Natural History of Tuberculosis: Duration and Fatality of Untreated Pulmonary Tuberculosis in HIV Negative Patients: A Systematic Review

Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting epidemiological data. Methodology and Principal Findings To estimate the duration and case fatality of untreated pulmonary tuberculosis in HIV negative patients we reviewed studies from the pre-chemotherapy era. Untreated smear-positive tuberculosis among HIV negative individuals has a 10-year case fatality variously reported between 53% and 86%, with a weighted mean of 70%. Ten-year case fatality of culture-positive smear-negative tuberculosis was nowhere reported directly but can be indirectly estimated to be approximately 20%. The duration of tuberculosis from onset to cure or death is approximately 3 years and appears to be similar for smear-positive and smear-negative tuberculosis. Conclusions Current models of untreated tuberculosis that assume a total duration of 2 years until self-cure or death underestimate the duration of disease by about one year, but their case fatality estimates of 70% for smear-positive and 20% for culture-positive smear-negative tuberculosis appear to be satisfactory

Geographical presences and absences. The role of Spanish academic geography in geopolitical debates

A set of factors has converged to create geopolitical issues of great importance in contemporary Spain. These relate as much to the incorporation of Spain in the process of globalization as to the internal organization of the Spanish State. This chapter examines the contribution of Spanish academic geography in the first two decades of this century to research and debate in the feld of political geography. The chapter has been prepared on the basis of a systematic review of the main Spanish academic journals in the feld, as well as references to a very considerable bibliography. The chapter comprises fve sections: the introduction presents the importance of geopolitical factors in contemporary Spain and states the hypothesis and methodology adopted to develop the chapter; the second section looks at the output of Spanish academic geography on the geopolitical position of the Iberian countries with respect to various geographical areas; the third focuses on studies concerning the borders of the Spanish state; the fourth section examines the work dealing with the institutional organization of what the 1978 Spanish Constitution calls 'nationalities and regions'; and fnally, the ffth section homes in on research into the spatial aspects of local and metropolitan governments. The chapter is then rounded off by a few brief conclusions