Human Health and Diseases Module

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© 2014 Johannes MAPURANGA
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READ AND UNDERSTAND BIOLOGY SO THAT YOU WILL NOT REACH YOUR
ACADEMIC MENOPAUSE QUICKLY!!!!!!!!!!!!!!!!!!!!!!!!! IN GOD WE TRUST, WITH
HIM NOTHING IS IMPOSSIBLE SO LET US STRIVE FOR EXCELLENCE
Emmerson John Dhiri Pvt. Ltd
Nkipraz
ADVANCED LEVEL BIOLOGY
In life as in football, you won‘t go far unless you know where the goalposts are. Have
a vision in life. The vision must be followed by venture. It is not enough to stair up the
steps but you must step up the stairs.
Patience and perseverance have a magical effect before which difficulties disappear
and obstacles vanish
Ceteris pari bas - Sua paremia laud

Contents page
Someone asked me, “Why do you insist on taking the hard road?” and I replied,
“Why do you assume that I see two roads?” So challenges are what make life
interesting and overcoming them is what makes life meaningful.
Life is like riding a bicycle. You can‘t fall off unless you stop pedalling. A bend in the
road is not the ends of the road unless if you fail to make the turn.
"Until one is committed, there is hesitancy, the chance to draw back, always
ineffectiveness. Concerning all acts of initiative (and creation) there is one elementary
truth, the ignorance of which kills countless ideas and splendid plans: that the moment
one definitely commits oneself, and then Providence moves too. All sorts of things
occur to help one that would never otherwise have occurred. A whole stream of events
issues from the decision, raising in one's favour all manner of unforeseen incidents and
meetings and material assistance, which no man could have dreamed would have come
his way. Whatever you can do, or dream you can, begin it. Boldness has genius,
power, and magic in it. "

Contents
HEALTH AND DISEASES ................................................................................................................................................. 3
DIET ............................................................................................................................................................................. 12
GASEOUS EXCHANGE .................................................................................................................................................. 25
SMOKING AND DISEASES ............................................................................................................................................ 48
DRUGS ......................................................................................................................................................................... 57
INFECTIOUS DISEASES ................................................................................................................................................. 66
IMMUNITY ................................................................................................................................................................ 103
2
HEALTH AND DISEASES
Describe whether health is more than simply the absence of a disease
- complete physical, mental and social being

- linked to happiness/fulfilling life
- having a positive outlook in life
- socially well adjusted
- ability to undertake physical/mental tasks without too much difficulty
- feeling good physically/physical fitness
- need for a balanced diet
- need of regular exercises/lack of exercises likely to suffer certain diseases
- both diet and exercise prevent obesity
- access to medical care
Outline the aspects that contribute towards good health
- good health is complete physical, mental and social well being

- ref. to balanced diet
- regular exercise/regular physical activity
- which ensure body is in best condition
- to combat disease
- limit drug intake/alcohol intake/smoking
- improving ability to cope with stress/other benefits of exercise
- regular sleep/rest + reasons
Disease
- difficult to define
- is a disorder or malfunction of the body leading to departure from good health.

- it is usually a disorder of a specific tissue or organ due to a single cause
- diseases are characterised by signs and symptoms that are physical, mental or both
- symptoms give an indication of the nature of the disease
- some diseases are acute and they last for a short time
- some are chronic and the effects continue for months or years
- many chronic diseases are extremely debilitating
Categories of diseases
- there are different ways of classifying diseases

- there are nine broad categories though some disease are classified into more than one category
Using named examples for each, explain what is meant by degenerative and inherited disease
degenerative
- gradual decline in body functions

- associated with characteristics of ageing
- caused by deficiencies of nutrients during childhood
- e.g. skeletal diseases/cardiovascular/cancers/Huntington‘s disease
inherited
- an inherited genetic fault

- mutation
- ref to mechanism of mutation
- pattern of inheritance
- e.g. cancer, PKU, cystic fibrosis
physical
- permanent or temporary damage to body parts

- body parts damages

- e.g. leprosy, multiple sclerosis, stroke
mental
- disorder occurring in brain cells
- no/a sign of physical damage may appear to the brain
- e.g. schizophrenia, claustrophobia, anxiety
infectious
- caused by pathogens which invade the body such as viruses, bacteria, fungi, worms, protoctists and
insects (e.g. lice)
- are also called communicable diseases because the pathogens can be transferred from person to
person
- e.g. TB, HIV, cholera, STIs
deficiency
- nutritional diseases
- due to poor nutrition/inadequate diet
- not passed to offspring
- scurvy, kwashiorkor, obesity
self-inflicted
- people‘s health is put at risk by their own decisions regarding their behaviour
- due to actions of an individual
- e.g. lung cancer/CHD/liver cirrhosis/anorexia nervosa, attempted suicide
social
- due to social behaviour and living conditions

- e.g. TB/cholera/infectious diseases , smoking related diseases
non-infectious

- all diseases not caused by pathogens
- no organism invasion
- not transmitted from one person to another
- e.g. deficiency disease, mental disease, night blindness
EPIDEMIOLOGY AND PATTERNS OF DISEASES
Epidemic
- a disease that suddenly spreads to affect many people e.g. cholera

- an outbreak of disease in a population
Endemic
- an infectious disease which is always present in a population e.g. TB

- this describes diseases that are always in a population
Pandemic
- a disease that spreads over a large area e.g. continent/worldwide

- an outbreak of disease that occurs across the world or across continents.
Prevalence
- the number of people in a population with a disease within any given time
Incidence
- number of new cases within a population occurring for a given time e.g. week/month/year
Epidemiology
- the study of patterns of disease and the various factors that affect the spread/distribution of the
disease
- data collected on disease (morbidity) and death (mortality) reveal patterns that can indicate how
diseases are spread and their likely cause or causes
Discuss the possible reasons for the global distribution of coronary heart diseases
- mainly confined to developed/affluent countries

- mainly due to lifestyle/sedentary
- fatty diets
- high in saturated fats
- cigarette smoking
- alcohol intake
- obesity
- high blood pressure
- lack of exercise
- fast foods
Explain the possible reasons for the global distribution of TB
- it is a pandemic disease (globally distributed)

- it is an endemic disease (always present)
- most prevalent in developing countries
- some of the TB strains becoming more resistant
- AIDS pandemic
- poor housing – overcrowding
- breakdown of TB control programme
- partial treatment of TB
- poor sanitation
- poor medical facilities
- TB spread in meat and milk
- high rate of transmission - droplet infection

Explain the possible reasons for the global distribution of measles
- most commonly affects developing countries;

- in places where conditions are overcrowded and insanitary;
- measles requires several booster shots to develop full immunity;
- in large cities with high birth rates, it can be difficult to give boosters or even follow up cases of
measles;
- refugees from these areas can spread the disease around, which makes it much more difficult to
treat than smallpox;

- measles is highly infectious;
- poor response to vaccine (children do not respond well to one dose of vaccine);
- deficiency immune system;
- or protein energy malnutrition;
- need several boosters which are expensive;
- high birth rates and flighting populations make it difficult for boosters;
- follow up cases and trace contacts also impossible;
Explain the possible reasons for the global distribution of HIV/AIDS
- is a pandemic disease (globally distributed)

- an epidemic (always present)
- linked to TB
- AIDS pandemic
- partial treatment of due to inability to purchase ARVs
- Highly confined in sub-Saharan Africa

- Rates of infection are lower in other parts of the world, but different subtypes of the virus have
spread to Europe, India, South and Southeast Asia, Latin America, and the Caribbean. Rates of
infection have leveled off somewhat in the United States and Europe.
- In Asia the sharpest increases in HIV infections are found in China, Indonesia, and Vietnam.
- Both the cost of these therapies and the poor health care delivery systems in many affected
countries need to be addressed before antiretrovirals can benefit the majority of people living with
HIV/AIDS.
- ‗Botswana, with the highest rate of infection, has experienced stable, democratic government and
a strong economy since independence in 1966.
- Mozambique, with the lowest rate of infection, experienced sixteen years of devastating civil war
from which it only emerged in 1992.

- While South Africa and Botswana are the two richest countries in Sub-Saharan Africa (as
measured in per capita gross domestic product),
- They include poverty and economic marginalization, poor nutrition, opportunistic infection,
migration, sexual networking and patterns of sexual contact, armed conflict, and gender inequality.
Some of these will be discussed in more detail below.
- HIV/AIDS, like all communicable diseases, is linked to poverty. The relationship is bi-directional
in that poverty is a key factor in transmission and HIV/AIDS can impoverish people in such a way
as to intensify the epidemic itself.
- poverty does seem to be a crucial factor in the spread of HIV/AIDS. It should be emphasised that
poor people infected with HIV are considerably more likely to become sick and die faster than the
non-poor since they are likely to be malnourished, in poor health, and lacking in health attention
and medications.
- In effect, all factors, which predispose people to HIV infection, are aggravated by poverty, which
―creates an environment of risk‖.
- Deep-rooted structural poverty, arising from such things as gender imbalance, land ownership
inequality, ethnic and geographical isolation, and lack of access to services.
- Developmental poverty, created by unregulated socio-economic and demographic changes such as
rapid population growth, environmental degradation, rural-urban migration, community
dislocation, slums and marginal agriculture.
- Poverty created by war, civil unrest, social disruption and refugees. High levels of rape and the
breakdown of traditional sexual mores are associated with military destabilisation, refugee crisis
and civil war (Walker, 2002: 7).
- closely associated with patterns of human mobility
- Large-scale economic migration has been a feature particularly of the southern African region
Massive migration of young, unmarried adults from presumably ―conservative‖ rural environments
to more sexually permissive African cities in recent years has been regarded as partly responsible
for the much higher infection levels observed in urban than in rural areas.
Values of Procreation:
- In Africa fertility is seen as demonstrating the masculinity and manliness of men, as well as
proving the significance of women as good wives. Because procreation is highly valued in African
society, both men and women are refusing to use condoms. Even though condoms are successful in
preventing the spread of AIDS, they also prevent reproduction. Thus, many individuals are willing
to risk contracting AIDS and have unprotected sex because fertility is so important to social status.
Myths:
- Myths influence the spread of HIV/AIDS in many ways. One strong belief held by a number of
Africans is that the West wants to control the population growth of Africa, and that the West is
trying to do this by convincing Africans to use condoms. The West is encouraging African nations
to use condoms as protection against AIDS, but many Africans believe that this is just a ploy to
curb reproduction rates. Many Christians in Africa believe that God is using AIDS as a weapon to
punish sinners. Since AIDS is often associated with promiscuity, many followers believe that God
will protect the innocent spouse from contracting AIDS, but use AIDS to punish the spouse that
was involved in sexual practices outside of her/his marriage. Two other popular myths are that
some Africans believe that regular infusions of sperm is required if a woman is to grow up to be
beautiful, and that sleeping with a virgin will rid an infected person from the disease.

DIET
A balanced diet
- A balanced diet is one which contains adequate amounts of all the necessary energy and nutrients
required for healthy growth and activity.
- This includes both macro nutrients (carbohydrates, fats and proteins) and micro nutrients (vitamins
and minerals).
- Sometimes cells can convert one compound to another, but this is not the case with a few things,
and these are known as essential since we must intake them in our food to survive.
- They include essential amino acids, essential fatty acids and most minerals.
Energy and nutrient requirements of people
Gender
- Males require more protein because their growth is greater than females during adolescence, and
after that stage they have a greater mass of tissue to repair and replace.
- Males require more of the vitamin B complexes that are needed for respiration and metabolism.
- Males require more calcium and phosphorus in adolescence because they develop larger bones
than females during this stage of growth.
Age
- Energy requirements increase with age, up to and including adolescence, as growth is rapid during
these years and physical activity is generally at high level.
- These energy requirements remain almost constant up to the age of 60 years, after which they
decrease as physical activity diminishes and body mass often decreases.

- Protein requirements increase with age, especially around puberty. This is because additional
protein is needed for the rapid growth around adolescence and thereafter, to repair and replace
cells.
- Calcium and phosphorus requirements are greater in the first year of life as they are laid down in
the bones of infants.
- The rate again increases in adolescence when the second growth spurt involves relatively rapid
elongation of the bones.
- After adolescence, the requirements remain constant.
- Requirements for other minerals and vitamins increases up to the age 20 years, but thereafter
remains relatively constant
Activity
- The more physically active a person is, the greater their energy requirement.
- It follows that, compared to an office worker; a manual labourer requires a greater energy intake,
especially of carbohydrate food.
Discuss with reasons why the diets of women should be modified during pregnancy and
lactation
Pregnancy
- Energy requirements increase more during the last three months

- For growth of the baby
- To build store fat ready for lactation
- Not first six months because extra energy needed is compensated for by reductions in physical
activity/metabolic rate
- increased need for proteins for growth of foetus
- extra protein for tissue in mother
- e.g. uterus/placenta/blood/breasts

- extra calcium for growth of bones/skeleton
- increased iron for haemoglobin/blood formation
- increased folic acid for protection against neural defects/spina bifida/improved absorption of iron
- increased vitamins (not Vitamins D or B6) for foetus
- increased Vitamin A for foetal growth and development of immune system/epithelia
- Vitamin A, C and D, although too much vitamin A can be harmful to the fetus in the early stages
of pregnancy.
- For this reason pregnant women are recommended to avoid liver, which is very rich in vitamin A.
Lactation
- extra energy for growth and activity of the baby

- extra protein for growth of the baby
- extra calcium for growth of bones/skeleton/teeth
- extra zinc for bones/some enzymes of the baby
- extra vitamins (as for pregnancy)
Dietary Reference Values (DRVs)
- This is sets of figures relating to the requirements for energy and nutrient intake of all healthy
individuals in the UK, this is sat by the department of Health in 1991.
- Dietary reference values are just that - they are values that can help you plan your diet and ensure
you are receiving everything you need in the right proportions.
 There are three types of Dietary reference values
(i) Estimated average requirement (energy/nutrients) - this is an estimate of the average
requirements of a population
(ii) Reference nutrient intake - enough or more for nearly all the population
(iii)Low reference nutrient intake - sufficient for those with low needs (this is at the bottom
of the range and is enough for only about 2% of the population).
Uses of DRVs
- Chefs (most professional cook) and caterers to design appropriate menus for groups of people
living in communities such as schools, old people's home and prisons.
- Managers to plan food supplies for large groups of people.
- Dieticians and others to assess the dietary needs of individuals, e.g. the elderly and pregnant
women.
- Individuals to calculate their own dietary requirements and to maintain or improve health.
- Food manufacturers to provide appropriate nutritional information on food labels.
Food Labels
- Dietary reference values are also used on food labels to allow customers to make the choice that
they want.
- Manufacturers may publish Recommended daily allowance information, and this must be accurate
by law - for a food to be a source of a nutrient it must have at least 17% of the recommended daily
allowance for that nutrient, and if it is 'rich in' a nutrient, it must contain over 50% of the
recommended daily allowance for that nutrient.
Describe the role of DRVs in estimating the diet of people in Britain
- DRVs are not recommended quantities for individuals

- based on normal distribution curve of requirements

- Mean requirement (EAR)- this is an estimate of the average requirements of a population. 50%
of the population will need more than the EAR for the energy or for nutrient and 50% will need
less.
- Reference nutrient intake (RNI) –this represents enough or more than enough to meet the energy
or nutrient needs of almost all the population, even those with high needs.
- Low reference nutrient intake (LNRI) – is almost sufficient for those with low needs (this is at
the bottom of the range and is enough for only about 2% of the population).
- Tables produced which show differing DRVs for different groups of people depending on
age/sex/pregnancy/lactation (any of these)

- tables are for energy or nutrients
- there are no LRNI or RNI for energy but they apply to nutrients
- but there are only EARs for energy
- because individual requirements within each category vary so much
- if RNIs for energy were published, some people might eat more than individual requirements –
- leading to obesity/ other harmful-to-health consequences
- safe intakes are a second group of DRVs
- for nutrients for which there are insufficient data to construct graphs/normal distribution curves
- e.g. Vitamin E/K/F and minerals such as fluoride in children
- an intake below the Safe intake would risk deficiency
- so one should aim for an intake just above
Describe the roles of essential fatty acids in the body
- an essential fatty acid is linoleic/linolenic acid

- liver converts EFAs into arachidonic acid/prostaglandins/thromboxanes
- blood clotting
- linoleic acid reduce risk of heart diseases

- regulating blood pressure
- vasodilation
- immune response
- renal functions
- contraction of uterus
- needed for lipoproteins
- transport of fat/breakdown of cholesterol
- needed for phospholipids in cell membranes
- reduce risk of heart disease
Describe the roles of essential amino acids in the body
- increase muscle mass and helps muscle recover after exercise e.g. leucine
- It also regulates blood sugar and supplies the body with energy. These functions make it
invaluable when the body is stressed.
- Leucine is used clinically to help the body heal, and it also affects brain function and can be used
in place of glucose in ‗fasting‘ states.
- isoleucine is important for the regulation of blood sugar.
important for antibody production e.g. threonine and is also needed to create other amino acids
that aid in production of collagen
- phenylalanine acts as a precursor to chemicals that regulate the central and peripheral nervous
system
- valine is necessary for muscle metabolism and the repair of tissues and can be useful in the
treatment of liver and gallbladder disorders.
- lysine enables the synthesis of carnitine, which converts fatty acids into energy and also plays an
important role in the production of hormones, antibodies and enzymes. Having a deficiency in
lysine can lead to niacin deficiency and cause a health condition called pellagra.
- this amino acid aids in the production of sulphur, which is necessary for normal metabolism and it
is also essential for the synthesis of haemoglobin and glutathione that fights against free radicals

Describe the roles of Vitamin A in the body
- vitamin A is converted into rhodopsin which is bleached when light enters the eye
- needed for vision
- healthy skin
- formation of mucous membranes
- bone and tooth growth
- immune system health
- epithelial cells use retinol from vitamin A to make retinoic acid, a chemical that aids cell growth
and differentiation, and without it the epithelia are not maintained properly
- and the body becomes susceptible to infections in the gut or gaseous exchange system, where
epithelia cells protects it.
Describe the roles of Vitamin D in the body
- Needed for proper absorption of calcium and phosphate

- Vitamin D (converted to an active form) promotes calcium and phosphate absorption from
intestines
- Strengthening of bones and teeth
- Acts on bone cells to regulate the deposition of calcium
Malnutrition
Explain what is meant by the term malnutrition
- Malnutrition is the general term for a medical condition caused by an improper or insufficient diet.
- it is usually caused by inadequate consumption, but as with obesity can be caused by over-
consumption.
- not a balanced diet
- one or more nutrients absent
- or not present in correct proportions

- e.g. obesity-too much
- anorexia nervosa- too little
Starvation
- This is both a lack of energy and nutrients,

- the body can last a rather large amount of time without food (as opposed to without water), since
it will drop its metabolic rate and utilise its reserves of carbohydrates, fats and proteins.
- The body uses glycogen stores in the liver (for less than a day), then fat stores (for 4-6 weeks,
depending on the person) and finally protein in muscles and other tissues.
- However, as long as people are well fed before the starvation, they are usually ok for a while - but
this is not true of those with previous deficiency, especially vitamin A deficiency.
Protein energy deficiencies
Discuss the consequences of a child of a diet which is deficient in protein
- two possible conditions =

- kwashiorkor and marasmus (both referred to as protein energy malnutrition)
- stunted growth/underweight
- small muscles
- limited production of antibodies
- reduced resistance to infectious diseases
- degree of deficiency will determine severity
Kwashiorkor
- thin hair/easily removed/loses pigment
- moon faced appearance
- swollen abdomen
- oedema, particularly in feet/legs
- characteristic skin lesions/flaky paint (crazy paving) appearance of skin/rough skin

- irritability/constant crying/little interest in surroundings
- fatty liver/permanent liver damage
- underweight
- delayed wound healing
Marasmus
- wizened/shrunken features
- old man‘s face
Anorexia
- Anorexia nervosa, a self-inflicted psychological disease with physical consequences, and in

extreme cases it can be fatal.
- Anorexia develops from extreme dieting, causing a weight well below normal, but the anorexic
will continue to diet, sometimes until death.
Discuss the possible consequences if a person suffers from anorexia nervosa
- muscle wasting
- loss of weight/very thin/emaciated
- loss of body fat
- body returns to pre-adolescent stage
- menstruation may cease
- infertility
- soft (downy) hair may grow on face and shoulders
- thin sparse hair
- symptoms of marasmus/reduced resistance to infection
- low blood pressure/cold hands and feet
- muscle waste away because proteins are used as a source of energy
- constipation/increased tooth decay
- vitamin/mineral deficiency may die of starvation
- may need to be hospitalised
- social problems (lying to friends/relationships with family)
- cause anxiety over self image/growing up psychological distress/obsessive about avoiding
food/overeating
- There is increased susceptibility to infection
- There are personality changes
Describe the consequences of a person being obese
- a condition of malnutrition (over-eating)

- obesity is defined in two ways
(i) 20% or more above the recommended weight for heights; or
(ii) A body mass index of greater than 30
- The body mass index is calculated as
Body mass index = body mass (in kg)
height (in metres)2
- is caused by eating more energy than used

- the energy is stored as fat, and as weight increases
- increases risk of diabetes, hypertension, CHDs
- arthritis/prostate/cervical/breast cancer (from increased strain on the skeleton)
- increased likelihood of developing hernia/gall stones/varicose veins and stroke
- high cholesterol levels
- risk of surgical operations
- body mass index (BMI) above 20%
- more above recommended weight
- awkward posture

Vitamin A deficiency
- dry rough skin

- inflammation of eyes
- drying or scarring of the cornea (xerophthalmia)
- night blindness
- malfunctioning of the rod cells
- poor maintenance of epithelia
- body become susceptible to infections, particularly measles and infections of the respiratory
system and gut.
Vitamin A is found in some animal foods such as milk, eggs and fish-liver oils, and some fruits.
Vitamin D deficiency (Describe how Vitamin D deficiency may affect the health of an individual)
- Vitamin D (converted to an active form) promotes calcium and phosphate absorption from
intestines
- affect deposition of calcium in bones
- and removal of phosphate from bone
- deficiency particularly damaging in childhood because skeleton is still growing
- deficiency disease in children = rickets
- too little calcium and phosphate results in bones being too weak/soft to support weight of the body
and bowing of legs occur
- and bending of spine
- in adults leads to osteomalacia
- bones weak/soft and susceptible to fracture
- poor orientation of the pelvic girdle

Describe the consequences for children and adults of a deficiency of Vitamin D
- vitamin D is a precursor of active hormone that stimulates the absorption and deposition of
calcium
- from sunlight
Children
- reduced calcification of bones/bones lack calcium

- for strengthening
- long bones of legs bow outwards
- reduced bone growth
- bone pain/pain in shoulders/spine/ribs/pelvis
- muscle weakness
- late eruption of teeth
Adults
- osteomalacia
- loss of calcium/softening of bones
- bones susceptible to fracture

GASEOUS EXCHANGE
- The gaseous exchange system links the circulatory system with the atmosphere
- It is adapted to
(i) Clean and warm the air that enters
(ii) Maximize the surface area for diffusion
(iii) Minimise the diffusion distance for oxygen and carbon dioxide
- Goblet cells are cells of the ciliated epithelium that produces mucus
- Upper part of the goblet cells is swollen with droplets containing mucin which has been secreted
by the cell
- The rest of the cell which is contains the nucleus is quite slender-like the stem of a goblet
- Mucus is also made in the glands beneath the epithelium
- It is a slimy solution of mucin which is composed of glycoproteins with many carbohydrate chains
to make them sticky and trap particles in inhaled air
- Some chemicals such as SO2 and NO2 dissolve in mucus to form acid solution which can irritate
the airways
- Between goblet cells are the ciliated cells
- Continual beating of their cilia carries the carpet of mucus upwards towards the larynx
- Each cilium has a tiny hook at the end to sweep mucus which moves at a speed of 1 cm per
minute
- When mucus reaches the top of the trachea it is usually swallowed so that pathogens are destroyed
by acid in the stomach
- Phagocytic white blood cells called macrophages patrol the surfaces of the airways scavenging
small particles such as bacteria and fine dust particles
- During an infection, they are joined by other phagocytic cells which leave the capillaries to help
remove pathogens

Pathway taken by an oxygen molecule as it passes from the atmosphere to the blood in the lungs
Mouth/nostrils, nasal passage, larynx, trachea, bronchus, terminal and respiratory bronchioles, alveolar
duct, alveolus, epithelium, connective tissues, endothelium of capillary, plasma, red blood cells
Trachea
- It leads from the throat to the lungs

- At the base of the trachea are two bronchi which subdivide and branch extensively forming a
bronchial tree in each lung
- Ciliated epithelium and goblet cells present and also smooth muscles are present
- Connective tissue with elastic fibres and collagen are present
- Has cartilage which keeps it open and lowers its resistance
- Cartilage also prevent them from collapsing or bursting as the air pressure changes during
breathing
- There is a regular arrangement of C-shaped cartilage rings in the trachea

Smooth muscles
- Bronchioles are surrounded by smooth muscles

- Can contract and relax to adjust the diameter of their tiny airways
- During exercise they relax to allow a greater flow of air to the alveoli
- Absence of cartilage makes the adjustments possible
Elastic fibre
- Allows bronchioles/alveoli to inflate/expand/stretch

- To hold inspired air to maximum volume/maximum surface area
- Recoil during expiration/expulsion of air
- Prevent alveoli bursting

Cartilage
- Keeps the airways open and air resistance low

- Prevent them from collapsing or bursting as the air pressure changes during breathing
- In the trachea there is a regular arrangement of C-shaped rings of cartilage, in the bronchioles there
are irregular blocks of cartilage
Goblet cells
- Secrete mucus
- Solution of mucin/glycoproteins with many chains of carbohydrates
- To trap small particles e.g. bacteria/spores/dust
- Moved by cilia upwards
- Protect alveoli
Bronchioles
- Found at the base of the trachea

- Have irregular blocks of cartilage
- Surrounded by smooth muscles which can contract or relax to adjust the diameter of these tiny
airways
- During exercise they relax to allow a greater flow of air to the alveoli
- Absence of cartilage makes the adjustments possible
- Ciliated epithelium and goblet cells are present and also smooth muscles are present
- Connective tissue with elastic fibres and collagen present
Alveolus
- Found at the end of the pathway between the atmosphere and the blood stream
- Have very tiny epithelial lining surrounded by many blood capillaries carrying oxygenated blood
- The short distance between air and blood means that oxygen and carbon dioxide can be exchanged
efficiently by diffusion

- Alveolar walls contain elastic fibres which stretch during breathing in and recoil during expiration
to help force air out
- This elasticity allows the alveoli to expand according to the volume of air breathed in
- When fully expanded during exercise, the surface area available for diffusion increases and the air
is expelled efficiently when the elastic fibres recoil
- Lining each alveoli is moist squamous epithelium which consists of very thin flattened cells,
reducing the distance over which diffusion must occur
- Collagen and elastic fibres are also present
- Special cells in the alveolar walls secrete a detergent-like chemical on the inside lining of the
alveolus
- This is called surfactant
- It lowers the surface tension of the fluid layer lining the alveolus and thereby reducing the amount
of effort needed to breathe in and inflate the lungs
- Surfactant also speeds up the transport of oxygen and carbon dioxide between the air and the
liquid lining the alveolus and helps to kill any bacteria which reach the alveoli
- Surfactant is constantly secreted and reabsorbed in a health lung
- No cilia present
- No goblet cells, squamous epithelium thin flattened cells with liquid surfactant on inner surface
and blood capillaries on outer surface
Adaptations of the alveolus for gaseous exchange
- Large surface area

- Thin epithelium therefore gases have a short distance to travel
- Surfactant is present
- A steep gradient is maintained by ventilation, a good blood supply and the presence of an oxygen-
carrying haemoglobin

Describe the functions of goblet cells, smooth muscle and elastic fibres in the gaseous exchange
system.
Goblet cells
- secrets mucus
- solution of mucin/glycoproteins;
- with many carbohydrate chains;
- ref. to glycosylation/adding sugars to proteins;
- to trap particles/bacteria/dust/spores;
- moved by cilia;
- protects alveoli
Smooth muscles
- contract/relax;
- adjust diameter of bronchioles R bronchi, trachea [2]
Elastic fibres
- stretch during breathing in;

- Recoil during expiration;
- Allows alveoli to expand (according to the volume of air breathed in) [3 max 2]
Elastin
- forms fibres;
- allows bronchioles/alveoli to inflate/stretch/expand;
- to hold inspired air/to maximum volume/to maximum surface area;
- recoil during expiration;
- prevent alveoli bursting;

Chronic Bronchitis
- Is caused mainly by smoking

- Tar in tobacco smoke inhibits the clearing action of the lungs
- It stimulates the goblet cells in the epithelium of the airways to secrete more mucus and as so
inhibits the sweeping action of the cilia
- As a result mucus accumulates in the bronchioles and the smallest of these are obstructed
- As mucus is not moved or at best only moved slowly, dirt bacteria and viruses collect and cause
smoker‘s cough
- The changes to the linings of the airways can be summarized as below
 Mucus glands in the trachea and bronchi enlarge
 Mucus glands and goblet cells secrete much more mucus
 Cilia are destroyed
 Epithelia are replaced by scar tissue
 Smooth muscle become thicker
 Airways are blocked by mucus
- These changes constitute chronic bronchitis
- Sufferers have a severe cough producing large quantities of phlegm which is a mixture of mucus
and bacteria and some white cells
- Bronchitis usually contributes to the development of emphysema
Emphysema
- Is a condition in which bronchioles collapse, leaving large spaces where surface area for gaseous
exchange used to be
- This is because the lungs are constantly infected, causing phagocytes to line the airways and to
reach them they release a protein digesting enzyme elastace
- It destroys the elastin in the walls of the alveoli allowing phagocytes to enter and remove bacteria

- The initial inflammation is caused by infections which in turn is caused by the accumulation of
mucus as a result of tar in the lungs
- As the protective system is compromised by bronchitis, infections become more common
- This leads to inflammation in the lungs: more macrophages line the lungs and phagocytes join to
form the blood
- These phagocytes release a protein digesting enzyme elastace to reach the surface of the alveolus
- Elastace destroys elastin in the connective tissue so that the alveoli do not stretch and recoil when
breathing in and out
- Because of this, the bronchioles collapse during exhalation trapping air in the alveoli, which often
bursts
- Large spaces appear where they have burst and this reduces the surface area for gaseous exchange
- Cells in the alveoli release an elastace inhibitor (α – antitrypsin) but some smokers produce less of
this than non-smokers so there is little to reduce the effects of the phagocytes
- Smokers are susceptible to developing emphysema
- The loss of elastin makes it difficult to move air out of the lungs
- The air remains in the lungs and is not refreshed during ventilation
- Together with the reduced surface area for gaseous exchange, this means that many people with
emphysema do not oxygenate their blood very well and have a rapid breathing rate and the blood
pressure also increases as blood vessels in the lungs become more resistant to the flow of blood
- As lung function deteriorates, wheezing occurs and breathlessness becomes progressively worse
- It may become so bad in some people that they cannot get out of bed
Describe the changes that occur in the lungs of people with bronchitis and emphysema
Bronchitis
- Enlargement of mucus glands in the airways (trachea and bronchi)

- Increased secretion of mucus
- Narrowing and obstruction of airways
- Thickening of smooth muscles
- Inflammation

- Epithelia replaced by scar tissue
- Destruction of cilia
- Blockage of airways or passages by mucus
- Coughing up of phlegm
Emphysema
- Digestion by phagocytes of pathways through alveolar walls
- Loss of elastin due to digestion by elastace/phagocytes
- Overextension and bursting of alveoli to form large air spaces
- Decrease in surface area for gaseous exchange
- Lack of recoiling of air spaces when breathing out
- Decrease in volume of air forced out from the lungs
- Shortness of breathe
Describe the changes that occur as emphysema develops in a smoker’s lungs
- inflammation;
- phagocytes move from blood to airways;
- release enzyme/elastace, to digest elastin/connective tissue;
- alveoli do not stretch and recoil/loose elasticity;
- alveoli burst;
- alveoli do no deflate to help force air out;
- elastace inhibitor in lung inactivated by smoke;
- decrease in surface area for gas exchange;
- lung air spaces/description of lung;
Describe the events in the development of lung cancer
- carcinogens cause mutations;

- e.g. UV light/tar/X-rays/asbestos;

- oncogenes transformed by carcinogens;
- cancerous cells do not respond to signals from other cells;
- uncontrollable cell division/mitosis;
- cancerous cells not removed by immune systems;
- absorption of nutrients from other surrounding cells;
- tumour gets bigger;
- begnin tumours;
- malignant tumours;
- tumour supplied with blood and lymph vessels;
- metastasis;
- blockage of intestines/lungs/blood vessels
- secondary growth;
Describe how emphysema and chronic bronchitis affects the gaseous exchange system
Emphysema
- digestion/destruction of elastin
- by phagocytes/elastace
- bursting of alveolus
- decrease in surface area for gaseous exchange
- lack of air spaces during breathing out
Chronic bronchitis
- enlargement of mucus glands in the trachea and bronchi;

- increased mucus secretion;
- destruction of cilia;
- epithelia replaced by scar tissue;
- thickening of smooth muscle;
- blockage of airways or passages by mucus

RESPIRATORY VOLUMES AND CAPACITIES
Tidal volume
- Is the volume of air breathed in and then breathed out during a single breath
- Is the volume of gas exchanged during one breath in and out
- Is the amount that moves in and out with each breath
- It is about 450cm3 during a quiet breath and after maximum exercise it rises to about 3dm3
- After normal inspiration the male continues to inhale and he can take in extra 1 500cm3 of air and
this is called the inspiratory reserve volume
- If after normal inspiration the male continues to exhale, he can force out an extra 1 500cm3 of air
- This is called the expiratory reserve volume
- At rest it is about 0.5 dm3 (500cm3)
Vital capacity
- Is the maximum volume of air that can be breathed in and then breathed out of the lungs by the
movement of the diaphragm and ribs
- Is the sum of the tidal volume, inspiratory reserve volume and represents the total amount of air
that can be inspired after a tidal expiration
- VC = IRV + TD + ERV
- It is the maximum volume of air that can be exchanged during one breath in and out (forced
inspiration and expiration)
- This is about 5.7dm3 for the male and 4.5dm3 for the female
- Even after forced expiration 1 500dm3 of air remain in the lungs and this amount is referred to as
the residual volume
Residual volume
- Is the amount of air that remains in the lungs after maximum forced expiration

Expiratory Reserve volume
- Is the amount of air that can be evacuated from the lungs after tidal expiration
Ventilation rate
- Ventilation rate is calculated as:
- Ventilation Rate = Tidal Volume × Breathing Rate
Summing specific lung volumes produces the following lung capacities:
- The total lung capacity (TLC), about 6,000 mL, is the maximum amount of air that can fill the
lungs (TLC = TV + IRV + ERV + RV).
- The vital capacity (VC), about 4,800 mL, is the total amount of air that can be expired after fully
inhaling (VC = TV + IRV + ERV = approximately 80 percent TLC). The value varies according
to age and body size.
- The inspiratory capacity (IC), about 3,600 mL, is the maximum amount of air that can be
inspired (IC = TV + IRV).
- The functional residual capacity (FRC), about 2,400 mL, is the amount of air remaining in the
lungs after a normal expiration (FRC = RV + ERV).
Some of the air in the lungs does not participate in gas exchange. Such air is located in the
anatomical dead space within bronchi and bronchioles—that is, outside the alveoli.

Explain the term tidal volume and vital capacity
Tidal volume
- is the volume of air breathed in and then breathed out during a single breath;
- is the volume of gas exchanged during one breath in and out/is the amount that moves in and out
with each breath;
- It is about 450cm3 during a quiet breath and after maximum exercise it rises to about 3dm3
Vital capacity
- is the maximum volume of air that can be breathed in and then breathed out of the lungs by the
movement of the diaphragm and ribs;
- is the sum of the tidal volume, inspiratory reserve volume and represents the total amount of air
that can be inspired after a tidal expiration;

- it is the maximum volume of air that can be exchanged during one breath in and out (forced
inspiration and expiration);
- This is about 5.7dm3 for the male and 4.5dm3 for the female;
AEROBIC EXERCISE
Explain the term aerobic exercise
- exercise that uses / exercise that improves cardiovascular system / heart;

- lungs / appropriate ref to breathing;
- ref oxygen;
- for aerobic respiration (in muscles);
- A mitochondria, equation for aerobic respiration, Krebs and oxidative phosphorylation
Explain why it takes several minutes for oxygen uptake to reach 3dm3 per minute
- heart must start to beat faster/circulation rate must be increased;
- breathing rate/depth must increase;

- takes time for physiological changes/carbon dioxide concentration to increase/oxygen
depletion/build up of ADP/disturbance of homeostasis to be detected;
Explain the term oxygen debt
- amount of oxygen needed to convert lactic acid back to pyruvic acid/restore ATP levels prior to
the exercise;

Explain why there is an oxygen debt
- anaerobic respiration has taken place;

- to meet immediate energy demands;
- lactic acid produced as a result;
- restoring normal level of oxygen in myoglobin;
- restoring creatine phosphate;
- creatine has its phosphate added again;
Outline briefly how oxygen debt is repaid
- through deep breathing for some minutes after exercise and;

- through rapid breathing or increased heart rate;

Explain why breathing rate does not return to normal immediately after the end of strenuous
exercise
- oxygen deficit / AW;

- supply of / demand for, oxygen, in muscles; R body
- tissues / muscles / organs, still respiring above resting level; A metabolic rate remains high;
- oxygen concentration in blood is low;
- carbon dioxide concentration is high / more CO2 removed; A ref to pH;
- ref to anaerobic respiration;
- lactate is, metabolised / respired / broken down / converted into glucose; A ‗gets rid of‘ / removes,
if linked with oxygen
- oxygen debt;
- reoxygenation of haemoglobin / AW; NOT oxidise
- reoxygenation of myoglobin / AW; NOT oxidise
- ref to phosphocreatine;
- AVP; ref to liver / ref to adrenaline;
Explain why resting pulse rate is often used as a measure of physical fitness
- low resting pulse,

- indicates physically fit / ora;
- large stroke volume / large quantity of blood pumped out with each beat;
- large heart / more muscular heart / more efficient heart; R strong heart
- idea that during exercise, heart rate does not increase much / heart does not work hard;
- decreases during training using aerobic exercise;
- easy to measure / does not need elaborate apparatus ;
- correlates with VO2 max;
- used to measure recovery time; R fit people have faster recovery rate

Discuss the short term effects of physical exercise on muscles and gaseous exchange
Effects on muscles
- Increased blood supply to muscles
- Muscle respire anaerobically (to produce ATP)
- Muscular fatigue may occur/muscle fail to contract and relax repeatedly with the same force
- Muscle fibres may be damaged (due to overstretching)
- Depletion of glycogen stores
Effects on gaseous exchange
- Stimulation of the SNS and secretion of adrenaline

- Vasodilation of arterioles/capillaries
- Due to greater rate of blood flow through capillaries/due to greater cardiac output
- Increase in ventilation
- Dilation of bronchioles
- Reduced resistance to air movement
Long term effects of exercise on the body
- stroke volume increases at rest.

- improved circulation. In response to the need to supply the muscles with more oxygen during
exercise, the body increases its number of capillaries, the smallest blood vessels in the body.
Existing capillaries also open wider.
- blood pressure decreases by up to 10 mmHg. An mmHg is a unit used for measuring pressure
levels.
- blood volume increases. The body produces a greater number of red blood cells in order to keep
the muscles supplied with oxygen during heavy exercise.
- heart muscles get stronger
- higher cardiac output/stroke volume increases

- heart chamber get larger/volume chambers increases
- heart muscles become larger/mass heart increases
- by 40% or more
- increased vascularisation/blood vessels increase
- size/number of mitochondria increases in the heart muscle fibres
- efficiency of circulation improves
- lowers blood cholesterol levels/saturated fats levels
- reduced risk of cardiovascular diseases
- low pulse rate at rest
- ‗muscles become stronger‘ as neutral
Ways in which the structure and function of the heart might be improved as a result of aerobic
fitness training programme
- resting pulse/heart rate lowered;

- therefore uses less energy/more efficient;
- cardiac output increased;
- stroke volume increased;
- increase in strength/power/endurance;
- diastolic pressure lower;
- resting systolic pressure lower;
- decrease in blood pressure for people with hypertension/prevents hypertension;
- reduced risk of coronary heart disease;
- reduced risk of atherosclerosis;
- size of heart increases;
- particularly left ventricle;
- improved blood supply/more capillaries;
- increase in size of muscle fibres;
- increase in number/size of mitochondria;

- more glycogen stored;
- increase in quantity of respiratory enzymes
- increase in myoglobin store
Long term consequences of lack of exercise on the body
- loss of muscle size;

- due to loss of fibres;
- reduced diameter of fibres;
- reduced number/size of mitochondria in muscles;
- les creatine phosphate stored in muscle;
- less glycogen/fat stored in muscle;
- less myoglobin in muscle;
- muscle strength/tone/endurance/power declines;
- few capillaries in muscles;
- poor coordination;
- slow reflexes;
- heart becomes weaker;
- small stroke volume;
- less efficient gas exchange;
- less haemoglobin/fewer red blood cells;
- decreased resistance to infection;
- less able to cope with stress;
- poor posture;
- low mental alertness;
- increased risk of osteoporosis/CHD/atherosclerosis/reduced mobility/joint problems/obesity
Explain how exercise can improve health
- health is not only the absence of disease, but physical, mental and social well – being of an
individual/

- good attempt at defining health;
- reduced risk of CV diseases/CHD/coronary heart thrombosis/stroke;
- improved respiratory fitness/gaseous exchange/vital capacity/VO2 max;
- improved resistance to infection/infectious diseases/improved immune system;
- heart muscle more efficient/increased stroke volume/capable of greater (cardiac) output;
- can help remedy asthma;
- resting pulse rate lowered/increases less during exertion/recovered time reduced;
- improved peripheral circulation/improved oxygen supply to muscles;
- reduces atherosclerosis/cholesterol deposition/plaque formation;
- reduces hypertension/high blood pressure;
- less likelihood of injuries/back pain/osteoporosis;
- reduces stress;
- increases BMR/metabolic reactions/reduces amount of body fat/obesity;
- improved sense of well being/feel good/mental well-being;
- increases secretion of endorphins/encephalins/serotonin/dopamine/
- ref. to pleasure pathway;
- improved mental alertness/concentration;
- increases flexibility of joints/reduces stiffness in joints;
- improved muscle tone/posture;
- AVP
State any two long term effect of regular exercise on muscle tissue such as that in the legs
increase in:
- size of muscle (fibres); A more muscle fibres / thicker muscle fibrils (per fibre) ;
- mitochondria / bigger mitochondria; A more cristae respiratory enzymes;
- vessels / capillaries; R increase blood supply to muscles;
- myoglobin;
- glycogen / fat / energy stores;
- muscle tone;

- phosphocreatine / creatine phosphate;
- more tolerance to lactate / less lactate produced;
- AVP; e.g. ref to fast twitch / slow twitch
- treat decrease in resting heart rate.

SMOKING AND DISEASES
Effects of tar in tobacco smoke on the gaseous exchange system
- stimulates extra cell division +thickening of the epithelium;

- which may develop into a tumour;
- tar coats the epithelium lining of the breathing tubes;
- causing irritation of the epithelial cell;
- epithelia replaced by scar tissue;
- production of excess mucus by the goblet cells;
- paralysis of cilia;
- build up of pathogens + mucous;
- smoker‘s cough/emphysema;
- reduced surface area for gaseous exchange;
Effects of tar and carcinogens in tobacco smoke on the gaseous exchange system
- paralyses/destroys cilia;
- stimulates over secretion of mucus by goblet cells;
- growth of scar tissue;
- leads to development of bronchitis/emphysema;
- epithelial lining coated with tar;
- carcinogens;
- combine with DNA/chromosomes of cells in the bronchial epithelium/lining;
- leading to tumour growth/growth in the epithelium/lining;
- bronchial carcinoma;
- malignancy;
- metastasis/secondary tumours;

The effects of nicotine and carbon monoxide on the cardiovascular system
Nicotine
- causes constriction of arterioles;

- stimulates release of adrenaline;
- increase heart rate/blood pressure;
- reduced peripheral blood flow;
- less blood flows to the skin/hands/feet (blood supply to extremities reduced);
- increased stickiness of blood platelets;
- increases cholesterol levels;
- which may lead to atherosclerosis;
- due to formation of atheromas
- increases likelihood of thrombosis;
Carbon monoxide
- combines with haemoglobin;

- to form a stable compound;
- haemoglobin has a greater affinity for carbon monoxide than oxygen;
- decreases oxygenation of blood/lead to shortage of oxygen;
- increases strain on the cardiovascular system to supply oxygen to all tissues;
- blood vessels more vulnerable to the development of atherosclerosis;
- may lead to CHD/stroke;
Describe how atherosclerosis develops
- onset may be caused by damage to lining of artery;

- smooth muscle cells proliferate at site of damage;
- phagocytes invade breaks and release growth factors and stimulate the growth of smooth muscle
cells/accumulation of cholesterol/slow down passage of LDLs back into the blood which therefore
deposit more cholesterol);

- atherosclerosis starts as fatty streaks;
- fatty substances deposited in inner coat/lining of arteries;
- deposited in inner surface of artery;
- also high proportion of cholesterol;
- usually large arteries;
- deposit is called atheromas;
- (uneven) patches develop called plaques/atheromatous plaques;
- causes walls of artery to thicken/lumen narrow;
- accept information presented in labelled diagrams;
- no details of development of thrombosis required;

Explain how atherosclerosis may lead to death
- plaques roughen the lining of artery;

- may lead to slow development of a blood clot/thrombus over the plaque;
- causes cessation or restriction of blood flow to affected area;

- if in coronary artery can cause coronary thrombosis;
- heart muscles starved of oxygen (myocardial infarction) and becomes damaged/dies/heart attack;
- if in brain can cause cerebral thrombosis/stroke;
- if clot breaks away can travel through blood vessels and jam at a narrower vessel (embolism);
- narrowing of arteries causes rise in blood pressure;
- may weaken wall of artery;
- wall may stretch/balloon out to form aneurysm, causing bursting of wall/hemorrhage;
- cerebral hemorrhage causes strokes;
Link between atherosclerosis and coronary heart disease
- atherosclerosis is the main cause of CHD;

- coronary arteries become narrower;
- therefore blood pressure increases;
- can damage walls of arteries/cause aneurysm, causing wall to burst;
- atheromas roughen lining of arteries causing blood clots/thromboses;
- clot can block coronary artery;
- clot may break away and lodge where artery narrows/embolism;
- heart muscle is deprived of oxygen and diets;
Evaluate the epidemiology and experimental evidence linking smoking to lung cancer and early
death
Epidemiology
- more smokers died of cancer;

- number of woman developing cancer increased with number of women smoking
- number of cigarettes smoked per day increased per day linked with death rate;
Experimental
- carcinogen identified in tar;

- dogs exposed to cigarette smoke developed tumours;
- rate of tumour development reduced when filter tipped brands used;
Discuss the epidemiological and experimental evidence which links smoking with disease.
- more new diseases in smokers;

- compared to non-smokers
- the higher the number of smokers the higher the number of sufferers
- experimental animals exposed to smoke developed diseases;
- compared to those not exposed to smoke;
- animals exposed to smoke have higher chances of developing disease
- filtered vs. unfiltered
Why sporting performance is lowered by smoking
- carbon monoxide combines with haemoglobin;

- to from carboxyhaemoglobin;
- up to 10% decrease in oxygen transport by blood/slight anaemia;
- reduces endurance activities;
- nicotine stimulates sympathetic nervous system;
- release adrenaline/epinephrine;
- increase in heart rate;
- raised blood pressure;
- reduced appetite;
- dust not removed from lungs;
- reduced lung efficiency;
How cigarette smoking can lead to coronary heart disease
- main cause of CHD is atherosclerosis;

- carbon monoxide/nicotine in smoke responsible;

- cholesterol deposited in, inner layers/.linings of artery walls;
- form plaques which lead to restriction of blood flow/clotting which can block vessels;
- smoking increases blood cholesterol/fat level;
- nicotine causes constriction of coronary arteries/arterioles;
- rise in blood pressure makes damage to walls more likely;
- increases number of platelets stimulating formation of blood clots;
- nicotine makes platelets more sticky;
- smoking causes rise in ratio of VLDLs/LDLs, to HDLs in blood so more
atherosclerosis/cholesterol deposited;
- decrease concentration of antioxidants/Vitamin C/vitamin E, so increasing damage to artery walls
by free radicals;
The difficulty in achieving a balance between prevention and cure of coronary heart diseases
- due to life style;

- such as smoking/diet/lack of exercise most causes can be avoided;
- government could take steps to encourage change of life;
- a few patients are victims of their own genetic;
- cure is expensive;
- e.g. heart transplants/coronary by-pass/drug treatment;
- ethical problems of who to treat, suitable example;
- since donors are few;
- problems associated with tissue rejection;
- should patient change their life style before treatment is made available
Arguments for diverting funds from the treatment of coronary heart disease to its prevention
- cure is expensive;
- e.g. heart transplant, coronary by-pass, drug treatment;
- difficult to find enough donor hearts;

- ethical problems of who to treat e.g. father with young family;
- many of the risks are avoidable;
- associated with life style - change will make people less susceptible;
Discuss the factors that should be taken into account when deciding how to share limited resources
between prevention and treatment of coronary heart disease
- treatment is expensive due to technology and professional expertise of surgeons;

- after – care also expensive (immunosuppressant drugs, e.t.c.);
- NHS working on tight/limited budget;
- preventive measures cheaper;
- not so dependent on expensive equipment/manpower;
- very expensive to advertise/train/employ health educators;
- difficulty in disseminating information;
- prevention saves a lot of suffering for potential victims;
- and families;
- e.g. may cause financial difficulties if wage earner affected/fatherless family/e.t.c;
- in terms of years of healthy life gained preventive measures may be better;
- great demand for treatment because heart disease so common;
- moral dimension – if a treatment is available should we not make resources available to use it;
- more lives can be saved by preventative measures;
Global distribution of CHD
- mainly confined to developed/affluent countries;

- due to lifestyle + sedentary work;
- fatty diets;
- high saturated fats;
- cigarette smoking;
- alcohol intake;

- obesity;
- high blood pressure;
- lack of exercise;
- fast foods;
Reasons why coronary heart disease is so common in developed countries
- caused by many factors most of which are common in developed countries;

- smoking s common risk factor;
- carbon monoxide and nicotine are the components responsible;
- carbon monoxide reduces oxygen carrying capacity;
- increasing strain on the cardiovascular system;
- nicotine increases stickiness of platelets, raising risk of clotting;
- diets tend to be rich in saturated fats;
- increased blood cholesterol and hence atherosclerosis;
- cause rise in ratio of LDLs to HHDLs;
- hypertension/high blood pressure common which puts arteries under strain;
- lack of exercise is a risk factor and life style/ occupations often sedentary
Common categories of diseases which could be applied to coronary heart disease
[Each category should be qualified with a suitable reason]
- physical;
- non-infectious;
- self – inflicted;
- degenerative;
- social;
- links with diet/lifestyle of developed countries;
- inherited;

DRUGS
Drug
- difficult to define;
- any man-made chemical taken into the body;
- (broadly) any chemical substance taken into the body;
- but this would include nutrients;
- chemicals which interfere with metabolism/physiology;
- ours or that of the pathogen;
- (narrowly) chemicals which interfere with nervous system/behaviour/brain/.perception/mental
function;
- these are described as psychoactive;
- any chemical used in medicine;
- may be restricted to chemicals that cause harm/illicit chemicals/abused chemicals;
Distinguish between physical and psychological dependence on drugs
- dependence is inability to stop use/addiction;

- withdrawal symptoms if go without drug;
- e.g. morning shakes with alcohol/cold turkey with heroin
Physical
- drug necessary for continued functioning of the body (metabolism in the body);
- prevents withdrawal/abstinence syndrome;
- withdrawal results in physical (and psychological)
- withdrawal symptoms e.g. opiates
- caused by drug replacing/imitating natural chemicals;
Psychological
- occurs when drug is needed as a compulsive desire to continue to take a drug;

- Reduces stress/anxiety/inhibitions;
- only emotional dependence/no physical dependency;
- withdrawal symptoms results in psychological symptoms
- changes in lifestyle and behaviour;
Withdrawal symptoms
- tremors;
- cravings/irritability/restlessness/anxiety;
- sweating;
- depression;
- sleep disturbance/insomnia;
- altered time perception;
- gastro interstitial problems/nausea/vomiting;
Drug tolerance and why it occurs with alcohol and heroin
- progressive decrease in body‘s response/effects become less intense with time/usage;

- user therefore uses larger and larger doses;
Heroin
- binds to pain receptor molecules at synapses;

- mimics encephalins/natural neurotransmitters;
- body adapts to presence of heroin and tries to restore original state;
- more receptors made at post-synaptic membranes;
- so more heroin needed to saturate them/have same effect;
Alcohol
- alcohol tolerance due to liver adapting;

- by producing more enzymes that break down alcohol;
- oxidized by MEOS/microsomal ethanol oxidizing systems
- nerve cells in brain become less responsive;
How you might tell whether a drug is socially acceptable or not
- survey of people‘s attitudes to the drug

- legislation i.e. laws governing sale and use of drugs;
- e.g. banned by law;
- the number of people who use the drug/prevalence of drug taking;
- the number of deaths from illegal drugs;
- general acceptance or rejection of drug – takers;
- e.g. it is socially acceptable to drink alcohol
- but not acceptable to inject heroin;
Factors that contribute to drug dependence
- to experience its psychic effect;

- to avoid the discomfort caused by its absence/withdrawal;
- the drug (or one of it metabolites) has become necessary for the continued function of the body;
- trying the drug out of curiosity;
- because of peer pressure/lack of self-identity;
- boredom
Why the use of heroin can result in damage to health
- use of unsterile needles to inject drug lead to blood poisoning/abscesses/skin infections at the sites of
injection;
- shared needles may lead to transfer of infective hepatitis B/HIV/AIDS;
- long term use can lead to liver disease/failure;
- can lead to blood poisoning;
- transmission of disease;
- e.g. HIV/AIDS/ hepatitis B;
- deficiency diseases/malnutrition due to reduced secretion of digestive juices/money spent on drugs
rather than food/loss of appetite
- tend not to eat well therefore malnutrition;
- tend not to maintain standards of hygiene;
- may overdose as tolerance builds up;
- respiratory/ cardiac centres of the brain can be fatally depressed;
- constipation common;
- street heroin may be impure and mixed with harmful substances, this can cause blood
poisoning/damage to blood vessels;
- damage to/collapse of blood vessels or veins due to injecting;
- tolerance leads to high doses/physical dependence/addiction is likely;
- associated life style has risks e.g. violence/crime/alcoholisms
- withdrawal/abstinence symptoms may lead to vomiting/choking/diarrhoea/dehydration/fever/high
blood [pressure;
- users can become part of a drug subculture/loose contact with family and friends;
- damage to foetus;
- damage to mental health;
Metabolism of alcohol
- alcohol dehydrogenase;
- alcohol converted to acetaldehyde/ethanol;
- NAD – hydrogen carrier;
- ethane dehydrogenase;
- ethanol to acetic acid/acetate/ethanoic acid;
- acetate converted to acetyl coA;
- enters Krebs Cycle;
- respired to carbon dioxide and water;

- liver metabolises alcohol as an energy source rather than fat;
- catalase may also oxidize alcohol;
- MEOS used when blood alcohol concentration (BAC) is higher;

Long term consequences of alcohol consumption on the liver, brain and peripheral nervous system
Liver
- inflammation;
- scarring/fibrous tissue;
- cirrhosis/hepatitis/jaundice/cancer;
- fatty liver;
- compression of blood vessels in liver (blood forced from portal veins into veins from oesophagus
and rectum);
Brain
- loss of short term memory

- impaired judgement;
- confusion/disorientation/anxiety/hallucinations;
- impaired motor control;
- dementia;
- sleep disturbance/reduced REM sleep;
- shrinkage of brain cells;
- by alcohol induced dehydration;
- inhibits secretion of AHD so kidneys remove more water than normal ;
- hypoxia – low blood oxygen causes death of brain cells;
- low blood glucose levels cause death of brain cells
- blockage of brain capillaries;
- loss of intellectual functions e.g. calculations, learning;
- Korsakoff‘s psychosis, leading to loss of short term memory and learning ;
- Wernicke‘s encephalopathy leading to comma, disturbance of speech/walking, confusion;
- Neglecting of diet leading to Vitamin B1 deficiency
- Leads to long term brain damage

Peripheral nervous system
- (poly) neuropathy (neurological disorder that occurs when many PNS throughout the body
malfunction simultaneously);
- damage to sensory nerves;
- feeling cold, pains/cramps/numbness(partial/total lack of sensation)/tingling;
- starts in hands and spread to centre of body;
- damage to motor neurones;
- muscle wasting/weakness;
- damage to autonomic nerves;
- related to faintness/incontinence(involuntary
urination/defecation)/impotence(powerlessness/feeble/weak)/blurred vision/poor control of gut;
- caused by Vitamin B1/thiamine deficiency;
- poor diet/all or most energy needs from alcohol so no balanced diet;
- damage to axons;
Short term effects of alcohol consumption on the brain
- depressant;
- effects depends on blood alcohol concentration;
- depresses brain function;
- by inhibiting reticular activating system (RAS);
- therefore activity of cerebral cortex
- intellectual faculties diminished;
- loss of coordination/judgement/control over fine movement;
- e.g. slurred speech/staggering walking;
- depression of respiratory centres/death;
- relaxed feeling/increased confidence/reduced tension;
- loss of inhibitions;
- slower reaction time;
- loss of balance;

- at higher levels, comma;
Social problems associated with heavy alcohol drinking
- personal relationship affected/considerable stress caused to the family;

- social isolation from friends/neighbours/embarrassment;
- violence in marriage + marital breakdown;
- correlated with wife battering (half husbands involved frequently drink);
- aggressiveness + destruction of property;
- crime as means to finance drinking;
- drink-driving + traffic accidents;
- neglect of food intake;
- frequent changes of jobs/loss of employment;
- uncontrollable anger;
- sexual assault;
- grandiose behaviour;
- young single women getting pregnant;
- conflict between parents affect children;
- sexual abuse of children;
- child neglect/children more likely to need child guidance/help from social services;
- children left unattended more likely to have accidents;
- poverty resulting from money spent on alcohol;
- poverty resulting from loss of job;
- poor health leading to loss of income/premature death;
- e.g. repossession of home, default on hire purchase/mortgage repayment;
Effects of heroin on the nervous system
- heroin is an opiate/depressant;
- does not stimulate vomit and nausea centres;
- psychoactive;

- binds (with high affinity and specificity) to pain receptors on the synapses;
- mimics encephalins;
- inhibits activities of the neurones concerned with pain;
- inhibits activities of cardiac and respiratory systems;
- gives a sense of warmth/rush;

INFECTIOUS DISEASES
Why infectious diseases are the leading causes of death in developing countries
- infectious disease are communicable/transmittable;

- pathogens spread from infected to uninfected people;
- some people have the disease but do not show an symptoms/are carriers;
- makes tracing very difficult;
- many developing countries struggle to pay health personnel;
- and to carry out effective prevention and treatment programmes;
- problem of development of clean water supply;
- good sanitation difficult to achieve;
- natural disaster/wars/civil unrest;
- growth of shanty towns;
- rural areas not reached;
- many developing countries in warmer regions where pathogens/parasites/insects/vectors thrive;
CHOLERA
- Cholera is a water-borne disease caused by a bacterium.

- It often appears in a population following a natural disaster, such as a major earthquake or flood.
- Cholera is caused by a bacterium called Vibrio cholerae.
Signs and symptoms of cholera
Common symptoms of cholera and the dehydration it causes include:
- watery, pale-colored diarrhea, often in large amounts.

- nausea and vomiting.

- cramps, particularly in the abdomen and legs.
- irritability, lack of energy, or unusual sleepiness.
- glassy or sunken eyes.
- dry mouth and extreme thirst.
- dry, shriveled skin.
Transmission of cholera
Describe how cholera can be spread from one person to another/ Explain how cholera is transmitted from
one person to another through water supply/
Describe and explain the ways through which cholera is transmitted
- food and waterborne disease;

- due to lack of proper sanitation/poor hygiene by infected person;
- feaces from infected person;
- contains Vibrio cholerae, the causative agent;
- contaminate water supply/water borne;
- water used to irrigate crops;
- sewage and water supply not separated / human faeces (sewage)
- contaminates water supply;
- person drinks water / eats food / swims in contaminated water / AW
- transmitted to uninfected person;
- via contaminated water;
- via contaminated food;
- e.g. vegetables irrigated with raw sewage;
- e.g. washing/bathing in contaminated water;
- pass out (of infected person) in feaces/(bacteria) leave person in faeces;
- infected people handle food/cooking utensils without washing hands;

Global distribution of cholera
- Cholera is now almost unknown in the developed world but can still cause large numbers of deaths in
less developed countries.
Outline the reasons why cholera is more likely to spread in less developed countries.
- lack of education/knowledge of hygiene;

- poor sanitation;
- lack of sewage treatment;
- raw sewage used to irrigate/fertilise crops;
- lack of water treatment;
- unable to control outbreaks due to lack of rehydration treatments;
- natural disasters;
- poor economy;
- civil unrest/migrants;
Reasons why cholera does not show the same global distribution as malaria
- malaria is transmitted by, mosquito / Anopheles / vector;

- distribution is determined by mosquito which lives in, tropics / subtropics /described; ora
- malaria not dependent on poor, hygiene / sanitation;
- cholera transmitted via water or food;
- sickle trait / genetic factors, influence distribution of malaria;
- ref to natural disasters / manmade disasters;
Why infants who are breast fed rarely suffer from cholera
- breast milk is sterile / idea;

- infants do not drink (contaminated) water / drink milk;

- passive immunity;
- milk may contain antibodies (to cholera);
- antibodies provide protection for infant;
Measures to control the spread of cholera
Sanitation should be qualified / explained

- piped water;
- ensure that water supply is separate from sewage;
- hygienic, removal / disposal, of faeces; A ‗human waste‘ / sewage treatment
- latrines;
- encourage breast feeding;
- treat people with cholera / provide ORT / provide antibiotics / provide trained
- medical personnel / medical facilities / access to medical facilities;
- boiled drinking water / sterilized water / chlorinated water;
- make sure people, eat cooked food / avoid raw food;
- AVP;; e.g. ref to education, vaccination, contact tracing, cordon sanitaire, ref to flies
Role of economic factors in the prevention and control of cholera
- waterborne disease;
- caused when water is infected by feaces from carrier/sufferer;
- important to purify water;
- important to have proper sewage treatment;
- developing countries often cannot afford the required measures;
- partly because they have large debts;
- education needed about importance of hygiene + economic link;
- cost money to train teachers/run advertising campaigns/build schools;
- locate and isolate carriers/sufferers;
- cost money to build hospitals/isolation wards/trace contacts/train staff/pay nurses;

- (economic) aid available in form of oral rehydration packs for treatment;
- cheap and effective;
- from international aid e.g. Red Cross;
- antibiotics can cure but often too expensive;
- little incentive for drug companies to develop cured because developing countries cannot afford them;
Explain why it has been proved difficult to develop a vaccine to control the spread of cholera
- V. cholerae in intestine;
- out of reach of immune system;
- antigenic concealment;
- antibodies broken down in intestine;
- antibodies are proteins;
- ref to pH and effect on structure or shape; e.g. in the stomach
- denaturation;
- vaccine stimulates antibodies in, blood / lymph;
- not in gut;
- oral vaccine needed;
- mutation;
- different strain idea;
- AVP; e.g. not required in developed countries
- developing countries cannot afford to develop vaccines
- no / limited, demand
- cholera can be treated with ORT
- can be treated with antibiotics

MALARIA
- malaria is caused by a single celled organism called Plasmodium.
- the organism is transmitted from one person to another by female anopheles mosquito.
- a mosquito takes up the gametes of a malaria parasite when it feeds on the blood of an infected
person.
- fertilisation occurs in the stomach of the mosquito and the immature parasites reproduce.
- infective stages of the malaria parasite migrate to the mosquito‘s salivary glands.
- a new person becomes infected when the mosquito takes another meal of the infected blood.
- the parasites enter the liver of the new victim where further reproduction takes place before migrating
to the red blood cells.
- when an organism such as mosquito is involved in transmission, it is called a vector.
- the malarial parasite can also be transmitted by a vector

Transmission of malaria
Explain how an infected is likely to have acquired malaria
- bitten by mosquito carrying malarial parasite;

- genus Anopheles/female;
- injects parasites with saliva/anticoagulant;
- ref to vector;
- mosquito fed on/bit/took a blood meal from an infected person;
- transmission by needle;
- injected into blood;
- after use by someone with malaria;
- (needle) shared/reused/used but not sterile;
- Transmission across placenta;
- Blood transfusions;
Signs and symptoms of malaria
People with malaria have the following symptoms:
- abdominal pain.
- chills and sweats.
- diarrhea, nausea, and vomiting (these symptoms only appear sometimes)
- headache.
- high fevers.
- low blood pressure causing dizziness if moving from a lying or sitting position to a standing position
(also called orthostatic hypotension)
Ways of preventing the spread of malaria

Explain the ways in which the transmission of the malaria life cycle can be disrupted
reduce mosquito numbers

- stock ponds with fish (Gambusia) to eat larvae ; R kill mosquitoes
- oil on surface ;
- spray bacteria (Bacillus thuringiensis) to kill mosquito larvae ;
- DDT / pesticide spray ;
- release of sterile male mosquitoes ;
- draining, ponds / bodies of water ;
avoid being bitten by mosquitoes

- wear insect repellant ;
- long sleeved clothes ;
- sleep under nets ;
- nets soaked in, insecticide / repellant ;
- sleep with, pigs / dogs ;
use drugs to prevent infection

- use, prophylactic drug / quinine / chloroquine / larium / artimesinin / vibrimycin
/ tetracycline / antimalarial ;
- use malaria vaccine ;
Social and biological factors in the prevention of malaria
Social
- poverty;
- no access to treatment/access to anti-malaria drugs;
- no access to mosquito nets/sleep under mosquito nets
- cultural beliefs

Biological
- Plasmodium strains resistant to some malaria drugs such as chloroquine

- development of resistance in Plasmodium/breaking life cycle of vector;
- development of resistance to pesticide;
- use of natural predators of vectors;
- some pesticides extend their effects to other innocent organisms;
- vaccination failing;
- Plasmodium an intracellular pathogen;
- an enormous reserve in monkeys;
- Plasmodium antigens change from time to time making vaccination difficulty;
Outline the problems associated with controlling the spread of malaria
- resistance of, Plasmodium / pathogen, to drugs;

- eukaryote / protoctist, has many genes;
- many surface antigens / antigenic variation; A ref to mutation
- inside red blood cells / in liver cells / antigen concealment;
- difficult for immune system to operate / idea;
- dormant / in body for a long time / symptomless carriers / long incubation;
- different stages in life cycle in the body;
- resistance of, vector / mosquito, to insecticides; A mutation / selection
- mosquito, breeds in small areas of water; A implications
- breeds quickly;
- mosquitoes, spread over large area / widely distributed / fly a long way;
- mosquito control programmes disrupted by war etc;
- lack of infrastructure (for control programmes);
- problems with sleeping nets, described;
- more effective when soaked in insecticide;
- - no vaccine;

- people lose immunity if, malaria eradicated / move to non-endemic area;
- poor primary health care / few doctors or other medical personnel;
- ref to poor housing / slums / shanties;
- ref to remote rural areas;
- ref to cost of control programmes;
- ref to travel / migration;
- ref to change in climate;
- ref to education;
- ref to problems of biological control;
- AVP; e.g. effects of insectides on, ecosystems / humans
- AVP; side effects of drugs
- impossible to isolate infected people
- ref to sterilising male mosquitoes
- opening new areas of tropics
- different, species / strains, of malaria
- cost to individual
- ref to detection in bloodstream
- blood transfusions
- mother to fetus across placenta
Outline the problems associated with the elimination of malaria
- resistance of mosquitoes to insecticides;

- such as DDT/dieldrin;
- difficulty in controlling the breeding places;
- resistance of some strains of Plasmodium/no effective vaccine against Plasmodium;
- migration of both people (infected and uninfected);
- expensive;
- attitude of society to elimination programme by WHO;
- environmental effects of insecticides;

Explain the link between malaria and sickle cell anaemia prevalence.
- possession of sickle cell trait has selective advantage in malaria areas;

- pathogens does not survive in red blood cells
- do not suffer from malaria
Causes of sickle cell anaemia
- a faulty occurs on the haemoglobin molecule;

- the 6th amino acid of the beta chain (146 amino acids)
- glutamic acid is replaced by valine;
- glutamic acid carries a negative charge and its polar, valine is non-polar;
- deoxygenated become less soluble;
- haemoglobin crystalises into a rigid rod-shaped fibre;
- it is a result of a base in substitution;
- thymine of a DNA triplet code CTC is replaced by adenine to make a CAC;
- the affected gene is on chromosome 11;
- the faulty gene is codominant;
- effect expressed only in homozygous condition
TUBERCULOSIS (TB)
Causes of TB
- TB is caused by two bacteria; Mycobacteria tuberculosis and Mycobacteria bovis.

- Tuberculosis is ultimately caused by the Mycobacterium tuberculosis, a bacterium that is spread
from person to person through airborne particles. Inhaling infected particles does not necessarily
mean that a person becomes infected.

- One of three things may happen when Mycobacterium tuberculosis enters the human body:
(i) the bacterium is destroyed because the body has a strong immune system 9attacked by the
macrophages in the lungs);
(ii) the bacterium enters the body and remains as latent TB infection. The patient has no symptoms and
cannot transmit it to other people;
(iii) the patient becomes ill with TB;
Signs and symptoms of TB
Most people who become infected with Mycobacterium tuberculosis do not present symptoms of the
disease.
However, when symptoms are present, they include:
- unexplained weight loss

- fatigue
- shortness of breath
- fever
- night sweats
- chills
- loss of appetite.
Symptoms specific to the lungs include:
- coughing that lasts for 3 or more weeks

- coughing up blood
- chest pain
- painful breathing
- pain when coughing.
Transmission of TB

- TB is a communicable disease that is spread primarily by tiny airborne particles (droplet nuclei);
- the disease spreads when infected people with the active form of the illness cough or sneeze;
- the bacteria spread through droplets in the saliva or sputum
- it spreads most rapidly among people living in overcrowded conditions;
- when a person with active TB coughs, sneezes, talks, or spits, tiny droplets containing the bacteria
are released into the air and can be inhaled by people who are close by.
- the bacteria can spread from the initial location in the lungs to other parts of the body through the
bloodstream.
- only a small number of bacteria are needed to cause an infection.
- persons with latent TB infection cannot transmit TB because bacteria are not present in their saliva
or sputum.
- M. bovis causes TB in cattle and is spread to humans in meat and milk;
- most people with TB are infected with M. tuberculosis.
- people with active TB can transmit the bacteria through the air by coughing and sneezing.
People at risk
Although anyone can be exposed to or get TB, some people are at higher risk for both exposure and
infection (though exposure does not necessarily result in infection). These higher risk groups include,
among others:
- the close contacts of someone who is infectious

- immigrants from areas where TB is common, such as Asia, Africa, and Latin America
- the poor
- the medically underserved
- racial and ethnic minorities
- persons living in congregate settings, such as correctional facilities;
- alcoholics and persons who inject drugs
- the homeless
- persons with HIV infection

- persons who are exposed to infectious TB on the job.
Of those infected with TB, the following run an especially high risk of developing active TB disease:
- persons with HIV

- persons whose infection is relatively recent (within the previous 2 years)
- injection drug users
- those with a history of inadequately treated TB.
- Persons infected with both HIV and TB has the highest known risk factor for developing active TB
disease.
- Whereas TB-infected persons who are not HIV-positive run a 10 percent lifetime risk of developing
active disease, those with both TB and HIV run a percent to 10 percent chance per year of
developing active disease
Global distribution of TB
- Worldwide

Explain the possible reasons for the global distribution of TB
- it is a pandemic disease (globally distributed)

- it is an endemic disease (always present)
- AIDS pandemic
- poor housing – overcrowding
- breakdown of TB control programme
- partial treatment of TB
- poor sanitation
- TB spread in meat and milk
- high rate of transmission - droplet infection
Problems associated in the prevention and control of TB
- some strains of TB bacteria resistant to drugs;

- the AIDS pandemic;
- poor housing and rising homelessness in inner cities in the developed world;
- the breakdown of TB control programmes particularly in the USA;
- partial treatment for TB increases the chance of drug resistance in Mycobacterium;
- attacks many of the poorest and socially disadvantaged because it is spread by airborne droplets;
- so people who are overcrowded are particularly at risk;
- those with low immunity particularly because of malnutrition or being HVI+ are also vulnerable;
- transmission is easily achieved but the bacteria may remain in the lung, or in the lymphoid tissue for
years until they become active;
Link between TB and HIV/AIDS

- TB is often the first opportunistic infection to strike HIV+ people;

- HIV infection may reactivate dormant infections of Mycobacterium tuberculosis;
- TB is now the leading cause of death of HIV+ people;
- The HIV pandemic has been followed very closely by a TB pandemic;
- There are high rates of incidence of all across the developed world and in the countries of the former
Soviet Union;
- Very high rates are also found in areas of destitution in developed countries;
- Social factors such as homelessness, neglect of primary health care and urban decay, contribute to
the spread of TB and these need to be addressed if the pandemic I to be curbed
Prevention
- once someone appears with the symptoms of TB, the sputum (mucus and pus) from their lungs is
collected for analysis;
- the identification of M. tuberculosis can be made very quickly by microscopy;
- isolation of sufferers while they are in their most infectious stage;
- this is particularly the case if they have an infection of a drug resistant strain;
- the treatment involves use of several drugs to ensure that all bacteria are killed, not just a few;
otherwise drug resistant strains are left behind to continue the infection;
- the WHO promotes a scheme to ensure that patients complete their course of drugs;
- DOTS (Direct Observation Treatment Short Course) involves health workers or responsible family
members, making sure that patients take their medicine regularly for 6 – 8 months;
- contact tracing and the subsequent testing of contacts for the bacterium is an essential part of
controlling TB;
- though contacts are screened for TB, the diagnosis can take up to two week;
- In children TB is prevented by vaccination;
- the BCG vaccine is derived from M. bovis and protect up to 70% of teenagers and its effectiveness
decreases with age unless there is an exposure to TB;
- the vaccine is effective in some parts of the world and less effective in others e.g. India;
- an effective method of control is the dual approach of milk pasteurisation and TB testing of cattle;
- any cattle found to test positive are destroyed;

- these measures have reduced the incidence of TB caused by M. bovis considerably it is hardly a
hazard to health in countries where these controls operate.
Treatment
- the treatment is long (6 months to 1 year), but many people do not complete their course of the drug
as they think that when they feel better they are cured;
- however it takes months to kill mycobacteria because they are slow growing;
- they are intracellular parasites surviving inside cells of the immune system, where they are
metabolically inactive therefore they are difficult to treat with drugs;
- strains of drug-resistant M. tuberculosis were identified when treatment with antibiotics, such as
streptomycin, began in the 1950s;
- antibiotics act as selective agents killing drug-sensitive strains and leaving resistant ones behind;
- drug resistance happens as a result of mutation;
- if three or four drugs are used in treatment, then the chance of resistance occurring is greatly
reduced,
- if TB is not treated or the person stops treatment before the bacteria are completely eliminated,
bacteria spread throughout the body increasing the likelihood that mutation will arise;
- prematurely stopping treatment means the M. tuberculosis develops resistance to all the drugs being
used;
- patients under poorly managed treatment programmes return home to infect others
- multiple drug resistant forms of TB (MDR-TB) now exist
Explain how an understanding of the disease tuberculosis (TB) can be used in its control and
prevention
- TB cause by Mycobacterium tuberculosis/bacillus;

- bacteria can be treated/controlled by antibiotics;
- sputum infected therefore dispose of sputum hygienically;
- associated with poverty/poor housing/poor living conditions;
- therefore social remedies important;

- overcrowding facilitates spreading;
- because droplet infection;
- also spread by physical contact/can be contagious;
- re-house if infected people cannot have own bedroom;
- education needed – poor education associated with poor hygiene e.t.c.;
- notifiable so can trace contacts;
- infectious phase brief/spread easily/spread by droplets so can isolate patients;
- bacteria can remain dormant for several years;
- so people who recover should not work in the food industry /become teachers;
- can be transmitted in milk, therefore pasteurize milk;
- test cattle (TT herds) and slaughter affected cattle;
- BCG vaccination given to children (aged 10 – 13 years);
- poor diet reduces resistance therefore good nutrition needed;
- all teachers X-rayed before starting job;
- screening possible in areas of high risk because X-rays show up lung damage
- high risk groups can have early vaccination (e.g. Asian immigrants I inner city poor housing);
- ref. to MDR/cocktails of antibiotics used;
- importance of finishing course of antibiotics;
- AVP;
Reasons for classifying TB as a social disease and lung cancer as a self-inflicted disease
TB
- social disease is due to social conditions/behaviour

- social factors aid to the spread of TB;
- poor housing;
- poverty/social class;
- poor diet, i.e. people with low immunity from malnutrition are also vulnerable;
- overcrowding living conditions;
- TB droplet infection/airborne infection;

- people sleeping/living together are at increased risk;
- prolonged exposure;
- poor unlikely to seek/complete treatment;
- TB is classified in other disease categories e.g. infectious;
Lung cancer
- Self-inflicted disease is due to one‘s behaviour;

- most lung cancers are caused by smoking;
- tar in tobacco smoke is a carcinogen;
- which alters DNA In epithelial cells;
- mutation
- development of malignant tumours;
- epidemiologists discovered a correlation between smoking and lung cancer, i.e. smokers are 18 times
more likely to develop lung cancer than non-smokers;
- risk of development of lung cancer decreases as soon as smoking decreases;
- personal choice to smoke;
- once started difficult to give up;
- addiction to nicotine;
- physical dependence;
- psychological dependence;
- lung cancer is classified in other categories e.g. degenerative, non-infectious;
ACQUIRED IMMUNODEFICIENCY SYNDROME

(AIDS)
- caused by HIV;
- the virus infects and destroys cells of the body‘s immune system (T-cells that control the body‘s
immune response to infection) so that their numbers gradually decrease;

- when their numbers are low, the body is unable to defend itself against infection, so allowing a
range of parasites to cause a variety of different infections (known as opportunistic infections);
- AIDS is not a disease but it is a collection of rare opportunistic diseases associated with
immunodeficiency caused by HIV infection;
- since HIV is an infective agent; AIDS is called an acquired immunodeficiency to distinguish it from
other types, for example an inherited form;
Structure of the HIV virus
- the outer envelope contains two glycoproteins gp120 and gp 41;

- the protein core contains the genetic material (RNA) and two enzymes, protease and reverse
transcriptase;
- reverse transcriptase uses the RNA as a template to produce DNA once the virus is inside a host cell;

Transmission
- in semen and vaginal fluid during sexual intercourse;

- infected blood or blood products;
- contaminated hypodermic syringes;
- mother to fetus across placenta;
- mother to infant in breast milk;
- HIV is a virus that is spread by intimate human contact: there is no vector and the virus is unable to
survive outside the human body;
- sexual intercourse is the main method of transmission;
- the initial epidemic in North America and Europe was amongst male homosexuals who had many
sex partners and practised anal intercourse;
- the mucus lining of the rectum is not as thick as that lining of the vagina;
- it is often damaged during intercourse and the virus passes from the semen to the blood;
- as many homosexuals were blood donors and also had heterosexual relationships, the virus spread
more widely;
- at high risk of infection were haemophiliacs who were treated with clotting substance (factor 8)
isolated from blood pooled from many donors;
- the transmission of HIV by heterosexual transmission is rising world wide
Viral Replication/Multiplication
- the virus binds to receptors present in the surface of the T4 lymphocytes;

- from here it enters the lymphocytes by endocytosis or by fusing with the cell surface membrane and
injects its viral RNA directly into the cell;
- the viral RNA is then copied into DNA by the activity of the enzyme reverse transcriptase;
- the viral DNA enters the lymphocyte nucleus and becomes incorporated into the cell‘s own DNA;
- thus it becomes a permanent part of the cells of an infected individual;

- every time the human cell divides, so does the viral DNA, and thus spread of the viral genes is rapid;
- the viral DNA may remain dormant for at least six years, the so-called latency period;
- however suddenly, for some unknown reason, the lymphocytes begin to make some copies of the
viral genes in the form of mRNA;
- these then migrate from the nucleus into the lymphocyte cytoplasm and direct the synthesis of viral
proteins and RNA;
- these assemble to form the new HIV viruses which leave the lymphocyte by budding out from
underneath the cell surface membrane;
- the viruses spread and infect many other lymphocytes and brain cells;
- eventually the cells in which the virus has multiplied and killed;
HIV and Immunity
- lymphocytes are very important white blood cells in the maintenance of normal immunity
- there are 2 types of lymphocytes in circulation- T and B lymphocytes
- B-lymphocytes are responsible for cellular immunity
- T- lymphocytes have a cluster of differentiation (CD) molecules receptors and co-receptors
- HIV attacks and destroys CD4 T- lymphocytes
- HIV also attaches to CNS, gut, and lymph nodes
- with the fall in CD4 lymphocyte count the individual becomes prone to opportunistic infections
HIV INFECTION PROGRESSION
- the phases of HIV infection include;
(i) HIV infection

(ii) Window period
(iii)Seroconversion
(iv) Asymptomatic HIV
(v) HIV /AIDS related illnesses
(vi) AIDS
1. HIV Infection
- initial infection with HIV
2. Window period
- time lag between infection and detection of antibodies;
- rapid multiplication of virus;
- person highly infectious;
- no signs and symptoms of disease and no detectable HIV antibodies;
- last 2-6 weeks or occasionally months;
3. Seroconversion (antibody – positive phase/ HIV-positive phase)
- the development of antibodies to HIV;
- part of the immune response;
- when people develop antibodies to HIV, they "seroconvert" from antibody-negative to antibody-
positive;
- a brief phase occurring 2-6 weeks up to a few months of exposure;

- antibodies develop;
- may be accompanied by flu-like illness, such as fever, head ache, muscle and joint aches, sore
throat, rash and diarrhea or rarely encephalitis with severe headache;
- may be called ACUTE HIV SYNDROME;
4. Asymptomatic HIV
- lasts from one year to 10-15 years or more;
- antibodies present but no apparent symptoms;
- this is the incubation period which may be accompanied by persistent generalized

lymphadenopathy (PGL) lasting for a long time without other disease symptoms;
5. HIV related illnesses (AIDS –related complex)
- lasts months to years;
- signs and symptoms increase because HIV is damaging the immune system;
- the individual may contract a variety of conditions known as opportunistic infections;
- symptoms are not life-threatening but become more serious and long lasting;
- common bacterial, viral and fungal infections occur and are often noted for their persistence and
virulence;
- oral and genital herpes or athlete‘s foot are common examples;
- if a person goes into ARC the duration of this type of infection is lengthened compared with that in
a normal healthy person;
- loss of weight may be seen at this stage;

- a significant drop occurs in the number of T helper cells;
- appropriate nursing is required since this stage is the first real onset of the disease diagnosis;
6. AIDS
- lasts usually less than one year unless treatment is available;
- terminal stage;
- life threatening infections and cancers occur because the immune system is severely weakened and
cannot cope;
- life expectancy depend on:
- the condition that develops;
- availability of treatment including ARVs, drugs for the treatment of other opportunistic infections;
- good nutrition;
- availability of psychosocial support and holistic care;

Factors that affect progression
- infection with different types of HIV;
- natural genetic differences in individual immune system;
- stress on the immune system through a general lack of fitness and exposure to repeated or severe
infections with different organisms;
- repeated STIs that keep the immune system highly active and so appear to speed up HIV
replication;
- state of mind;
- other stressors such as overtiredness, poor diet, under nutrition and heavy drinking of alcohol;

Global distribution
- worldwide especially in Africa and South- East Asia;
Explain the possible reasons for the global distribution of HIV/AIDS
- is a pandemic disease (globally distributed)

- an epidemic (always present)
- linked to TB
- AIDS pandemic
- partial treatment of due to inability to purchase ARVs
- Highly confined in sub-Saharan Africa
- Rates of infection are lower in other parts of the world, but different subtypes of the virus have
spread to Europe, India, South and South-East Asia, Latin America, and the Caribbean. Rates of
infection have leveled off somewhat in the United States and Europe.
- In Asia the sharpest increases in HIV infections are found in China, Indonesia, and Vietnam.

- Both the cost of these therapies and the poor health care delivery systems in many affected
countries need to be addressed before antiretrovirals can benefit the majority of people living with
HIV/AIDS.
Prevention and treatment of HIV/AIDS

- AIDS is caused by a virus and while bacteria can be controlled by antibiotics, these are not effective
against viruses;
- most treatments are therefore limited to relieving symptoms;
- present research on treatment and prevention is concentrating on three areas;
(i) restoring or improving the damaged immune system;
(ii) developing drugs that will stop the growth of the virus and also treat the other infections and
symptoms that result from HIV infection;
(iii) developing a vaccine against the virus;
(iv) development of drugs
The other obvious precautions which can be followed in trying to prevent the disease are:
- use of a barrier during intercourse can prevent the virus from infecting through blood or semen. Thus
the use of sheath or condom is recommended.
- restriction to one sexual partner and the absence of promiscuity will also clearly reduce the risk of
infection;
- use of clean needles and syringes by drug addicts;
- testing blood donated for the presence of antibodies to HIV which indicates whether or not the donor
is infected; blood containing these antibodies is not used;
- educating people about the disease particularly in reassuring the public about the real risks.
- contact tracing
- needle exchange schemes operate in some places to exchange used needles for sterile needles to
reduce the chances of infection with HIV and other blood borne diseases;
- in developed countries, blood collected from blood donors is routinely screened for HIV and heat
treated to kill any virus;
- people who think they may have been exposed to the virus are not encouraged to donate blood;

- HIV+ women are advised not to breast feed their children because of the risk of transmitting the
virus to their child because both viral particles and infected lymphocytes are found in breast milk ;
Social and economic factors in the prevention of HIV AIDS
- HIV transmitted by sexual intercourse with infected person/mother to child;

- education on ways of preventing transmission is important;
- education in work places on methods of preventing the spread of HIV;
- education on use of condoms to reduce risk of infection during intercourse
- sharing unsterilized needles among illicit drug users;
- injecting drug users can be advised not to share needles;
- sharp instruments like razors/shaving machines must not be shared;
- HIV+ not willing to disclose status/unwilling to go for testing;
- fear of stigmatization by society
- ARVs available but not affordable to all;
- prostitution due to poverty;
- polygamy/promiscuity;
- Government to inject more money in awareness campaigns;
- HIV+ women (in developing countries) can be advised not to breastfeed;
- HIV+ women to take antiretroviral drugs (navirapine) before delivery;
- Blood collected from blood donors routinely screened for HIV and heat treated to kill any viruses;
CHEMOTHERAPY AND ANTIBIOTICS

- the term antibiotic strictly refers to substances that are of biological origin whereas the term
chemotherapeutic agent refers to a synthetic chemical;
- the distinction between these terms has been blurred because many of our newer "antibiotics" are
actually chemically modified biological products or even chemically synthesized biological
products;

- the generic terms to refer to either antibiotics or chemotherapeutic agents are antimicrobic or
antimicrobial agent.;
- however, the term antibiotic is often used to refer to all types of antimicrobial agents.
Chemotherapy
- chemotherapy is the use of drugs to treat or cure infections;

- effective drugs show selective toxicity, killing the pathogen but having no effect on host cells;
- there is a wide range of chemotherapeutic agents for bacterial and fungal infections, but few for
viral infections;
- some drugs are derived from natural compounds but others, such as isoniazid used for treatment of
tuberculosis, are synthetic
Antibiotics
- are natural chemotherapeutic agents made by microorganisms;

- in dilute solutions they inhibit the growth of, or kill, other microorganisms;
- many antibiotics are modified chemically to increase their effectiveness;
Mode of action of antibiotics
- although there are a number of different types of antibiotic they all work in one of two ways:
 a bactericidal antibiotic kills the bacteria by either interfering with the formation of the
bacterium's cell wall or its cell contents; e.g. penicillin is a bactericidal;
 a bacteriostatic stops bacteria from multiplying.
- antibiotics interfere with some aspect of growth or metabolism of the target organism such as
 synthesis of bacterial walls;
 protein synthesis (transcription and translation);

 cell membrane function;
 enzyme action;
- penicillin functions by preventing the synthesis of the cross links between the peptidoglycan
polymers in the cell wall;
- this means that they are only active against bacteria which are growing;
- most types of bacteria have enzymes for destroying penicillin (penicillinases) and are therefore
resistant to the antibiotic;
- the main sites of action are shown in the diagram below:

- different diseases are treated with different antibiotics;
- all strains of some bacteria are resistant to several antibiotic; e.g. M. tuberculosis is resistant to
penicillin;
Broad spectrum and narrow spectrum antibiotics
- antibiotics are classed as bactericidal or bacteriostatic according whether they kill bacterial cells
directly or indirectly;
- they are also divided into classes such as cephalosporins or macrolides depending in their
chemical structure and action;
- all antibiotics can also be described as either narrow spectrum or broad spectrum.
- broad spectrum are effective against a wide range of bacteria

- narrow spectrum are effective only against a few;
Narrow spectrum antibiotics
- those with a narrow spectrum of action can kill only a small number of species of bacteria, maybe
even just one;
- narrow spectrum antibiotics tend to be very specific and act on a molecule in the metabolism of
one particular type of bacteria that is special to that species;
Advantages of narrow spectrum antibiotics
- the narrow-spectrum antibiotic will not kill as many of the normal microorganisms in the body as
the broad spectrum antibiotics. So, tt has less ability to cause superinfection.
- the narrow spectrum antibiotic will cause less resistance of the bacteria as it will deal with only
specific bacteria.
Disadvantages of narrow spectrum antibiotics:
- narrow spectrum antibiotics can be used only if the causative organism is identified.
- if you don't choose the drug very carefully, the drug may not actually kill the microorganism
causing the infection.
Broad spectrum antibiotics

- broad spectrum antibiotics are active against a wide range of bacterial species;
- broad spectrum antibiotics act on structures or processes that are common to many different
bacteria, such as the components of the cell wall.
Selection of antibiotics
- antibiotics should be chosen carefully;

- screening antibiotics against the strain of the bacterium or fungus isolated from sufferers ensures
that the most effective antibiotic can be chosen;
- the diagram below shows results of antibiotic sensitivity test carried out on a strain of the human
gut bacterium E. coli that causes epidemics of food borne and water borne diseases;
- bacteria are collected from feaces, or from food or water and grown on an alga medium;
- different antibiotics are absorbed onto discs of filter paper placed on the agar plate;
- the plate is incubated and the diameters of the inhibition zones where no bacteria are growing are
measured;
- the diameters are compared with standard diameters as in the tables below and the most
appropriate antibiotics are chosen;
- increasingly, bacteria which were once susceptible to antibiotics are now resistant;
- this has a great impact on disease control as it prolongs epidemics, lengthening the period of time
when people when people are ill and increasing the risk of higher mortality rates;
- the inappropriate and widespread use of antibiotics should therefore be discouraged;
- some drugs should be kept for use as a last resort when everything else has failed, and drug
companies must continue to invest in research for new drugs to replace those which quickly
become redundant;
Advantages and limitations of using antibiotics
- kill pathogen after infection;

- interfere with growth/metabolism of pathogen;

- e.g. protein synthesis/synthesis of cell wall;
- do not harm host;
- not effective against viruses;
- mainly used against bacteria and fungi;
- some narrow spectrum/effective against a limited range of micro-organisms;
- bacteria can become resistant
Role of antibiotics in treatment of infectious diseases
- mainly used against fungi and bacteria;

- cell wall synthesis inhibited/stops growth;
- protein synthesis inhibited;
- disrupts translation/DNA replication;
- disrupts cell wall/membrane function;
- acts as an enzyme inhibitor;
- causes lysis;
- bactericidal;
Side-effects of antibiotics
Below is a list of the most common side-effects of antibiotics:
- diarrhoea - researchers from Stanford University School of Medicine found that rise in sugars in the
gut following antibiotic treatment allows harmful bacteria to get a foothold and cause infection.
Harmful bacteria thrive on sugar;
- feeling and being sick;
- infections of the mouth, digestive tract and vagina.
Below is a list of rare side-effects of antibiotics:
- formation of kidney stones (when taking sulphonamides).

- abnormal blood clotting (when taking some cephalosporins).

- sensitivity to sun (when taking tetracyclines).
- blood disorders (when taking trimethoprim).
- deafness (when taking erythromycin and the aminoglycosides).

IMMUNITY
- Immunity is the protection against diseases provided by the body‘s immune or defence system.
- There are two parts of this system:
(i) The non-specific system
(ii) The specific system
Non-specific system
- The defenses present from birth form the non-specific system.
- This system does not distinguish between different pathogens and gives the same response
each time the same pathogen attacks.
Specific Immune system

- Gives a highly effective, long-lasting immunity to anything the body recognizes as foreign.
- Specialised cells known as lymphocytes direct a defence against specific pathogens.
- Although highly efficient, this immune response is slow, when it encounters a pathogen for the
first time.
- During the first encounter, some lymphocytes produce special protein molecules, called
antibodies which are targeted specifically at the invading pathogen.
- Although the capability of producing antibodies is present from before birth, they are only
produced when the appropriate pathogen invades.
- The specific immune system recognizes pathogens because their surfaces are covered in large
molecules such as proteins, glycoproteins and polysaccharides.
- The immune system also recognizes the toxins that are produced by pathogens as foreign
particles.
- Any molecule that the body recognizes as foreign is called an antigen.

Primary defence against disease
- The defenses that prevent pathogens from entering the body:
Surface barriers
Defence mechanism Function
Skin Prevents entry of pathogens and foreign substances
Acid secretions Inhibit bacterial growth on skin
Mucus Prevents entry of pathogens, mucous membranes also

produce defensins (small toxic peptides) that kill
pathogens
Nasal hairs Filter bacteria in the nasal passages
Cilia Move mucus and trapped materials away from respiratory

passages
Gastric juice Concentrated HCl and proteases destroy pathogens in the

stomach
Acid in vagina Limits the growth of fungi and bacterial in female

reproductive tract
Tears, saliva Contain lysozyme which destroys bacteria
Other non-specific cellular, chemical and co-ordinated defenses
Normal flora Compete with pathogens, may produce substances toxic to

pathogens

Fever Body wide response inhibits microbial reproduction and

speeds body repair processes
Coughing and sneezing Remove pathogens from respiratory tract
Inflammatory response Involves leakage of blood plasma and phagocytes from

capillaries. Limits spread of pathogens to neighbouring
tissues, concentrates defences, digests pathogens and dead
tissue cells, released chemical mediators attract phagocytes
and lymphocytes to the site
Phagocytes Engulf and destroy pathogens that enter the body

(macrophages and
neutrophils)
Cells of the Immune system
- Originate from the stem cells in the bone marrow

- Stem cells retain the ability to divide by mitosis forming large numbers of cells which
differentiate into specialised cells
- There are two groups of these cells involved in defence:
(i) Phagocytes: neutrophils and macrophages
(ii) Lymphocytes
Phagocytes
- For secondary defence against disease – phagocytosis

- If a pathogen enters it must be killed before it has time to reproduce and cause symptoms of
disease. This is the role of the phagocytes.
- Are continuously produced by the bone marrow throughout life.
- They are stored there and leave in the blood to be distributed around the body.
- They are scavengers and involved in the non-specific response.
2 types of phagocyte:
Neutrophil
- The most common type of white blood cell (60%)
- Smaller than macrophages
- Travel throughout the body
- They have a multi-lobed nucleus
- Granulocytes - granular cytoplasm
- Granules contain degradative enzymes
- They are very short lived few hours in blood, few days in tissue (half life in blood is about 12
hours – perhaps an evolutionary response to the possible infection of parasites living inside this
type of cell)
- They are attracted to areas of cell and tissue damage, probably by chemicals released by the
ruptured cells
- Able to squeeze through walls of blood capillaries and move about tissue spaces (diapedesis)

- Their numbers increase rapidly during an infection, when they are released from stores in the
bone marrow.
The cell with the lobed nucleus [in the centre] is a neutrophill; a type of a phagocyte.
Monocyte
- Comprise 4% of white blood cells
- Larger than neutrophils
- Bean shaped nucleus
- Agranulocytes - no granules in cytoplasm
- When they leave the blood they act as neutrophils or they differentiate into macrophages –
larger cells that patrol tissues especially lungs, liver, spleen and lymph nodes
- Can engulf larges particles e.g. malarial parasite (Plasmodium)
- Some are stationary and line blood spaces in organs such as liver (Kupffer cells)
- Cytoplasm contains numerous larger lysosomes
- Long lived – few days in blood, months or even years in tissues
- Can proliferate in tissues

The cell with a horseshoe-shaped nucleus is a monocyte; from the family of phagocytes.
Lymphocytes
- Produced before birth and lave the bone marrow to fill the lymphoid system
- They are generally not phagocytic but instead secrete antibodies and the hormone-like cytokines.
- There are two types of lymphocytes:
(i) T lymphocytes (often called T cells)
(ii) B lymphocytes (often called B cells)

The cell with a uniformly circular nucleus is a lymphocyte; it can either by a B-lymphocyte or T-
lymphocyte. Notice its size; which roughly equals that of a RBC.
- The comparatively huge cell in the centre is a plasma cell; it is formed upon differentiation
[something close to specialization] of B-lymphocytes during an immune response.
- Both of these must go through a maturation process which starts just before birth.
(a) Describe the origin, maturation and mode of action of phagocytes;

- originate from stem cells in the bone marrow
- stem cells divide by mitosis

- cells differentiate into specialised cells and stored in the bone marrow
- examples are neutrophils/macrophages/monocytes/polymorphs
- Monocytes leave the bone marrow before being fully functional and attain maturity in the blood
stream.
- After 40-60 hours of circulation by a mature monocyte, it settles in the tissue and increases in size
slightly, now a macrophage [e.g. the alveolar macrophage in the alveoli].
- On the other hand neutrophils do not leave bone marrow until maturity
- involved in non-specific responses
- Phagocytes/neutrophils/macrophages act between initial infection by bacteria and immune
response.
- All three types of phagocytes share the same job, i.e. phagocytosis [killing by engulfing]. The
mechanism is described below...
Phagocytosis
- phagocytes act between infection and immune response
- include macrophages and neutrophils
- presentation/treatment of antigen by macrophages
- attracted to site of infection by histamine proteins produced by mast cells
- chemotaxis i.e. the process by which cells are attracted to the bacteria.
- it may be by the materials released by the bacteria or opsonization, and opsonin is a type of
antibody that renders bacteria more susceptible to phagocytosis [which may be by coating of the
outer membrane of bacteria], or by agglutination [via agglutinins which 'clump' together bacteria
at wound/area of infection].
- complements/lymphokins/microbial components attract neutrophils
- accumulate at wounds/site of infection
- squeezing through capillary walls (diapedesis)
- binding of neutrophils direct to bacteria/receptors
- compliment/antibody/opsonins facilitate binding
- surface membrane infold/invaginate to surround bacteria/antigen
- forming a phagosome

- lysosome fuse with the phagosome
- forming a phagolysosome
- bacteria killed by toxic free radicals/hydrogen peroxide
- intracellular digestion (lysosomal enzymes)
- products of digestion absorbed into cytoplasm
Phagocytosis going on..
Distinguish between phagocytes and lymphocytes

Phagocytes
- macrophages and neutrophils
- involved in non-specific response/engulfing the bacteria/pathogen/antigen
- can squeeze through capillary walls

Lymphocytes
- B and T cells
- involved in specific response
- remain in circulatory system and lymphatic system
- produce antibodies
Explain the meaning of the term immune response, making reference to the terms antigen, self and
non-self;
- An immune response is a body's reaction to an antigen which a marker molecule in the cell
surface membrane of foreign bodies that sets off an immune response.
- The discrimination between self and non-self cells is an integral part of our immune system.
- This distinguishing is possible by the presence of glycoproteins or other types of recognition
molecules.
- Our body functions normally when no abnormal recognition protein/molecule is encountered by
our immune system but when foreign particles exhibiting recognition proteins that our not
normally found in our body are encountered then our body's defense mechanism starts rolling, i.e.
an immune response is initiated.
- This can be a product of two scenarios:
 Tissue Transplant leading to tissue rejection because the donor can never have the same
recognition proteins as the acceptor. That‘s why, following up a tissue transplant, the acceptors are
usually at prescriptions that suppress their immune system from starting an immune response.
 Invasion of Bacteria and other foreign particles

Distinguish between B- and T-lymphocytes in their mode of action in fighting infection, and
describe their origin and functions;
- The lymphocytes are the backbone of our immune system without them our immune system would
be of no use.
- Moreover the two main types of lymphocytes, the T and B lymphocytes are interdependent that is
why a person infected by the AIDS virus has a severely depleted immune system due to the
destruction of T-Lymphocytes.
- Both of these cells originate in the stem cells of the bone marrow.
- While the B-cells mature in the bone marrow, the T-cells move as precursors [non-functional
form] to the thymus gland where they mature and T-lymphocytes which are over reactive and can
cause harm to the body's own cells are also destroyed here.
B-Lymphocytes
- B-Lymphocytes can differentiate into Memory Cells and Plasma Cells.
- memory cells act as an immunological memory of the antigen in question after the body is exposed
to it for the first time and has countered it and remains in the blood stream for months or even
years to initiate a more severe secondary immune response when that antigen is encountered
again.
- plasma cells are there to produce antibodies against a specific antigen and thus have a more
developed and extended Rough Endoplasmic Reticulum and Golgi Body.
T-Lymphocytes
- There are of two main types; Helper Cells and Cytotoxic Cells.
- T- Helper Cells sells act like assistants to the immune system, when they come across an immune
cell such as a Dendritic Cell or Macrophage displaying {on their cell membrane like war trophies,
after they have destroyed an antigen bearing cell =)] an antigen which they are also specific to,
they form a temporary bond at the T-Cell Receptor (TCR) which can be thought of as a binding

site on an enzyme and release chemicals called cytokines which simulate other immune system
cells like
- Macrophages and Lymphocytes to take action against the intruder.
- This simulation can be done in the form of B-Lymphocytes activation and differentiation to
produce plasma cells.
- While Cytotoxic Cells exclusively scan the cell membranes of the bodies' own cells for changes in
the Major Histocompatibility Complex [it can be thought of as a genomic region in a cell
responsible for protein synthesis and displaying of the proteins encoded inside the cell on the cell
surface membrane], malignant growth [as in cancer], cell invasion by viruses and other
intercellular parasites alter the MHC of the cell [i.e. other/more types of proteins will started to get
synthesized] and thus Cytotoxic Cells act on it and destroy the cell as a whole.
There are two routes that an immune response can follow we will briefly outline both of them...The first
one is a simpler
Humoral Response
- involves B-cells
- B cells release antibodies into the blood plasma, tissue fluid and lymph. As the antibodies are
released into fluids and the attack on the microorganisms takes place in the fluid this type of
immunity is called humoral, humor means fluid.
- Antibodies of B cells attack bacteria and some viruses
- A non-activated B-cell has several antigen binding sites (antigen receptors) attached to its cell
membrane whose shape is identical to the antibodies that the cell can make.
- All the receptors in the membrane of one cell are identical, so a given cell can recognize only one
type of antigen.
- A complementary antigen attaches to it
- When it binds to an antigen the cell is activated to clone itself, meaning that it multiplies to form
many identical copies of itself.
- Activation requires the presence of lymphokins secreted by T-helper cells as well as antigen.
- Memory cells and effector cells (plasma proteins) are formed
- These secrete large numbers of antibody into the blood, tissue fluid and lymph.

- Effector cells live for a few days only
- Memory cells survive for long periods of time and enable rapid response to be made to any future
infection
Cell-Mediated Response
- Involves T-cells
- T cells attack the following:
(i) Cells that have become infected by a microorganism most commonly a virus
(ii) Transplanted organs and tissues
(iii)Cancer-causing cells
- The whole cell is involved in the attack thus cell-mediated immunity.
- T cells do not release antibodies
The cell surface membrane of T cells contains specific receptors with particular shapes, similar to
antibodies.
- The receptors do not recognize the whole antigen molecules unlike antibodies
- They bind only to fragments of antigens or other foreign molecules which are presented to them by
other cells, often macrophages
- Mature T cells possess a T4 molecule (T4 cells) or a T8 molecule (T8 cells) which give them
different functions.
- T4 cell are known as T helper cells. The HIV virus which causes AIDS infects mainly T-helper
cells.
- There are two types of T8 cells known as suppressor cells and killer cells (or cytotoxic cells).
- Each type of T-cell produces a different type of lymphokine.
- Lymphokins are small peptide nolecules with various functions.
- T4 cells work in association with macrophages.
- The macrophage first captures an antigen-carrying organism.
- It then chops off a piece of the antigen an presents it at its cell surface where it is recognized as a
foreign peptide by a T4 cell (one with a matching receptor)
- The T cell then produces large amounts of lymphokines.
- This have various functions which include;

(i) stimulate T cells to multiply
(ii) promote inflammation
(iii) stimulate B cells to make antibodies
- killer cells produce smaller amounts of lymphokines, but kill body cells which have become
infected by viruses and cancer cells. This si done by a chemical attack or by punching holes in the
cells.
- They recognize e.g. a stray part of a virus on the outside of an infected cell or a mutant protein
produced by a cancer cell.
- They also attack and gradually destroy transplanted organs.
- Suppressor cells secrete lymphokines that depress the activity of all the different types of white
blood cells including phagocytes.
- Helper cells secrete lymphokines which increase the activity of all the different types of white
blood cells

Role of lymphocytes in cell mediated and humoral response
- cell mediated/cellular involves T-cells;
- humoral involves B-cells
- clonal selection
- receptors on T/B cell membranes for recognition of antigen
- divide/mitosis to form clones
- T cells to form effector cells
- B cells to form plasma cells
- B cells/plasma cells release antibodies (into blood/plasma)
- different types of antibodies IgM/IgG
- ref. to structure of antibodies
- ref. to modes of action
- T-helper cells activate B-cells
- activate macrophages
- secretion of lymphokins
- T-cytotoxic cells destroy virus infected cells
- T-suppressor cells control immune response
- memory cells
- slow primary response/fast secondary response (Idea –could be shown on a graph)
Memory Cells
- memory cells are important if a second infection of an antigen occurs
- the population of memory cells is much larger than the original population of B cells from which
they came from.
- Therefore the response to the second infection called secondary response is much more rapid and
is also greater than the primary response to the original infection as shown in the graph below.
- The primary response may not be rapid enough to prevent a person suffering from an infection but
if that person survives, they will rarely suffer from it again because of the greater secondary
response.
- With each exposure, the response gets more efficient.

- This is the basis of vaccination (booster doses).
Explain the role of memory cells in long-term immunity

- produced by both T and B lymphocytes/cells
- survive for long periods
- remain in lymphoid system and circulate in blood and in lymph
- constantly checking for return of pathogen with same antigen
- go fewer divisions before differentiating into plasma cells
- Second response called secondary response
- greater than primary response to original infection
- Antigen presenting cells/APCs continue to expose
- antigen to memory cells to maintain memory

Immunological Memory
- Primary immune response – cellular differentiation and proliferation, which occurs on the first
exposure to a specific antigen
- Lag period: 3 to 6 days after antigen challenge
- Peak levels of plasma antibody are achieved in 10 days
- Antibody levels then decline
- Secondary immune response – re-exposure to the same antigen
- Sensitized memory cells respond within hours

- Antibody levels peak in 2 to 3 days at much higher levels than in the primary response
- Antibodies bind with greater affinity, and their levels in the blood can remain high for weeks to
months

Describe the role of lymphocytes in cell mediated and humoral response
- cell mediated/cellular involves T-cells;
- humoral involves B-cells
- clonal selection
- receptors on T/B cell membranes for recognition of antigen
- divide/mitosis to form clones
- T cells to form effector cells
- B cells to form plasma cells
- B cells/plasma cells release antibodies (into blood/plasma)
- different types of antibodies IgM/IgG
- ref. to structure of antibodies
- ref. to modes of action
- T-helper cells activate B-cells
- activate macrophages
- secretion of lymphokins
- T-cytotoxic cells destroy virus infected cells
- T-suppressor cells control immune response
- memory cells
- slow primary response/fast secondary response (Idea –could be shown on a graph)
Relate the molecular structure of antibodies to their functions;

- An antibody is a molecule synthesized by an animal in response to the presence of foreign
substances called antigens
- Each antibody is a globular protein molecule called immunoglobulin.
- Structure consists of four polypeptide chains
- Two heavy chains and two light chains
- The chains are held together by disulphide bridges
- It has a constant and a variable region
- The variable part is specific to each type of antibody produced

- There are different classes of antibodies e.g. IgS, IgM, IgA, IgE and IgD
- Its structure consists of two heavy chains (H-chains) and two light chains (L-chains)
- It has a constant and variable part, the variable acts like a key which specifically fits into a lock
- The body van produce an estimated 100 million different antibodies recognizing all kinds of
foreign substances, including many the body has never met.
- It does this by shuffling different sections of parts of the genes on which produce the variable
region.
Antigen
- An antigen is a molecule which can cause antibody formation

- All cells possess antigens in their cell surface membranes which acts as markers, enabling cells to
recognize each other.
- Antigens are usually glycoproteins
- The body can distinguish its own antigens (self) from foreign antigens (non-self) and normally
makes antibodies against non-self antigens.
- Microorganisms carry antigens on their surface

- They are proteins that are utilized by the immune system to detect and neutralize foreign objects.
- They consist of light chains (the two smaller ones) and the heavy chains (the two central ones)
which both have a variable region (specific to every different type of antibody) at the tips with an
antigen-binding site (shown in yellow).
- The heavier chains and the heavy and light chains are linked together by disulfide linkages which
are a type of covalent bonds that are formed upon the oxidation of thiol groups [-SH2] that are left
over from the cysteine molecules.
- They are very important to the functioning of the antibody because most of its functions are carried
out in an extracellular aqueous environment which attacks both the other available alternatives,
ionic bonds and hydrogen bonding so the preservation of an antibody's structure is critical to its
proper functioning and the disulfide linkages ensure just that.
Functions of antibodies
- Opsonization - the stimulation of other immune cells (like Macrophages) to engulf a foreign
particle.

- Agglutination - the clumping together or precipitation of antigen-bearing material.
- Lysis - breakdown of an antigen bearing particle.
- Detoxification - the neutralization of harmful substances produced by foreign particles.
Explain what is meant by monoclonal antibodies and describe how they may be used to diagnose
diseases
- antibodies developed from a single cell/clone;

- they have a defined specificity;
- reactive with a single epitome/antigen;
- early diagnosis – couple to fluorescent markers to locate antigens;
- e.g. Chlamydia/streptococcal throat infections/gonorrhea/STDs;
- Chlamydia difficult to distinguish from gonorrhea/difficult to diagnose;
- used to diagnose lung/breast/colon//rectal cancer;
- classification of type of leukemia by specific markers on white blood cells;
- ensures correct treatment (for leukemia) given;
- distinguish between leukemias and lymphomas (both types of cancer of white blood cells);
- distinguish between closely related herpes viruses 1 (cold sores on lips and 20% of genital herpes)
and herpes virus 2 (genital infections);
- recommended treatment is different for two viruses;
- therefore important to distinguish between them;
- monitors spread of malaria by identifying stages in infected mosquitoes;
Active immunity
- result of infection/naturally/artificially/vaccination
- body manufactures its own antibodies
- stimulated by memory cells
- most effective/rapid response (second infection)

- persists for a long time
Passive immunity
- antibodies from another individual

- give immediate protection
- protects for short time (about a week)
Natural
- natural active
- natural infection by pathogen/antigen
- natural passive
- antibodies from mother to foetus/across placenta
- antibodies in colostrums/breast milk to baby
Artificial
- artificial active
- injection of pathogens/antigens into the body
- artificial passive
- ready-made antibodies injected into the body
How vaccination give protection against diseases
- vaccination- injection/administration of an antigen

- causes production of antibodies (against the antigen)
- vaccination is artificial immunity
- booster injection may be used for longer lasting/more effective protection
- response due to B and T cells

- memory cells survive for a long period
- memory cells are B cells
- memory cells enable a rapid response
- antibody brings about destruction of antigen/organism carrying it
- effective against infectious diseases 9e.g. small pox/diphtheria/polio/measles/whooping cough)
- vaccinate children in national/international campaigns
Describe why vaccination managed to eradicate small pox but not malaria
Small pox
- varilosa virus stable
- (harmless) strain of (live) vaccine effective
- vaccine could be kept for a long time (6 months)
- infected people were easy to identify
- ring vaccination was possible
- political stability during that time
Malaria
- no vaccine/no effective vaccine against the protozoan
- resistance of Plasmodium to drugs
- resistance of vector/mosquitoes to DDT/deldrin/insecticide
- difficulty of mosquito control
- expensive to expand the programme
- civil wars disrupt the programmes
Measles
- caused by an RNA virus

- viruses are intracellular pathogens
- antigenic concealment

- have a short time in the blood
- major changes in the epitate as a result of mutation
- poor response to vaccine (children do not respond well to one dose of vaccine)
- deficiency immune system
- or protein energy malnutrition
- need several boosters which are expensive
- high birth rates and flighting populations make it difficult for boosters
- follow up cases and trace contacts also impossible
- refugees and immigrants from reservoirs of the infection
- it is highly infectious resulting in the whole population requiring vaccination which is highly
expensive
- the virus is of hiring attenuated virus can be virulent
Tuberculosis
- some strains of TB bacteria resistant to drugs;
- the AIDS pandemic;
- poor housing and rising homelessness in inner cities in the developed world;
- the breakdown of TB control programmes particularly in the USA;
- partial treatment for TB increases the chance of drug resistance in Mycobacterium;
- attacks many of the poorest and socially disadvantaged because it is spread by airborne droplets;
- so people who are overcrowded are particularly at risk;
- those with low immunity particularly because of malnutrition or being HVI+ are also vulnerable;
- transmission is easily achieved but the bacteria may remain in the lung, or in the lymphoid tissue for
years until they become active;
Cholera
- V. cholerae in intestine;
- out of reach of immune system;
- antigenic concealment;

- antibodies broken down in intestine;
- antibodies are proteins;
- ref to pH and effect on structure or shape; e.g. in the stomach
- denaturation;
- vaccine stimulates antibodies in, blood / lymph;
- not in gut;
- oral vaccine needed;
- mutation;
- different strain idea;
- AVP; e.g. not required in developed countries
- developing countries cannot afford to develop vaccines
- no / limited, demand
- cholera can be treated with ORT
- can be treated with antibiotics
ALLERGIES
- Allergy means ‗altered reaction‘ – it is the inappropriate and harmful response of the body‘s defence
mechanisms to substances that are normally harmless.
- Allergies are caused by the immune system responding inappropriately to harmless substances which
can lead to severe illness.
- Asthma and hay fever are examples of allergic reactions - reacting to allergens that are antigenic but
shouldn't cause harm.
- When these allergens are inhaled, B cells produce antibodies, including histamines, when the tissues
are damaged. and these coat the mast cells that are found in the lining of the airways, sensitizing the
body to these allergens
- Examples of allergens include pollens, dust mite, molds, danders, and certain foods. People prone to
allergies are said to be allergic or atopic

- Now, every time this allergen enters the body, the antibodies are stimulated to release histamine,
causing the blood vessels to widen and become leaky - fluid and white blood cells leave capillaries.
- The area where histamines are released become hot, red and inflamed. Hay fever causes the nose and
throat to become inflamed and irritated.
- It can be an attack of sneezing and runny eyes (hay fever), an itchy red rash (eczema), wheezing when
breathing (asthma) or swelling of lips and tongue and vomiting (food allergy). Allergies affect about a
third of the population.
Hay fever
- Hay fever (allergic rhinitis) is the most common of the allergic diseases
- refers to seasonal nasal symptoms that are due to pollens.
- Year round or perennial allergic rhinitis is usually due to indoor allergens, such as dust mites or
molds.
- Symptoms result from the inflammation of the tissues that line the inside of the nose (mucus lining
or membranes) after allergens are inhaled.
- Adjacent areas, such as the ears, sinuses, and throat can also be involved. Hay fever is an allergic
reaction to airborne allergens.
Symptoms
- Irritation in the nose resulting in vigorous bouts of sneezing
- Release of a large volume of watery mucus making the nose run
- Itchy watery eyes
- Itchiness in the mouth, throat and ears
- Blocked nose and sinuses
- Runny nose
- Stuffy nose
- Nasal itching (rubbing)
- Itchy ears and throat
- Post nasal drip (throat clearing)

Cause
- Hay fever is not necessarily caused by hay. It generally occurs during the summer months and may be
triggered by grass pollen in the air. This generally peaks in June.
- Tree pollen which peaks in April.
- Fungal spores such as those of moulds that occur on foliage (including grasses).
- Non-seasonal hay fever is most often triggered by faecal pellets of dust mites or by hair of pets which
may be coated in saliva or urine.
Treatment
- Treatment of an allergic reaction involves avoiding the allergen as far as possible and preventing or
treating the symptoms.
Asthma
- Asthma is a breathing problem that results from the inflammation and spasm of the lung's air
passages (bronchial tubes).
- Asthma is a chronic inflammatory disease of the airways, trigger by a range of allergen.
- The inflammation causes a narrowing of the air passages, which limits the flow of air into and out of
the lungs.
- Asthma is most often, but not always, related to allergies.
- When an allergen is inhaled histamine is released by the mast cells in the lungs.
- This causes inflammation of the lining of small air tubes, secretion of excess mucus and contraction
of the muscles in the wall of the airways making breathing difficult if not impossible.
- Asthmatics have a more serious problem
- their airways are nearly always inflamed, but during an asthmatic attack this inflammation worsens.
- Fluid leaks from the blood into the airways and the goblet cells secrete large amounts of mucus,
blocking the smaller airways with fluid.
- This forces the muscles to contract, narrowing the airways and increasing air flow resistance.
- This makes breathing very difficult and can have fatal consequences.
- Asthma has been linked to increased air pollution and passive smoking.

Cause:
The allergens that commonly cause asthma are:
- House dust mites: These are very small (0.3 mm) and there may be thousands of them of them in a
gram of dust in a mattress or carpet. The allergen causing asthma is actually the faecal pellets of the
dust mites which are so small they are easily inhaled into the lungs.
- Pets: the allergen is the saliva or urine on hairs or feathers which are shed around the house.
- Engine emissions, especially particles of soot: emissions from petrol and diesel engines have been
blamed for the increase in childhood asthma but this has not been proven.
- Organic solvents.
- Wood and floor dust.
- Spores from fungi in rotting vegetation.
- Some medicines.
Symptoms:
- Difficulty with breathing (shortness of breath)

- Chest tightness; a cough, especially at night.
- Wheezing – a whistling sound due to air moving through swollen and partially obstructed airways

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2014 COPYRIGHT

© 2014 Johannes MAPURANGA

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Emmerson John Dhiri Pvt. Ltd

Ceteris pari bas - Sua paremia laud

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GASEOUS EXCHANGE .................................................................................................................................................. 25

SMOKING AND DISEASES ............................................................................................................................................ 48

INFECTIOUS DISEASES ................................................................................................................................................. 66

IMMUNITY ................................................................................................................................................................ 103

- complete physical, mental and social being

Outline the aspects that contribute towards good health

- good health is complete physical, mental and social well being

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- there are different ways of classifying diseases

- gradual decline in body functions

- an inherited genetic fault

- permanent or temporary damage to body parts

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- due to social behaviour and living conditions

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EPIDEMIOLOGY AND PATTERNS OF DISEASES

- a disease that suddenly spreads to affect many people e.g. cholera

- an infectious disease which is always present in a population e.g. TB

- a disease that spreads over a large area e.g. continent/worldwide

- mainly confined to developed/affluent countries

Explain the possible reasons for the global distribution of TB

- it is a pandemic disease (globally distributed)

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- most commonly affects developing countries;

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Explain the possible reasons for the global distribution of HIV/AIDS

- is a pandemic disease (globally distributed)

- Highly confined in sub-Saharan Africa

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Energy and nutrient requirements of people

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- Energy requirements increase more during the last three months

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- extra energy for growth and activity of the baby

Dietary Reference Values (DRVs)

Describe the role of DRVs in estimating the diet of people in Britain

- DRVs are not recommended quantities for individuals

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Describe the roles of essential fatty acids in the body

- an essential fatty acid is linoleic/linolenic acid

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Describe the roles of essential amino acids in the body

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Describe the roles of Vitamin D in the body

- Needed for proper absorption of calcium and phosphate

Explain what is meant by the term malnutrition

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- This is both a lack of energy and nutrients,

Protein energy deficiencies

Discuss the consequences of a child of a diet which is deficient in protein

- two possible conditions =

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- Anorexia nervosa, a self-inflicted psychological disease with physical consequences, and in

Discuss the possible consequences if a person suffers from anorexia nervosa

Describe the consequences of a person being obese