UNDERSTANDING JOHN RAWLS CONCEPTION OF JUSTICE

Hydro politics is the modern term for water issues. Every country wishes to protect its sweet water resources, especially those that have difficulties with rivers that run through more than one country. Water is required for the survival of over 180 species. This study is center on the importance of water to all living things, including humans, as well as to countries and their economies. The conflicts and treaties are also covered in the area of study on hydro-politics on the river Jhelum between India and Pakistan. Both countries have fought wars over water more than once, and if the water distribution issue can handle peacefully then their relationship may improve. The Jhelum River began in the disputed area of Jammu and Kashmir and flows through Pakistan and meets the Indus River. The distribution of Jhelum water was settled by the Indus Water Treaty in 1960, but India's repeated breaches made it a problem between the two neighboring states and one of the reasons for conflict between them. The research's main goal is to not only examine the causes of conflict but also to predict how it will be resolved in the future.

A Comparative Study of the Genotype Mtbdrplus® Assay Against a Standard Culture Method for Diagnosis and Drug Susceptibility Testing of Tuberculosis

Background: Nearly one-third of the global population, i.e. two billion people, is infected with Mycobacterium tuberculosis and is at risk of developing the disease. More than eight million people develop active tuberculosis (TB) every year, with about two million dying from the disease annually. Diagnosis of tuberculosis inKenya remains dependent on smear microscopy. New methods of TB diagnosis are needed which have better accuracy and are still cost effective. Molecular methods of TB diagnosis have come under investigation in a lot of studies recently. However, they have their own limitations including the inability to differentiate between active organisms and dead bacilli in specimens. Aim: To determine the sensitivity and specificity of the Genotype® MTBDRplus assay in the detection of resistance to Isoniazid and Rifampicin in mycobacterium tuberculosis isolates. Materials and methods: This is a descriptive and comparative study in which the performance of a new laboratory assay will be compared to the existing (reference) method. All sputum specimens submitted for TB culture and sensitivity to the Aga Khan University Hospital Laboratory microbiology section during the period from August 2008 – April 2009 were included in the study. All sputum specimens submitted underwent smear microscopy, culture and sensitivity testing by the MGIT 960 system and DNA extraction and Genotype MTBDRplus assay for both the direct specimen as well the positive culture tube. Results: 202 sputum specimens were included in the study. Valid phenotypic DST results were obtained for 135 cultures (68%). The number of strains resistant toRIF and INH was 4.5%, 14% respectively. Valid GenoType® MTBDRplus assay results were obtained for 116 DNA extracts (86%). Sensitivity and specificity of the test for the detection of Isoniazid resistance were 0.68 (95% CI: 0.43 - 0.87) and 0.99 (95% CI: 0.95 - 0.99) respectively. Sensitivity and specificity of the test for the detection Rifampicin resistance was 0.78 (95% CI: 0.40 - 0.97) and 0.99 (95% CI: 0.96 - 1.00) respectively. Comparative analysis demonstrated scientifically acceptable overall agreement between molecular (sputum specimens) and phenotypic DST results as shown below (Cohen’s Kappa = 0.76 (95% CI: 0.59 - 0.93) for Isoniazid resistance and Cohen’s Kappa = 0.81 (95% CI: 0.60 - 1.02) for Rifampicin resistance Conclusions: The Genotype MTBDRplus assay demonstrated acceptable sensitivity and specificity for use in laboratory diagnosis of Tuberculosis and the detection of drug resistance.