Gene/Protein Disease Symptom Drug Enzyme Compound
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In the year 2100 a global mean temperature increase of 2 degrees C, and a 50 cm rise in sea level are expected. An escalation in the intensity and duration of heat waves will increase mortality, whilst higher temperatures in cold regions may reduce it. On a global scale, vector-borne diseases such as malaria, dengue, yellow fever and some types of viral encephalitis are likely to increase. 50 to 80 million more cases of malaria could occur annually. Elevated temperatures and more frequent floods could cause an increase in salmonellosis, cholera and giardiasis. Indirectly, shortages of freshwater and foods may cause serious health problems. The world may see more environmental refugees. For Norway a temperature increase of 3-4 degrees C during winter and 2 degrees C in summer is expected, with more precipitation, especially in western parts. The possibility of the Gulf Stream turning at 40 degrees N and causing a temperature decrease of 10 degrees C, is not very likely. Malaria could reestablish itself in Europe, but hardly in Norway. The most harmful arthropod vector in Norway, the tick Ixodes ricinus, might extend its range into the most populated parts of the country. Marine algal blooms might increase the risk of cholera. Health problems caused by greater floods, poisonous algae and certain freshwater cercaria might increase.
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PMID:[Health effects of climatic changes--possible consequences for Norway]. 906 11

Emerging and reemerging infections are attracting greater attention from the public health and medical communities. Pathologists and other physicians are increasingly aware of the importance of the subspecialty of infectious disease pathology as a tool for diagnosis, surveillance, and research of emerging infections. In this communication, we describe the role that infectious disease pathologists have played during the last 2 years in broadening our understanding of selected emerging infections, including such examples as new variant Creutzfeldt-Jakob disease and bovine spongiform encephalopathy, leptospirosis, microsporidiosis, Ebola hemorrhagic fever, and cyclosporiasis. The significance of providing pathology services, especially the autopsy, to patients with potentially hazardous communicable diseases is discussed with the supposition that it is unethical to exclude or withhold health care from a patient based on his or her underlying disease or on risk factors for acquiring a disease. The increasing occurrence of infectious diseases imported into the United States and other nations, including human immunodeficiency virus-1 group O, dengue fever, tuberculosis, malaria, diphtheria and cholera in immigrants and travelers, and Ebola virus in nonhuman primates, emphasizes the necessity for pathologists of having competence with infectious disease pathology. It is critical that new generations of pathologists not only be trained in the subspecialty of infectious disease pathology, but that they also be willing participants in the diagnosis and investigation of infectious diseases. The lack of training programs for infectious disease pathologists, as well as the deficiency in infectious disease pathology support for ongoing and future epidemiologic investigations and research, has led to the broadening of pathology services and initiation of a dedicated section of Infectious Disease Pathology at one of the nation's premier public health institutions, the Centers for Disease Control and Prevention in Atlanta, Ga. Together with preexisting groups of medical and veterinary infectious disease pathologists at universities, the Armed Forces Institute of Pathology, the US Army Medical Research Institute of Infectious Diseases, and the National Institutes of Health, this new program will significantly strengthen the capability of the United States to respond to future challenges of emerging and reemerging infections, both in this country and abroad.
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PMID:Emerging and reemerging infections. Progress and challenges in the subspecialty of infectious disease pathology. 927 4

International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities.
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PMID:A week in the life of a travel clinic. 933 67

What have we learned? Pharmacogenetics, heritable variation in response to xenobiotics, is present in all forms of life. Initially, human data perhaps have created the most excitement, and they provide much biochemical detail. However, if we look at pharmacogenetic variation of insects and bacteria, we see it as a characteristic of populations; individuals with inborn resistance to various toxicants can cause the survival of a population by the process of Darwinian selection. Diversity of a population and Darwinian selection are different milestones serving population survival. Variation of drug response may represent variation of drug targets, drug metabolism, and probably drug transport. Metabolic variation appears to be the most prominent; at present, it is not clear whether this prominence has historical or biological causes. It is an interesting exercise to compare pharmacogenetic resistance with intoxication and resistance to infection by invasion of disease-carrying bacteria or other pathogens. The big difference is that pathogens tend to show variabilities that drugs do not have. The immune system is made to deal with the genetic variabilities linked to the short life span of most pathogens. However, there are, besides the immune system, several cases of genetic host resistance associated with the long life span of mammalian hosts. Such genetic host resistances are factors equivalent to pharmacogenetic variation. Current data pertain to resistance against malaria, tuberculosis, cholera, and AIDS. Most pharmacogenetic variants within a population are preadaptive, that is, they are established before xenobiotic exposure. Hence, one must postulate a multiplicity of variants in a population capable of resisting a multiplicity of drugs. The persistence of this multiplicity suggests that most variants are either present in heterozygous form and are thereby advantageous for their carriers, or they are selectively neutral mutants. It means that the biological cost of pharmacogenetic diversity, measured in terms of reduced fertility, should be low in a population. The frequencies of variant genes are usually not the same in different populations. Also the nucleotide substitutions in a variable gene often differ between populations. In other words, pharmacogenetic differences between populations are typical events. Pharmacogenetics is usually thought of as the study of a situation in which a single gene product exerts control over a given drug response so that a failure to respond, or an excessive response, may result. However, one should not forget that random variation is always present, probably reflecting the randomness of mutations plus variation of any environmental factors that might contribute. This underlying randomness of variation will always affect the picture of any all-or-none variation. Future pharmacogenetics must deal with both random and monogenic variation.
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PMID:Pharmacogenetics in biological perspective. 944 63

International movement of individuals, populations, and products is one of the major factors associated with the emergence and reemergence of infectious diseases as the pace of global travel and commerce increases rapidly. Travel can be associated with disease emergence because (1) the disease arises in an area of heavy tourism, (2) tourists may be at heightened risk because of their activities, or (3) because they can act as vectors to transport the agent to new areas. Examples of recently recognized diseases with relationship to travel include HIV, Legionnaire's disease, cyclosporiasis, Vibrio cholerae O139 Bengal, hantavirus, and variant Creutzfeldt-Jacob disease. Reemerging diseases include dengue fever, malaria, cholera, schistosomiasis, leptospirosis, and viral hemorrhagic fevers. In addition, tuberculosis, drug-resistant shigellosis, and cholera have been major concerns in refugee and migrant populations. Because of the unique role of travel in emerging infections, efforts are underway to address this factor by agencies such as the CDC, WHO, the International Society of Travel Medicine, and the travel industry.
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PMID:Emerging infectious diseases and travel medicine. 949 41

The population in sub-Saharan Africa is growing faster than increases in food production, resulting in a net decrease in food production per capita. The Food and Agriculture Organization has stated that there is a "risk of widespread hunger" which could be prevented by "effective planning of water resources". However, the potential effects of such schemes on the human population are often inadequately assessed and the effect of large dams on human health is not clear. The potential risk to human health of water resources was emphasized a few years ago but no effective preventive programs were implemented, probably because of inadequate availability of information and lack of awareness. The effects on health of "large" water resource projects are not uniform within a population. Decision-makers have tended to focus on the positive effects, to obtain support for their plans. These include: 1) improvement in the well-being of the population (safe water more readily available, new infrastructure, better access to health care) and 2) increases in the food supply (more vegetables and fish available due to irrigation). Thus, there has been a logical expectation that more, better quality food will become available as a result of these schemes, whereas in fact, health and nutrition has often worsened, particularly in young children. Most of the diseases associated with water resource management are communicable, including diseases directly related to the presence of large quantities of water, such as: malaria, which increases in incidence immediately after the building of the dam, after which a new balance develops between the human population and the parasites, schistosomiasis, the disease which increases most in response to the building of dams, particularly in its most severe gastrointestinal form, diarrhea, as water is a major means of dissemination for many organisms, including those causing digestive tract infections and gastroenteritis (amebiasis, salmonellosis, cholera), due to poor sanitation, other parasitic infections, such as onchocerciasis and trypanosomiasis, which should be monitored as they may also threaten the population. Other communicable diseases may appear or increase in incidence with the influx of migrants to the irrigated area. Sexually-transmitted diseases and HIV infection are a particular problem. The large numbers of insects (mosquitoes, blackflies) may also have harmful effects on populations adapting to the new environment. These effects are related to each other and to the environmental changes. New types of food affect people's feeding habits and generate new sources of income. However, they may also lead to new and higher expenditure. There are also likely to be major socio-demographic changes associated with changes in reproductive behavior and women's activities. The location and nature of new homes and infrastructure (e.g. schools, health centers, roads) also contribute to the success or failure of the dam project. There are many constraints to be considered and a more comprehensive approach to the problem is required. Health and nutritional status may be used as simple indicators of the ability of the population to adapt to a new environment. This makes it possible to construct a causal model to identify the most effective and relevant areas of intervention. Health and nutrition issues are of vital importance and scientific findings should be used in decision-making processes for planning future large dam schemes.
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PMID:[Large dams, health and nutrition in Africa: beyond the controversy]. 950

Malaria control was a relatively low priority for the British in India: despite being the principal cause of sickness and death among the Indian people, malaria affected the colonial economy only indirectly and, unlike epidemics of cholera or plague, presented few challenges to public order. Nevertheless, malaria was an important disease: not only in terms of its effects upon the health and livelihood of the indigenous population, but also in the language and politics of colonial rule. Malaria was a signifier of India's "backwardness" and its prevention was closely associated with the mission to "civilize" and tame the Subcontinent. But the gap between this rhetoric and the reality of colonial policy was unconvincingly wide, and the Government of India's failure to tackle the problem of malaria was increasingly criticised by imperialists and nationalists alike.
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PMID:"Hot beds of disease": malaria and civilization in nineteenth-century British India. 965 27

Economic deterioration and a decade of military rule have had a disastrous impact on the health of women and children in Burma. In 1996, Burma's infant mortality rate was 105/1000 live births. The major causes of child mortality and morbidity are intestinal and respiratory infections, malaria, malnutrition, and vaccine-preventable diseases. Low birth weight, iodine and vitamin A deficiency diseases, and iron-deficiency anemia are widespread. Cholera outbreaks occur each year. The Universal Child Immunization Program, supported by UNICEF, reaches less than 60% of eligible children. The maternal mortality rate is 580/100,000 live births; most are related to unsafe abortion. Basic reproductive health care is available only in select areas of the country. 17-22% of women use modern contraception. UNAIDS has estimated that 440,000 Burmese are HIV-infected and there are 14,000 AIDS orphans. HIV prevalence is 26.5% in urban prostitutes, 91% among injecting drug users near the Chinese border, and 10.6% among pregnant women in one border town. Any improvement in the health status of the population requires a shift in priority on the part of the military government from weapons build-up to health promotion and protection.
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PMID:Burma: a country's health in crisis. 977 77

Variable protection against malaria blood-stage infection has been demonstrated in mice following parenteral immunization with the highly conserved 19 kD carboxylterminal fragment of the merozoite surface protein-1 (MSP119) using CFA/IFA and other adjuvants. Here we show that intranasal immunization of BALB/C mice with yeast expressed Plasmodium yoelii MSP119 plus a mixture of native and recombinant cholera toxin B subunit, could induce serum MSP119-specific antibodies at titres ranging from 20 000 to 2 560 000. The Ig subclass responses were predominantly G1 and G2b. Intranasal immunization led to protection following challenge (peak parasitaemia < 1%) in mice with the highest MSP119-specific titre (>/= 640 000). In two of the three protected mice, a peak parasitaemia of 0.1%-1% was followed by a boost of the antibody response whereas one of the three protected mice did not boost its antibody response after a peak parasitaemia of 0.02%. In unprotected mice, antibody levels rose, then fell, following the detection of parasites in the peripheral blood. CD4+ T cell-depletion abrogated the ability of the mice to boost their antibody response following challenge. These data demonstrate the potential for intranasal immunization with MSP119 to protect against malaria.
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PMID:Intranasal immunization with yeast-expressed 19 kD carboxyl-terminal fragment of Plasmodium yoelii merozoite surface protein-1 (yMSP119) induces protective immunity to blood stage malaria infection in mice. 976 8

For over a decade we have maintained within a district of 5 million people, a system of prompt reporting of cases of childhood vaccine-preventable diseases, encephalitis, meningitis, hepatitis, and rabies; together with a sentinel laboratory surveillance of cholera, typhoid fever, malaria, HIV infection and antimicrobial-resistance patterns of selected pathogens. The system combined government and private sectors, with every hospital enrolled and participating. Reports were scanned daily on a computer for any clustering of cases. Interventions included investigations, immunisation, antimicrobial treatment, health education, and physical rehabilitation of children with paralysis. All vaccine-preventable diseases have declined markedly, whilst malaria and HIV infections have increased steadily. Annual expense was less than one US cent per head. The reasons for the success and sustainability of this model include simplicity or reporting procedure, low budget, private-sector participation, personal rapport with people in the network, regular feedback of information through a monthly bulletin, and the visible interventions consequent upon reporting. This district-level disease surveillance model is replicable in developing countries for evaluating polio eradication efforts, monitoring immunisation programmes, detecting outbreaks of old or new diseases, and for evaluating control measures.
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PMID:Disease surveillance at district level: a model for developing countries. 979 29


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