge of ailments, which show similar symptoms and signs to multiple sclerosis.

A recent research study has given hope to multiple sclerosis patients. This is the year 2008 Myelin repair research. In the year, 2008 Myelin Repair Foundation got the first patent and in 2010, the second patent of the research. This research has similar suggestions as to the cause of multiple sclerosis with the Professor Jeffrey’s 2001 research on multiple sclerosis. Both studies show that multiple sclerosis might be an autoimmune infection. This supports the idea that multiple sclerosis occurs because of the immune system errors. The Myelin Repair research differs with Jeffrey’s research in treatment for the condition. The research Jeffery did aimed at discovering medications for symptoms while Myelin repair research aims at discovering treatments to control development of the condition. This new development is necessary in helping people at risk of the disease to delay the progression of the condition (Murray, 2008).

In conclusion, Multiple sclerosis is a disease, which destroys an individual’s central nervous system. Once the disease has destroyed the central nervous system, impulses from the brain and spinal cord can longer pass through nervous fibre in a normal way. This altering of transportation of nervous impulses affects normal body and sensory coordination and functions. This is the cause if disability and loss of sensory functions in patients of multiple sclerosis. Researchers have developed new methods and techniques, which make it easy to diagnose and slow the progress of this disease. There are other medicines and treatment options still under study, which has created hope for people with multiple sclerosis.

References

Alastair C and Alasdair A. (2008). Report From request, The Lancet, vol. 372, no 9648, pp1502-1517.

Alonso A and Hernia A. (2008). Temporal trends in the incidence of multiple sclerosis. Neurology, 71(2), 129-135.

Coles J, Compston D, Selma K, et al. (2009). Experimental medicines in multiple sclerosis and compassionate use. J R Coll Physicians Ed in, 39, 35–7.

Darcy C. (2012). Multiple Sclerosis: An overview Clinical review MS part 1. Nursing and Residential Care, 14(8), 335-337.

Franciotta D, Salver M, Lolli F, Aloisi F and Serafini B. (2008). B cells multiple sclerosis. Lancet Neurology Journal, 7( 9), 852 – 858.

Hafler DA.( 2013). Multiple Sclerosis. The journal of Clinical Investigation, 788-792.

International Multiple Sclerosis Genetics Consortium. (2009). SHORT COMMUNICATION The expanding genetic overlap between multiple sclerosis and type diabetes. Genes and Immunity. 10, 11–14.

Korteweg T. (2011). MRI in Multiple Sclerosis:From diagnosis to prognosis. Lancet neurology, 5, 221-227.

Murray T, (2008). Multiple Sclerosis: The History of the Disease, Dalhousie MS Research Unit.

Richman S & Scrub T. (2012). Quick Lessons about Multiple Sclerosis. California, and Clinical information system.

Sandra A, and Hans, V N. (2012). Multiple Sclerosis. Oxford.

Serafin B, Muzio L Rosicarelli B and Aloisi F. (2013). Radioactive in Situ: hybridization for Epstein–Barr virus–encoded small RNA support the presence of Epstein–Barr virus in the multiple sclerosis brain. Brain Journal of Neurology, 1-6.

Serpell G, Notcutt W and Collin C. (2013). Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis. Journal of Neurology, 260(1), 285-295

Steen C, D’haeseleer M, Hoogduin J, Ferns Y, Cambron M, Mostert J, Heersema D, Koch M and De Keyser J. (2013). Cerebral white-matter tissue, blood flow and energy metabolism in multiple sclerosis. Multiple Sclerosis Journal.

Talbot, P. 2010). Understanding the Types of Multiple Sclerosis and Prognostic Indicators. British Journal of Neuroscience Nursing, 6( 4),161-166.

HITECH Legislation

HITECH Legislation

Organizations must use health information technology in a meaningful way in order to receive incentives. The US department of health and human services has a structure of factors that must be met before qualifying to receive EHR incentives.

The primary goals of HITECH legislation are to advance American patient care provision through an exceptional investment in health information technology (HIT). The legislation also aims to provide backing and technical support to providers of HIT. It seeks to enable coordination and establish connectivity to the public health community in case of healthcare emergencies. The legislation also aims to make sure of adoption of health information technology in different organizations to reduce the cost of healthcare, improve care coordination, and reduce healthcare disparities.

The meaningful use criteria of the legislation has both negative and positive impacts on the adoption of health information technology. The legislation has had positive effects in my organization. Firstly, the legislation has led to improvements in patients’ privacy. The legislation protects the disclosure of health information of patients. Nursing practitioners are aware of the need to maintain patients’ privacy in my organization. Secondly, the legislation has improved public participation on healthcare provision. The public has been able to participate through the development of my organization’s HIT infrastructure. Thirdly, my organization has received incentives because of significant use of HIT. This has had a significant boost on the quality of health care of my organization.

There have been negative impacts in my organization because of the legislation. The legislation has diluted the compliance of HIPAA privacy and security rules (Kempfert, 2011). This has translated to reduction in portability healthcare insurance in my company. The overall effect has been the fact that; the legislation has increased the expenditure of my organization, mainly through the development of its HIT infrastructure to conform with health information technology (Murphy, 2010a). In addition, this has led to my organization laying more emphasis on meeting the criteria for HIT incentives rather than improving the quality of healthcare (McGonigle, 2012). This has led to the compromise of the quality of patient care in my organization.

The incentives that encourage the use of EHR include monetary benefits to providers such as funding the organization and reimbursement to health practitioners. These incentives get accrued to organizations that meet the criteria for meaningful use in order to encourage them to continue the use of health information technology. Meaningful use refers to providers that use certified EHR technology in an effective manner (Tomes, 2011). The providers must also use electronic exchange of health information, reports clinical health measures and improve quality, safety, efficiency, and reduce health disparities. In addition, they must improve care coordination, population and public health and ensure adequate privacy and security protections for personal health information (Classen et al, 2011). Meaningful use is measurable through self-attestation and electronic reporting. The incentives and meaningful use concept have an important influence on the worth of healthcare. Incentives have increased adoption of healthcare information technology in most organizations resulting to improvement in the quality of healthcare. In addition, it has improved privacy and efficiency in health recording. This has added to the development in the value of healthcare. However, some organizations work to meet the criteria for receiving incentives at the expense of the quality of healthcare (Pipersburgh, 2011).

I have identified Classen’s article on “Finding meaning in meaningful use”. The article recounts that health information technology is developing at a slow pace. It postulates that the legislation will have a significant improvement on the adoption of HIT (Murphy, 2010b). The article articulates that the intent of meaningful use is to provide incentives to providers of HIT and improve the quality, safety and efficiency in healthcare delivery (Brown, 2010). This article outlines that achieving improved healthcare will be difficult to realize than initially thought.

Information technology can meet the requirements of meaningful use through the use of several structures. The structures can range from systems for computerized physician order entry to decision support. The article outlines that meaningful use criteria require assessment of different quality measures to report whether information technology meets meaningful use. Measuring different goals of information technology can demonstrate whether it can realize meaningful use. In addition, the Certification Commission for health information technology should undertake a rigorous certification of health information technology to ensure the realization of meaningful use (Arlotto, 2010). There should be health tools to evaluate HIT and ensure it can meet the requirements of meaningful use.

In conclusion, the need to improve efficiency and quality in healthcare has increased investments in health information technology. The perception is that adoption of health information technology can reduce costs and improve the quality of patient care. HITECH legislation seeks to empower and ensure the adoption of health information technology through the provision of incentives to providers.

References

Arlotto, P. (2010). 7 Strategies for improving HITECH readiness. (Healthcare Financial Management), 64(11), 90–96.

Brown, B. (2010). The ultimate directions for meaningful use of EHRs. Journal of Health Care Compliance, 12(5), 49–50.

Classen, D. C. (2011). Discovering meaning in meaningful use. New England Journal of Medicine, 365(9), 855–858.

Kempfert, A. E. (2011). Patient care development in the United States: HITECH Act and HIPAA privacy policy, security measures, and enforcement Issues. FDCC Quarterly, 61(3), 240– 273.

McGonigle, D., and Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.

Murphy, J. (2010a). Impact of health IT on care quality: How are we doing 10 years after IOM’s Crossing the Quality Chasm Report? Journal of Healthcare Information Management, 24(4), 7–9. Retrieved from http://www.himss.org/content/files/jhim/24- 4/3_MURPHY.pdf

Murphy, J. (2010b). Nursing informatics. The journey to meaningful use of electronic health records. Nursing Economics, 28(4), 283–286.

Pipersburgh, J. (2011). The struggle to escalate the implementation of EHR technology in hospitals by physicians in the United States through the use of the HITECH Act background and the Medicare Incentive Program. Journal of Health Care Finance, 38(2), 54–78.

Tomes, J. P. (2010). Preventing the trap in the HITECH Act’s benefit timeframe for implementing the EHR. Journal of Health C

Christian Ethics Teachings in Relation to Homosexuality

Christian Ethics Teachings in Relation to Homosexuality

Marriage signifies Christ’s union with people. This apparently is one of the definitions of marriage in a Christian context. Christian marriage is holy and represents God’s promise to reunite with his people. From this definition, marriage should provide people with an opportunity to praise and serve God through their union to be one. Other people in the secular world consider marriage as an amalgamation between two people with a view of enjoying life pleasures together. This completely contradicts the Christian marriage described in the Bible. From a Christian perspective of marriage, it dates back to the times of Genesis. This is the beginning of the world according to the Bible. At this time, God decided to give Adam a helper to help him continue serving God in the Garden of Eden. This clearly shows God’s purpose for marriage. The purpose was to bring two people, male and female, together for them to work together in order to glorify God. According to Rogers, this in turn will bring Christian marriages the joy and blessing God has purposed for Christians.[1] Thus, a Christian marriage is against same sex marriage in the form of homosexuality.

The helper that God created for Adam was Eve, a woman; this represents the union God intended for people to have in a Christian context. People, including some Christians have a different opinion of marriage and the helper God intended to give a man. People in the modern world accept same sex marriages as a part of marriage. Marriage, according to the Christian definition, is God ordained, and as such ought to be holy and conducted in a holy way. For marriage to pass the test of holiness, couples should ensure utmost faithfulness in their union and support each other at all times.[2] However, this is not the case in modern secular marriages. Couples do not offer each other the support required in their union. Many couples in modern marriages fail to uphold honesty and faithfulness to each other. This is a reason for high divorce among couples in a modern world. This goes against the definition of a Christian marriage.

The Biblical stance on marriage is that Christian marriage is for the purpose of procreation and raising families. This is against what many people perceive marriage to be. All over the world, there is the general thought that marriage is for sexual pleasure and personal fulfilment. Many people today get into marriage with the idea they will be happy once married. Modern sexual approaches cause the liberal views and have greatly contributed to this thought about marriages. This is also the reason many people are cohabiting in the modern world. To them marriage serves just one sole purpose, sexual pleasure and satisfaction. When God created Eve, he told both Adam and Eve to venture out into the world, multiply, and fill the earth. Many have misinterpreted this statement, and as a result, people engage in sexual relations outside marriage. God intended marriage to serve as an institution that will raise children in the way that He pleases. To others marriage solely serves the purpose of companionship and as a result, they choose to live together, but have no children. This contradicts the Christian definition of marriage.[3]

Christian marriage represents God’s eternal love to human kind. God’s love surpasses all and is permanent. This is what Christian marriage is all about, permanence. From a Christian perspective, marriage should be a permanent union between a man and a woman. This relationship should stand against until the end of time. Other people do not uphold this definition of marriage and have created a room for separation and divorce. [4] Christian marriage does not make provisions for this; the only factor that should separate couples in a Christian marriage is death. In the secular world, marriage is a union between two people who are of the same gender or the opposite gender that has no guarantee of lasting forever. This provides the freedom to change partners through divorce or separation. Many families are breaking up because a large number of people are adopting this definition of marriage that contradicts Christian marriage.

The Holy Bible talks about sexuality and homosexuality; there are verses mainly in Genesis, Leviticus, Romans and Samuel that speak about this sensitive issue.[5] The Bible though not directly opposes same gender sexual relationship in the book of Genesis. Genesis speaks of God creating a woman from a man’s rib. When Adam wakes up from his sleep, he finds Eve, the woman who God has created for him. He appreciates her. Later God tells them to multiply and fill the earth. This part of the Bible implies that God is only happy with relationship between a man and a woman since this is the form of relationship capable to fulfil his command of filling the earth. Homosexual relationships do not support God’s will to reproduce. This is one of the reasons for the Bible rejecting such form of relationships. Eve was a woman, which is a suggestion in the Bible that God intended the all-sexual relationships ought to be only between a man and a woman. Other animals uphold this, but humans argue against it. Liberals argue that God in Genesis said He created a man in His personal image and as such, the man has a right to decide which form of relationship to uphold. They argue that since a man takes God’s form, a human being has freedom of choice to choose the form of sexual relationship that best pleases him or her.

Still in the book of Genesis, many Bible conservatives argue that God created a woman for Adam because he intended sexual relationships to be between the individuals who complemented each other both anatomically and emotionally. Same sex marriages do not allow for anatomical compliment since the parties involved are of the same gender.[6] Since going against the Bible contributes to sin, homosexuality is a sin according to the Bible. The books of Romans and Corinthians lump homosexuality together with other sexual sins such as adultery. This makes it a sinful act before God. God did not intend people to show their emotions and passion for each other in any other context, especially outside a marriage between a man and a woman. Liberal Christians and other people, who believe that the sole determiner of wrong and good is God, agree that homosexuality and any other sexual activity outside marriage is wrong and contrary to the Bible.

The Bible’s stance on sexual activity is that all forms of sexual activity are for marriage. Several verses in the Bible support this, with some especially in Romans and Corinthians condemning all forms of sexual activities and terming them as sin, which will deny entry into the kingdom of God to such people. The Bible describes sex as a holy mystery, which God has reserved to married couples. The Bible clearly spells out that a man and a woman shall leave their parents and unite as one to form their family. Those with a conservative view towards the Bible argue that in Genesis the Bible gives the right to reproduce to these who choose to marry. This is not direct, but since the earlier verses suggest that God created a man and a woman to procreate and fill the earth, then it is possible to state that the Bible objects any form of sexual activity outside marriage and also against homosexuality relationships. [7] The Bible’s hint at opposition to homosexual activity whether inside or outside marriage is evident. This is can be exhumed in Genesis where after two angels visited Lot, the Sodomites found the angels from God appealing, and God cursed Sodom and Gomorrah for their sexual impurity. If the Bible was to support homosexual activities, then, the writer of the verse would not have used the terms a man and a woman explicitly. Those with liberal views suggest otherwise since they argue that the Bible is only against sexual activity outside marriage, but does not specify that homosexual activities among married gay people are wrong. They believe it would be erroneous for God to punish homosexuals who engage in sexual activities while in marriage, and continue to serve God in all other aspects of their relationships. They further argue that it is wrong to isolate homosexual activities since the Bible does not only mention homosexual activities, but also mentions other sins. In summary, the Bible does not support any form of sexual activity outside marriage.

Christian views on homosexuality vary with some groups supporting homosexuality and conservative Christians are greatly opposed to it. The conservative Christians believe homosexuals disapprove God’s decision to create Eve, a woman, for Adam instead of another Adam. They support their arguments with verses mostly in Genesis that show the origin of human kind. Disapproving God makes homosexuality a wrong and sinful practice that according to conservative Christians ought not to happen. On the other hand, there are liberal Christians who question the motive behind marriage whether a gay marriage or a straight couple marriage. This group argues that it is not right to disapprove all gay marriages since some of these relationships have true and unending love between the partners. This is one of the pillars of true Christianity to love each other eternally as Christ loves humans. [8] They further argue that some marriages between people of the opposite sex fail to uphold the values of honesty and faithfulness, which are important for every Christian marriage. Despite their differences, both these Christian groups agree that the Bible condemns all sexual activities outside marriage. According to Christianity, Christian ethics teaches that full sexual relationships ought to take place within marriage. This means that whether a relationship is between two people of the similar gender or not, the parties involved should reserve any form of sexual activity until they get married.

Liberal Christians and other liberal minds believe that marriage and all other aspects of life should change with the changing society.[9] For this reason, they support gay marriages since current times provide that each and every person has the right and freedom to make their own decisions. Some liberals believe that homosexuals have genes that make them gay. Liberal Christians also believe that it is best to interpret the Bible with the existing society. They believe God’s word should adjust with the changing times. They also hold the idea that those Bible writers failed to recognise homosexual relationships and as a result, some only wrote against these relationships. On the other hand, conservatives, both Christians and none Christians believe that it is against the rules of nature and God to have any other form of relationship besides normal relationships between a man and a woman. Despite all the variations in opinions, all these groups agree that uncontrolled sexual behaviour especially outside marriages can be disastrous and should not exist in the society. While Christians uphold that any form of sexual behaviour outside marriage is wrong, other groups may fail to agree, but either way they either support or condemn homosexuality.

As much as some Christians oppose homosexual relationships, a large number still agree it is unfair to discriminate against these groups. Even other non-religious groups opposed to homosexuality still agree that it wrong to discriminate against gays since they are humans like others. However, conservative people feel that gays can change this form of behaviour.[10] Contrary to their views, liberal minds believe that as a human being it is impossible to control emotions and the person one chooses to love. They argue that as much as almost all the relationships in the Bible are between men and women, Jesus told his disciples to love their neighbours in the same measure as they love themselves. They argue that if Jesus were in the modern society, He would be happy for the committed gay relationships, as opposed to straight sex oriented couples who have built their relationships on deceit and for all the wrong reasons. In simple terms, Christians and other individuals around the world form their opinions about homosexuality depending on their faith and beliefs. They argue differently, but in some opinions, they agree. Many people believe that sexual activities are reserved for married couples.

The Roman Catholic stance on homosexuality is that it is not right and orderly in the sense that it is evil. Conservative Roman Catholics argue that homosexuality fails to acknowledge the purpose of sexual activity as God intended it. Homosexuality is sinful and immoral according to Roman Catholic beliefs. This is because homosexual relationships fail to meet both the uniting and procreation roles of a marriage according to the Bible. The church does not limit these teachings on homosexuality only, but also on other sinful sexual activities such as sodomy and adultery. The Roman Catholics state that homosexuality is a conservative approach and the church believes that the only correct and right relationships before the eyes of God are male-female relationships. The Church of England has held that homosexual marriages are wrong and sinful. Its sentiments resemble those of the Roman Catholics.[11]

Baptist church, the Methodist and the Anglican churches are on the verge of breaking because of different opinions regarding same sex marriages. The Methodist church of Britain is yet to take a definitive stance on homosexuality. This church does not denounce discrimination against homosexuals, and affirms homosexuals’ participation in the ministry. However, this church no longer blesses same-sex marriages. Meanwhile, the United States Methodist church does not support inclusion of homosexuals in church activities such as sacraments. However, this church clearly states that homosexuality is against its teachings, and as a result it prohibits homosexuals to be ordained as church ministers.[12]

Another church divided on the issue of homosexuality is the Anglican Church. This church, being a protestant church, has a good number of liberal minds. They believe since God created everything, He also created homosexuals the way they are; they believe that all those verses and Biblical quotes that condemn homosexuality are archaic and biased. Their stance on the issue of homosexuality is that there is no way God can create a homosexual then accuse His own creation of sinning. They agree that the Bible condemns sinful acts among homosexual activities and others such as adultery. Liberals argument is that no human has the capability to know what is right and wrong in the Bible, and this is not a justified means to discriminate against homosexuals or to terms them as sinners.[13]

On the other hand, extreme Anglican conservatives argue that the practice of homosexuality is wrong according to the Bible. They argue that homosexuals make a personal choice to be who they are since humans have the ability to control their desires. They believe such relationships are because of dysfunctional relationships and a corrupt world. Their stance on homosexuals is that they are perverts and are skilled to use politics and media to move their immoral activities to the limelight. To them homosexuality is the worst form of a sexual sin. In the Bible, they clearly state it is God’s word, which is unquestionable and since the Bible opposes homosexuality they strongly stand by this.[14]

Christian teachings and ethics do not support sexual activities outside marriage. This is the stance of many churches and other religious groups in society. Issues of homosexuality create a large division among Christians, with some supporting and other opposing this form of relationships. As a theoretical reflection, it is essential to assess the truth in these teachings. This is using the theological principle of “not yet”, which states that Christ exhibited his love for humanity sacrificing Himself for people’s sin. In a similar manner, people should show their love through sacrificing sexual pleasures and activities outside marriage until they get married. This way couples will remain faithful to Christian teachings, which besides stating it is unethical to have sexual activities before marriage urge people to have unending love for each other in relationships. [15]This is what Christ emphasised on; true love that surpasses all kinds of love. Corrupt worldly ideas continue to carry Christians away from their stance on sexual activities before marriage.

My view on sexual activities before marriage is that no sexual activity should occur prior to marriage. The Bible does not support such activities through the Biblical stories told in it. As a strong Christian faithful, my views on sexual activities outside marriage are that they are sinful acts, which displease God. On the issue of homosexuality, I believe that no human ought to judge another’s activities and choices. I am of the view that God forgives all sins; no sin is greater than others. This means that even homosexuality is a sin that God can forgive, and all humans are sinners of different sins. Therefore, discriminating against them is not justifiable. As humans, we should agree and leave conflicting issues that only God can give solution to, the way they are. However, as much as it is not right to discriminate against homosexuals it is essential to realise that it is a sin from a Biblical perspective because this practice goes against the rules of nature and does not meet the goals of marriage as God intended it. God purposed marriage to be a holy institution in which two people of different gender would unite. These two people ought to help one another to serve God in their different capacities. Another reason why God created marriage is to procreate and fill the earth. Critics argue this is possible even in homosexual families, but it is not possible biologically. Therefore, it does not serve as a strong justification for homosexuality in my view.

In conclusion, God created sex and reserved it for married people. This makes any form of sexual activity outside marriage a sinful act, which Christians should refrain from to serve God in their marriages and relationships as it should be. The issue of gay marriages is a controversial issue that has resulted in a great unending debate, both in churches and the entire universe. The Bible, which is a Christians` guide, opposes this, and some Christians follow suit. The liberal ones argue one should interpret the Bible according to the present time. The debate is not ending any time soon, but if the Bible is right, then homosexuality is a sin.

Bibliography

Ash Christopher, Marriage and Sex in the Service of God, (IVP, 2003).

Boswell James, Christianity, Social Tolerance and Homosexuality, (Chicago University Press, 1980).

Bradshaw Timothy, (ed.), Which is the Way Forward? Christian Voices on Homosexuality and the Church, (Hodder & Stoughton, 1997).

Coleman Peter, (ed. Michael Langford), ‘Christian Attitudes to Marriage: From Ancient Times to the Third Millennium’, SCM, (2004) .

Doe Michael,’ Seeking the Truth in Love: the Church and Homosexuality’, DLT, (2000).

Dormor Duncan and Morris Jeremy (Eds.), An Acceptable Sacrifice? Homosexuality and the Church, (SPCK, 2007).

John Jeffrey, ‘Permanent, Faithful, and Stable: Christian Same-Sex Partnerships’, Affirming Catholicism, (1993).

McCarthy David Matzo, ‘Becoming One Flesh: Marriage, Remarriage and Sex’, in The Blackwell Companion to Christian Ethics, (Blackwell, 2004), chapter 21.

Paul II John. ‘On the Original Unity of Man and Woman’, 9 November 1979, <http://www. Vatican.va/holy_father/john_paul_ii/audiences/catechesis_genesis/documents/hf_jii_aud _19791107_enht>

Rogers Eugene F., ed., Theology and Sexuality, (Blackwell, 2002) .

[1]Eugene F. Rogers, ed., Theology and Sexuality, (Blackwell, 2002)

[2][2]David Matzko McCarthy, ‘Becoming One Flesh: Marriage, Remarriage and Sex’, in The Blackwell Companion to Christian Ethics, (Blackwell, 2004), chapter 21

[3]John Paul II. ‘On the Original Unity of Man and Woman’, 9, November 1979, <http://www.vatican.va/holy_father/john_paul_ii/audiences/catechesis_genesis/documents/hf_jii_aud_19791107_en.html>

[4]Jeffrey John, ‘Permanent, Faithful, and Stable: Christian Same-Sex Partnerships’, Affirming Catholicism, (1993)

[5]Timothy Bradshaw (ed.), The Way Forward? Christian Voices on Homosexuality and the Church, (Hodder & Stoughton, 1997)

[6]Timothy Bradshaw (ed.), The Way Forward? Christian Voices on Homosexuality and the Church, (Hodder & Stoughton, 1997)

[7]Peter Coleman, (ed. Michael Langford), ‘Christian Attitudes to Marriage: From Ancient Times to the Third Millennium’, SCM, (2004)

[8]Michael Doe,’ Seeking the Truth in Love: the Church and Homosexuality’, DLT, (2000)

[9]James Boswell, Christianity, Social Tolerance and Homosexuality, (Chicago University Press, 1980)

[10]Peter Coleman, (2004)

[11]Timothy Bradshaw (ed.), The Way Forward? Christian Voices on Homosexuality and the Church, (Hodder & Stoughton, 1997)

[12]Ibid

[13]Duncan Dormor and Jeremy Morris (eds.), An Acceptable Sacrifice? Homosexuality and the Church, (SPCK, 2007)

[14]Ibid

[15]David Matzo McCarthy, ‘Becoming One Flesh: Marriage, Remarriage and Sex’, in The Blackwell Companion to Christian Ethics, (Blackwell, 2004), chapter 21

Tuberculosis

Tuberculosis is both a dangerous and an infectious disease. A bacterium known as mycobacterium tuberculosis causes the illness. The disease attacks lungs but can also affect other organs of the body. The disease has become rare in developed countries but remains a significant epidemic in the middle and low-income countries. An estimated one and a half million people perish from the disease annually globally (Varaine & Rich, 2013). This makes it the highest killer disease in adults second from another infectious disease AIDS, with a majority of the deaths in low-income countries. Treatment remains a constant constraint to patients and a heavy burden for health care systems all across the world. With Tuberculosis being a significant killer disease, it is essential to study the causes, risks, treatment, diagnosis and developments, the health care system has made in an attempt to avert the condition.

Cause of Tuberculosis

Mycobacterium causes the disease, when allowed to grow within the body system. It takes long for the disease to develop after infection because the bacteria multiply slowly (Varaine & Rich, 2013). This bacterium mostly affects the lungs and soon spreads to other body organs. Its effect on the lungs causes pulmonary tuberculosis. The bacteria, which spread to other body organs, are the cause of extra pulmonary tuberculosis (Centres for Disease Control and Prevention, 2000).

Mycobacterium Tuberculosis

Mycobacterium a small rod shaped bacteria about 2 to 4 um in length causes Tuberculosis and other diseases in humans (Varaine & Rich, 2013). Mycobacterium is ‘acid-fast organism’; a name health practitioner derived from the stains scientist and researchers use in the evaluation of tissue specimens. These bacteria are strictly aerobic and thrive in environments with an oxygen supply (Varaine & Rich, 2013). Bacteria may remain latent for years in the secondary stage of infection, sometimes even for months or years. Active tuberculosis may occur weeks or even years after the primary infection (Reichman and Bhavaraju, 2008). The slow rate of occurrence is because of the slow multiplication of mycobacterium. Pulmonary Tuberculosis affects the lungs; it is common in patients with HIV/AIDS because their antibodies are weak to resist disease. This TB spreads to other body organs during a silent phase of the ailment, often in the early stages of infection. Active TB can occur in other the body organs such as lymph nodes, vertebrae, kidney, genital organs and abdominal cavity (Zahrt, 2000).

It is possible to grow tuberculosis bacteria in laboratories. Medical researchers grow the bacteria in laboratories to study it and form analyse the resistant to drugs of the bacteria. This bacterium grows faster in a blood agar than an egg based medium. For this reason, many researchers who grow the bacteria in laboratories use the blood agar (Eichbaum, & Rubin, 2002).

Transmission

Tuberculosis is an airborne disease, which pass from one person to the other through respiration. The source of infection is a person with pulmonary or laryngeal tuberculosis. These are the only types of Tuberculosis that spread. Extra pulmonary tuberculosis is not a transmittable disease. The reason pulmonary tuberculosis and laryngeal tuberculosis are transmittable is because they are in the lungs and larynx respectively. As a result, bacteria encounter air exhaled during coughing, conversations, sneezing or even normal breathing. During these activities, an infected person produces tiny infectious droplets of bacteria. These droplet nuclei are about one to five microns in diameter. The droplets can remain suspended in the air for several hours, depending on the environment. Transmission occurs when one inhales these droplets. Other causes are rare, such as Mycobacterium Bovi transmitted through cowmilk. Children are less likely to transmit tuberculosis because of the weaker sputum in their coughs and low bacillary load (American Thoracic Society, 1999).

People at Risk

HIV/AIDS patients and children are at a higher risk of acquiring Tuberculosis because their body immune systems are weak to handle the bacteria. HIV/AIDS weakens the body immune system making people vulnerable to this disease. Another vulnerable group to the disease is the women. Worldwide, women bear a heavy burden of poverty, poor health and disease. Females are at a high risk of HIV/AIDS infection because, in most instances their men are not faithful, and have multiple relationships. As a result, young women aged between fifteen years to twenty-four years of age with tuberculosis outnumber young males. Poverty is the main cause of high tuberculosis prevalence among women. (Centres for Disease Control and Prevention, 2000).

Signs and Symptoms

Some people do not show any signs for active tuberculosis. Others develop coughs with blood tinged mucous, fever night and appetite loss. These symptoms arise due to the bacteria using up oxygen in the body. This leads to coughs and shortness of breath. In some people, there are no symptoms because the bacteria have a slow progression process. This lengthens the latency stage of the bacteria. In the latent stage, the bacterium is inactive and does not show any signs (Handa, Mundi & Mohan, 2012).

Diagnosis

There are several diagnostic methods for tuberculosis among them sputum smear microscopy, and staining method. Sputum smear method allows rapid and reliable identification of patients with pulmonary tuberculosis if the bacilli sputum concentration exceeds five thousand bacilli per millilitre (American thoracic Society, 2000). Reliability of the sputum depends on the quality of sputum. Taking sputum in the morning yields more reliable results than at any other time because at night one rarely spits sputum since they are asleep. This makes the sputum produced in the morning highly concentrated with bacilli. The reason why health practitioners use sputum spread method to test for pulmonary tuberculosis is that sputum passes through the trachea and is likely to contact bacilli. The staining method is another diagnostic that medical practitioners use. This method uses a technique where mycobacterium retains a primary stain after exposure to decolourising acid-alcohol. The two staining methods that nurses and other health practitioners use most of the times are carbolfulshin procedure and flouro-chrome methods (Partners in Health, 2003). The two methods work best in high load laboratories. The reason why doctors use the red-stain method is that this strategy can detect even other forms of tuberculosis besides pulmonary tuberculosis (World Health Organization, 2011).

Prevention

The first step towards preventing Tuberculosis is to identify the main cause. An individual contact is the main method of transmission of the epidemic (Maher, 1997). Majority of the people who spread this disease are undiagnosed and do not know that they are ailing. This makes it necessary for governments and health systems to create tuberculosis awareness campaigns to let people know the importance of testing for tuberculosis. This will help identify an individual with the disease and inform them on the transmission methods. Awareness programs offer insight into preventive measure one can take to safeguard him or herself from this disease.

Treatment

Treatment of tuberculosis involves taking quadruped drugs, isoniazid, rifampicin, and pyrazinamide and Ethambutol, under the supervisions and direction of a qualified medical practitioner for six months (Centres for Disease Control and Prevention, 2003). Mycobacterium tuberculosis has a thick fat coating, which makes it difficult to kill the bacteria. Recent studies have found an antibiotic that can kill the bacteria after destroying it thick cover. Pryidomycin, an antibiotic produced from the bacterium Dacylosporangium fulvum is the antibiotics, which has given many doctors and tuberculosis patients the hope of killing tuberculosis bacteria. In active bacterium, pylidomycin depletes fatty acids and mycolic acids that form the walls of the bacteria. This makes it possible for the antibiotic together with antibodies to kill the bacteria (Hartkoorn, et al., 2012).

Statistics

About ninety percent of individuals infected do not show any signs of the disease, a situation known as latent infection. If the disease is untreated about a half or third infection cases, will die from the disease while early treatment cures the disease. About ninety-five percent of the deaths are from low-income areas. This is because of lack of resources to treat the disease among this segment of society. This makes it impossible for patients to access medical treatment, which results in many deaths (Varaine & Rich, 2013).

Research and Development in Tuberculosis

The first major breakthrough in combating tuberculosis was identifying the causes and transmission methods. This led to public measures and awareness. The discovery of ways to grow the bacteria in laboratories and development of tuberculin skin test and x-ray imaging were major developments in the nineteenth and twentieth century. Recent studies have elicited how Mycobacterium tuberculosis becomes dormant when its environment becomes hostile (Takenami, et al, 2013). When the bacteria are in a dormant state, they appear to be resistant to common anti-tuberculosis medications. New drug development procedures now test potential agents against both active and inactive forms of the bacilli (Perkins & Cunningham, 2007).

Gene array studies are showing that bacterial molecules and molecular pathways can be targets of potential new drugs. Researchers are currently testing several medicines developed this way (American Academy of Paediatrics, 2012). This is centrally to what was possible in the early years where the health practitioners knew almost nothing about the condition. Treatment was not possible during that time since even the cause of the disease was a mystery to people.

Since research has unearthed more information about the bacteria, newer, faster, and more accurate tuberculosis diagnostic methods are replacing old methods. These new techniques also give clues to how the human immune system deals with infection. Unravelling the genetic sequence of the bacteria has fostered the development of gene amplification tests that can diagnose the disease and detect drug resistance. These techniques can accomplish in hours or a few days what medical practitioners used to take weeks, thus reducing the chances of a person spreading the disease before diagnoses and treatment. This development marks the milestones taken in fighting this disease. In the past, this was not possible since the old methods were slow and inaccurate, which resulted to false diagnosis. This is probably the reason as to why it was extremely difficult to treat and control the spread of tuberculosis in the past. In terms of vaccination, researchers have made remarkable developments ever since the first discovery of the first tuberculosis vaccine, Bacilli Calmettte-Guerin, which French researchers developed in 1921 (Wang, et al, 2002). Contrary to Bacilli Calmette-Guerin Vaccine, modern vaccines work in different places. It is essential to realize one of the weaknesses of Bacilli Calmette-Guerin vaccine is it did not work in all geographical areas (Andersen, et al, 2000; Shelburne, et al, 2002).

In conclusion, tuberculosis is a significant epidemic and killer disease in the world. The disease had greatly reduced to low levels in the past, but with the high prevalence of HIV/AIDS the disease has returned. Developing countries account for about ninety percent of the disease because of poverty, malnutrition, deficiency of health care services and lack of awareness on the disease. Tuberculosis has existed for thousand years; during this time, researchers have made tremendous progress in the fight against the disease.

References

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American thoracic Society. (1999). Diagnostic standards and classification of tuberculosis in both adults and children. American Journal of Respiration Critical Care Med, 161 (4), 1376-1395. Retrieved from http://ajrccm.atsjournals.org/cgi/reprint/161/4/1376.

American Thoracic Society. (2000). Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. Am J Respir Crit Care Med, 161, S221-5247

Andersen P, Munk M.E., Pollock J.M., & Doherty T.M. (2000). Specific immune-based diagnosis of tuberculosis. Lancet, 356, 1099-104.

Centers for Disease Control and Prevention. (2000). Notice To Readers: Updated Guidelines For The Use Of Rifabutin Or Revamping For The Treatment And Prevention Of Tuberculosis In HIV-Infected Persons Taking Protease Inhibitors Or Non-Nucleoside Reverse Transcriptase Inhibitors. M. M. W. R. 49:185-I 89.

Centres for Disease Control & Prevention. (2003). Infectious Diseases and Treatment of Tuberculosis. Morbidity and Mortality Weekly Report, 52(RR11), 1-77.

Eichbaum, Q., & and Rubin, J. (2002). Tuberculosis: Advances in Laboratory Diagnosis and Drug Susceptibility Testing. Am J Clin Pathol, 118(Suppl 1), S3-S17.

Handa U., Mundi I. & Mohan S. (2012). Nodal Tuberculosis Revisited: A review. J infects Dev Ctries, 6(1), 6-12.

Hartkoorn, C., Sala, C., Neres, J., Pojer, F., Magnet, P. Mukherjee, J. Uplekar, S. Boy-Röttger, S., Altmann, K., & Cole, S. (2012). Towards a new tuberculosis drug: pyridomycin – nature’s isoniazid. EMBO Mol. Med.

Maher, D., Harries, A., Spinaci, S. & Chaulet, P. (1997). Treatment of tuberculosis: guidelines for national programmes. CAB Direct, 1-77. Retrieved from: http://www.cabdirect.org/abstracts/19982002966.html;jsessionid=295358C141A387217CF510057E07CDE2?gitCommit=4.13.29.

Partners in Health. (2003). PIH Guide on medical management of MDR-TB. Partners in Health, Boston. Retrieved From:http://whqlibdoc.who.int/publications/2009/9789241547765_eng.pdf.

Perkins M.D. & Cunningham J. (2007). Facing The Crisis: Improving The Diagnosis Of Tuberculosis In The HIV Era. J Infect Dis, 196(1), S15–27.

Reichman, L.B & Bhavaraju, R. (2008). Guidelines for the Diagnosis of Latent Tuberculosis Infection in the 21st Century, 2nd Edition. Newark: New Jersey Medical School Global Tuberculosis Retrieved From Institute;http://www.umdnj.edu/globaltb/products/diagnosisofltbi.htm

Shelburne A, Rodriguez-Barradas M.C, Hamill R.J., Greenberg S., Atmar R., Musher W., Gathe J.C, Visnegarwala F. & Trautner B.W. (2002). Immune Reconstitution Inflammatory Syndrome: Emergence of a unique Syndrome during Highly Active Antiretroviral Therapy. Medicine Baltimore, 81(3), 213-227.

Takenami, L., Loureiro, C., Machado A. Jr., Emodi, K., Riley L. & Arrud S. (2013). Clinical Study:Blood Cells and Interferon-Gamma Levels Correlation in Latent Tuberculosis Infection. Hindawi Publishing Corporation, 1-18.

Veraine, F. & Rich, M.L. (2013). Tuberculosis: Practical Guide for Clinicians, nurses, laboratory technicians and medical auxiliaries. Medicines Sans Frontiers, Partner in Health.

Wang L., Schulzer M., Elwood R.K., Turner M, & FitzGerald J. (2002). Meta-analysis of the effect of Bacille CalmetteGuerin vaccination on tuberculin skin test measurements. Thorax, 57,804-809.

World Health Organization. (2011). Rapid Implementation of the Expert MTB/RIF diagnostic test. Geneva. Retrieved from: http//:whqlibdoc.who.int/publications/2011/9789541501569_eng.pdf.

Zahrt C. (2000). Molecular mechanisms to regulate persistent Tuberculosis bacterial infection. Microbacteria and Infection, 5, 159–167.