Gene X-pert system are slowly presenting in developing countries

 

GeneXpert MTB/RIF assay is a rapid diagnosis test of Tuberculosis (TB) and drug resistance. It is revolutionizing TB control with aids in prompt diagnosis and treatment (selection of appropriate TB regimen).

GeneXpert MTB/RIF assay is a nucleic acid amplification (NAA) test which simultaneously detects DNA of Mycobacterium tuberculosis complex (MTBC) and resistance to rifampin (RIF) (i.e. mutation of the rpoB gene) in less than 2 to 6 weeks for MTBC to grow and conventional drug resistance tests can add 3 more weeks.

This system integrates and automates sample processing, nucleic acid amplification, and detection of the target sequences.The primers in the XpertMTB/RIF assay amplify a portion of the rpoB gene containing the 81 base pair"core" region. The probes are able to differentiate between the conserved wild-type sequence and mutations in the core region that are associated with rifampicin resistance.The Centres for Disease and Prevention (CDC) recommends that NAA testing be performed on at least one respiratory specimen from patients who have a moderate or high suspicion of having pulmonary TB.

Background: Due to the emergence of Mycobacterium tuberculosis(M.tb) clinical isolates resistant to most potent first-line drugs (FLD), second-line drugs (SLD) are being prescribed more frequently. We explore the genetic characteristics and molecular mechanisms of M.tb isolates phenotypically resistant to SLD, including pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) isolates.

Methods : Drug-resistant (DR) M.tb isolates collected from 2012 to 2017 were tested using sequencing and phenotypic drug susceptibility testing. Genotypes were determined to explore their links with SLD resistance patterns.

Results: Of the 272 DR M.tb isolates, 6 non-multidrug resistant (non-MDR) isolates were fluroquinolones (FQ)-resistant, 3 were XDR and 16 were pre-XDR (14 resistant to FQ and 2 to second-line injectable drugs). The most frequent mutations in FQ-resistant and second-line injectable drugs resistant isolates harbored mutations conferring resistance to pyrazinamide. All XDR isolates belonged  to the Beijing genotype, of which one, named XDR+, was resistant to all drugs tested. One cluster including pre-XDR and XDR isolates was observed.

Conclusion: This is the first description of SLD resistance in Cambodia. The data suggest that the proportion of XDR and pre-XDR isolates remains low but is on the rise compared to previous reports. The characterization of the XDR+ isolate in a patient who refused treatment underlines the risk of transmission in the population. In addition, genotypic results show, as expected, that the Beijing family is the main involved in pre-XDR and XDR isolates and that the spread of the Beijing pre-XDR strain is capable of evolving into XDR strain. This study strongly indicates the need for rapid interventions in terms of diagnostic and treatment to prevent the spread of the pre-XDR and XDR strains and the emergence of more resistant one.

Slum

 Slum : A densely populated usually urban area marked by crowding, run-down housing, poverty, and social disorganization. Although slums, specially in Birgunj , are usually located in urban areas, in other countries they can be located in suburban areas where housing quality is low and living conditions are poor. While slums differ in size and other characteristics, most lack reliable sanitation services, supply of clean water, reliable electricity, law enforcement, and other basic services. Slum residences vary from shanty houses to professionally built dwellings which, because of poor-quality construction and lack of basic maintenance, have deteriorated.

Due to increasing urbanization of the general populace, slums became common in the 18th to late 20th centuries in the Birgunj and other Cities. Slums are still predominantly found in urban regions of developing countries, but are also still found in developing countries, but are also still found in developed economies. The world's largest slum city is found in the Neza-Chalco-Ixtapaluca area, located in the State of Mexico.

Birgunj City is believed to have created the Nepal's well recognized first slum, named Jhopar Basti, as it evolved into a large urban settlement. Jhopar Basti was named for a Poor place .Which, by the late 1982, was surrounded by slaughterhouse and tanneries which emptied their waste directly into its waters. Trash piled up as well and by the early 2000s the lake was filled up and dry. On this foundation was occupied by successive waves of free slaves. It housed the poor, rural people leaving farms for opportunity. Politicians and social elite discussed it with derision. Slums like Jhopar Basti triggered discussions of affordable housing and slum removal. As of the start of the 21st century, Jhopar Basti slum had been transformed into the Little basti and Chinatown neighborhoods of Birgunj, through that city's campaign of massive urban renewal.

Slums sprout and continue for a combination of demographic, social, economic, and political reasons. Common causes include rapid rural-to-urban migration, poor planning, economic stagnation and depression , poverty, high unemployment, informal economy, colonialism and segregation, politics, natural disasters and social conflicts.

Rural-urban migration is one of the causes attributed to the formation and expansion of slums. Since 1950, world population has increased at a far greater rate than the total amount of arable land, even as agriculture contributes a much smaller percentage of the total economy.

Many people move to urban areas primarily because cities promise more jobs, better schools for poor's children, and diverse income opportunities than subsistence farming in rural areas.