Compare your analysis of the case to your peers’ viewpoints. In places where you disagree, offer a competing understanding of where the priorities lie. In areas where you agree,

Amber Discussion:

There are multiple factors that may contribute to Baruti’s cardiovascular disease diagnosis. First of all, his age is an important factor. According to the National Institute on Aging (n.d.), people over the age of 65 have an increased risk of coronary heart disease, heart attack, and heart failure. Another important factor is a family history. In this situation, Baruti has a family history of coronary vascular disease with increased mortality in the males in his family in their 40s and 50s. With coronary heart disease, the vessels associated with blood flow to the heart do not work correctly or become clogged with a buildup of cholesterol (National Heart, Lung, and Blood Institute, 2022). Family history is considered a risk factor that increases a person’s lifetime risk for atherosclerotic cardiovascular disease, and it should prompt monitoring and treatment of other risk factors (Sharif et al, 2021). Another factor in this situation is the limited access of healthcare. If he did not have routine check-ups with a healthcare provider, he could have had risk factors for heart disease that he was not aware of. Earlier detection of these risk factors could have prevented the disease process from getting even worse. Hypertension and high cholesterol are also risk factors for heart disease (U.S. Department of Health and Human Services, 2023). With hypertension, many patients do not have symptoms. With high cholesterol, the surplus cholesterol builds up inside of the walls of the arteries causing narrowing and decreasing the supply of blood flow to the heart and other organs. Diabetes is also a risk factor as sugar can accumulate within the blood. Finally, daily behaviors can play a role in the development of heart disease. Diets that include an excess consumption of saturated fats, trans fats, and cholesterol can cause atherosclerosis and heart disease. An excess of salt can increase blood pressure leading to hypertension. A sedentary lifestyle increases a person’s risk of other conditions which can result in an increased risk of heart disease. Smoking can cause significant damage to the heart and blood vessels leading to heart disease. Age, family history, limited access to healthcare, and behaviors are the most important factors in the development of cardiovascular disease in this situation.

The factors that are most important in the occurrence of infectious diseases include preexisting conditions, limited access to healthcare, and contact with an infected person. Preexisting conditions that can increase a person’s risk of acquiring Tuberculosis and other infectious diseases include HIV, diabetes, severe kidney disease, a decreased body weight, and smoking in this case, Baruti has limited access to healthcare. He could have other medical conditions that he is unaware of if he has not had routine check-ups with a healthcare provider. Some healthcare problems, such as diabetes, are a risk factor for acquiring Tuberculosis and developing heart disease. In addition, some behaviors, such as smoking, also increase a person’s risk for both conditions. Finally, Baruti has been moving from one farming community to the next. With each relocation, he is exposed to new people. He could have easily come into contact with an infected person without realizing. Those who have come into contact with someone with Tuberculosis or are living in a country where it is common are at a greater risk for acquiring it (U.S. Department of Health & Human Services, 2021). According to the UK Health Security Agency (2022), Sudan is considered one of the countries with a high incidence of TB.

National Heart, Lung, and Blood Institute. (Mar 24, 2022).  What is coronary heart disease?  Coronary Heart Disease – What Is Coronary Heart Disease? | NHLBI, NIH

National Institute on Aging. (n.d.).  Heart health and aging. Retrieved on May 15, 2023 from  Heart Health and Aging | National Institute on Aging (nih.gov)

Sharif, M., Rifai, M.A., Stone, N.J., Blumenthal, R.S., Shapiro, M.D., & Patel, J. (2021, Feb 1).  Power of the pedigree: The Family history variable for ASCVD risk stratification. American College of Cardiology.  Power of the Pedigree: The Family History Variable for ASCVD Risk Stratification – American College of Cardiology (acc.org)

UK Health Security Agency. (2022, June 23).  WHO estimates of tuberculosis incidence by country and territory, 2020 (accessible text version).  WHO estimates of tuberculosis incidence by country and territory, 2020 (accessible text version) – GOV.UK (www.gov.uk)

U.S. Department of Health & Human Services. (2023, Mar 21).  Know your risk for heart disease. Centers for Disease Control and Prevention.  Know Your Risk for Heart Disease | cdc.gov

U.S. Department of Health & Human Services. (2021, Feb 16).  Tuberculosis (TB) disease and latent TB infection: Symptoms: risk factors & treatment. Centers for Disease Control and Prevention.  Risk Factors | Features | TB | CDC

Assa Discussion:

Based on the family history of cardiovascular disease ,Baruti has been genetic predisposition. With a positive diagnostic of tuberculosis ,Baruti is at great risk of development of cardiovascular disease if not diagnosed .Basham and Karim (2022) noted that people that are diagnosed with tuberculosis have an increased risk of mortality,respiratory disease and cardiovascular disease. In addition to genetics ,Baruti is a migrant farmer by profession. With frequent travel and relocation,Baruti is not always guaranteed access to healthcare and is living in a community with low literacy among which could also be carriers of TB or other infectious disease.The transmission of TB is greater in areas where large numbers of people inhabits one small area,or where people have greater number of encounters with others and typically these individuals will share the same socio-economic risk factors (Alisjahbana et al ., 2021).

In Sudan ,infection rate are climbing and mortality rates are increasing.According to Sudan: Tuberculosis on the rise in Sudan (2021), case of TB went from 40 cases per 100,000 to 67 cases per 100,000, with a detection rate of 60-64%. This information is not great for the people of Sudan,as almost 40% of infected people are unaware and untreated .Although treatment is free of charge in Sudan ,it was noted that stigma may be related to not seeking treatment for TB (Sudan : Tuberculosis On the Rise in Sudan,2021). In Baruti's case ,he is a migrant farmer ,and while treatment is free ,without adequate access to it ,it will not be of any benefit to him . It was noted that many of the labs that test and process testing for TB have closed due to staffing shortage ,making it more difficult for people to get tested and have definitive results (Sudan: Tuberculosis On the Rise in Sudan,2021). 

Alisjahnana,B., Koesoemadinata, R. C., Hadisoemarto,P.F., Lestari, B.W., Hartati, S., Chaidir,L., Huang, C.-C., Murray, M., Hill, P.C., & McAllister,S.M.(2021). Are neighborhoods of tuberculosis cases a high-risk population for active intervention? A protocol for tuberculosis active case finding. PloS One, 16(8), e0256043.  https://doi-org.ezproxy.snhu.edu/10.1371/journal.pone.0256043

Basham, C.A., & Karim, M.E. (2022). A E-value analysis of potential unmeasured or residual cardiovascular disease . Annals of Epidemiology , 68, 24-31.  https://doi-org.exproxy.snhu.edu/10.1016/j.annepidem.2021.12.009

Sudan: Tuberculosis On the Rise in Sudan. (2021). AllAfrica.Com (English).

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