ABORTION

An abortion is the termination of a pregnancy by the removal or expulsion from the uterus
of a fetus/embryo, resulting in or caused by its death. An abortion can occur spontaneously due to
complications during pregnancy or can be induced, in humans and other species. In the context of
human pregnancies, an abortion induced to preserve the health of the gravida (pregnant female) is
termed a therapeutic abortion, while an abortion induced for any other reason is termed an elective
abortion. The term abortion most commonly refers to the induced abortion of a human pregnancy,
while spontaneous abortions are usually termed miscarriages.
Abortion has a long history and has been induced by various methods including herbal
abortifacients, the use of sharpened tools, physical trauma and other traditional methods.
Contemporary medicine utilizes medications and surgical procedures to induce abortion. The
legality, prevalence, and cultural views on abortion vary substantially around the world. In many
parts of the world there is prominent and divisive public controversy over the ethical and legal issues
of abortion. Abortion and abortion-related issues feature prominently in the national politics in
many nations often involving the opposing pro-life and pro-choice worldwide social movements.
Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus
due to accidental trauma or natural causes before approximately the 22nd week of gestation; the
definition by gestational age varies by country. Most miscarriages are due to incorrect replication of
chromosomes, they can also be caused by environmental factors. A pregnancy that ends before 37
weeks of gestation resulting in a live-born infant is known as a "premature birth". When a fetus dies
in utero after about 22 weeks, or during delivery, it is usually termed "stillborn". Premature births
and stillbirths are generally not considered to be miscarriages although usage of these terms can
sometimes overlap.
The most common cause of spontaneous abortion during the first trimester is chromosomal
abnormalities of the embryo/fetus, accounting for at least 50% of sampled early pregnancy losses.
Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection,
and abnormalities of the uterus. Advancing maternal age and a patient history of previous
spontaneous abortions are the two leading factors associated with a greater risk of spontaneous
abortion. A spontaneous abortion can also be caused by accidental trauma; intentional trauma or
stress to cause miscarriage is considered induced abortion or feticide.
A pregnancy can be intentionally aborted in many ways. The manner selected depends
chiefly upon the gestational age of the embryo or fetus, which increases in size as it ages. Specific
procedures may also be selected due to legality, regional availability, and doctor-patient preference.
Reasons for procuring induced abortions are typically characterized as either therapeutic or elective.
An abortion is medically referred to as therapeutic when it is performed to:
save the life of the pregnant woman;
preserve the woman's physical or mental health;
terminate pregnancy that would result in a child born with a congenital disorder that would
be fatal or associated with significant morbidity or
selectively reduce the number of fetuses to lessen health risks associated with multiple
pregnancy.
An abortion is referred to as elective when it is performed at the request of the woman "for reasons
other than maternal health or fetal disease.
CHOLERA
Cholera, sometimes known as Asiatic or epidemic cholera, is an infectious gastroenteritis
caused by enterotoxin-producing strains of the bacterium Vibrio cholerae. Transmission to humans
occurs through eating food or drinking water contaminated with Vibrio cholerae from other cholera
patients. The major reservoir for cholera was long assumed to be humans themselves, but
considerable evidence exists that aquatic environments can serve as reservoirs of the bacteria.
Vibrio cholerae is a Gram-negative bacterium that produces cholera toxin, an enterotoxin,
whose action on the mucosal epithelium lining of the small intestine is responsible for the disease's
most salient characteristic, exhaustive diarrhea. In its most severe forms, cholera is one of the most
rapidly fatal illnesses known, and a healthy person's blood pressure may drop to hypotensive levels
within an hour of the onset of symptoms; infected patients may die within three hours if medical
treatment is not provided. In a common scenario, the disease progresses from the first liquid stool
to shock in 4 to 12 hours, with death following in 18 hours to several days, unless oral rehydration
therapy is provided.
In most cases cholera can be successfully treated with oral rehydration therapy. Prompt
replacement of water and electrolytes is the principal treatment for cholera, as dehydration and
electrolyte depletion occur rapidly. Oral rehydration therapy or ORT is highly effective, safe, and
simple to administer. In situations where commercially produced ORT sachets are too expensive or
difficult to obtain, alternative homemade solutions using various formulas of water, sugar, table salt,
baking soda, and fruit offer less expensive methods of electrolyte repletion. In severe cholera cases
with significant dehydration, the administration of intravenous rehydration solutions may be
necessary.
Antibiotics shorten the course of the disease, and reduce the severity of the symptoms.
However Oral rehydration therapy remains the principal treatment. Tetracycline is typically used as
the primary antibiotic, although some strains of V. cholerae exist that have shown resistance. Other
antibiotics that have been proven effective against V. cholerae include cotrimoxazole, erythromycin,
doxycycline, chloramphenicol, and furazolidone. Fluoroquinolones such as norfloxacin also may be
used, but resistance has been reported.
Rapid diagnostic assay methods are available for the identification of multidrug resistant V.
cholerae.

New generation antimicrobials have been discovered which are effective against V.
cholerae in in vitro studies. The success of treatment is significantly affected by the speed and
method of treatment. If cholera patients are treated quickly and properly, the mortality rate is less
than 1%; however, with untreated cholera the mortality rate rises to 5060%.

Prevention
Sterilization: Proper disposal and treatment of infected fecal waste water produced by cholera
victims and all contaminated materials (e.g. clothing, bedding, etc) is essential.
Sewage: anti-bacterial treatment of general sewage by chlorine, ozone, ultra-violet light or
other effective treatment before it enters the waterways or underground water supplies helps
prevent undiagnosed patients from inadvertently spreading the disease.
Sources: Warnings about possible cholera contamination should be posted around
contaminated water sources with directions on how to decontaminate the water (boiling,
chlorination etc.) for possible use.
Water purification: All water used for drinking, washing, or cooking should be sterilized by
either boiling, chlorination, ozone water treatment, ultra-violet light sterilization, or anti-
microbal filtration in any area where cholera may be present.
A vaccine for cholera is available in some countries, but prophylactic usage is not currently
recommended for routine use by the Centers for Disease Control and Prevention (CDC). During
recent years, substantial progress has been made in developing new oral vaccines against cholera.
Two oral cholera vaccines, which have been evaluated with volunteers from industrialized countries
and in regions with endemic cholera, are commercially available in several countries: a killed whole-
cell V. cholerae O1 in combination with purified recombinant B subunit of cholera toxin and a live-
attenuated live oral cholera vaccine, containing the genetically manipulated V. cholerae O1 strain
CVD 103-HgR. The appearance of V. cholerae O139 has influenced efforts in order to develop an
effective and practical cholera vaccine since none of the currently available vaccines is effective
against this strain. The newer vaccine (brand name: Dukoral), an orally administered inactivated
whole cell vaccine, appears to provide somewhat better immunity and have fewer adverse effects
than the previously available vaccine. This safe and effective vaccine is available for use by
individuals and health personnel. Work is under way to investigate the role of mass vaccination.


















RABIES
Rabies is a viral neuroinvasive disease that causes acute encephalitis (inflammation of the
brain) in warm-blooded animals. It is zoonotic (i.e. transmitted by animals), most commonly by a bite
from an infected animal but occasionally by other forms of contact. Generally fatal if left untreated,
it is a significant killer of livestock in some countries.
The rabies virus travels to the brain by following the peripheral nerves. The incubation
period of the disease depends on how far the virus must travel to reach the central nervous system,
usually taking a few months. Once the infection reaches the central nervous system and symptoms
begin to show, the untreated infection is usually fatal within days.
Early-stage symptoms of rabies are malaise, headache and fever, later progressing to more
serious ones, including acute pain, violent movements, uncontrolled excitement, depression and
inability to swallow water. Finally, the patient may experience periods of mania and lethargy,
followed by coma. The primary cause of death is usually respiratory insufficiency.
The rabies virus is the type species of the Lyssavirus genus, which encompasses other similar
viruses. Lyssaviruses have helical symmetry, with a length of about 180 nm and a cross-sectional
diameter of about 75 nm. These viruses are enveloped and have a single stranded RNA genome with
negative-sense. The genetic information is packaged as a ribonucleoprotein complex in which RNA is
tightly bound by the viral nucleoprotein. The RNA genome of the virus encodes five genes whose
order is highly conserved. These genes are nucleoprotein (N), phosphoprotein (P), matrix protein
(M), glycoprotein (G) and the viral RNA polymerase (L).
From the point of entry, the virus travels quickly along the neural pathways into the central
nervous system (CNS), and then further into other organs. The salivary glands receive high
concentrations of the virus thus allowing further transmission.
The period between infection and the first flu-like symptoms is normally two to twelve
weeks, but can be as long as two years. Soon after, the symptoms expand to slight or partial
paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia,
terror, hallucinations, progressing to delirium. The production of large quantities of saliva and tears
coupled with an inability to speak or swallow are typical during the later stages of the disease; this
can result in hydrophobia, where the patient has difficulty swallowing because the throat and jaw
become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his
or her thirst. The disease itself was also once commonly known as hydrophobia, from this
characteristic symptom.
Death almost invariably results two to ten days after the first symptoms; the few humans
who are known to have survived the disease

were all left with severe brain damage, with the
exception of Jeanna Giese (see below). It is neurotropic in nature.
The reference method for diagnosing rabies is by performing PCR or viral culture on brain
samples taken after death. The diagnosis can also be reliably made from skin samples taken before
death. It is also possible to make the diagnosis from saliva, urine and cerebrospinal fluid samples,
but this is not as sensitive. Inclusion bodies called Negri bodies are 100% diagnostic for rabies
infection, but found only in 20% of cases.

STROKE
A stroke is the rapidly developing loss of brain function due to disturbance in the blood
supply to the brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or
embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function,
leading to inability to move one or more limbs on one side of the body, inability to understand or
formulate speech, or inability to see one side of the visual field. In the past, stroke was referred to as
cerebrovascular accident or CVA, but the term "stroke" is now preferred.
A stroke is a medical emergency and can cause permanent neurological damage,
complications, and death. It is the leading cause of adult disability in the United States and Europe.
In the UK, it is the second most common cause of death, the first being heart attacks and third being
cancer. It is the number two cause of death worldwide and may soon become the leading cause of
death worldwide. Risk factors for stroke include advanced age, hypertension (high blood pressure),
previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and
atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.
The traditional definition of stroke, devised by the World Health Organization in the 1970s,
is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by
death within 24 hours". This definition was supposed to reflect the reversibility of tissue damage and
was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24-hour
limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms
that resolve completely within 24 hours. With the availability of treatments that, when given early,
can reduce stroke severity, many now prefer alternative concepts, such as brain attack and acute
ischemic cerebrovascular syndrome (modeled after heart attack and acute coronary syndrome
respectively), that reflect the urgency of stroke symptoms and the need to act swiftly.
A stroke is occasionally treated with thrombolysis ("clot buster"), but usually with supportive
care (speech and language therapy, physiotherapy and occupational therapy) in a "stroke unit" and
secondary prevention with antiplatelet drugs (aspirin and often dipyridamole), blood pressure
control, statins, and in selected patients with carotid endarterectomy and anticoagulation.











Malaria
Malaria is a vector-borne infectious disease caused by protozoan parasites. It is widespread
in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. Each year, there
are approximately 350500 million cases of malaria, killing between one and three million people,
the majority of whom are young children in Sub-Saharan Africa. Ninety percent of malaria-related
deaths occur in Sub-Saharan Africa. Malaria is commonly associated with poverty, but is also a cause
of poverty

and a major hindrance to economic development.
Malaria is one of the most common infectious diseases and an enormous public health
problem. The disease is caused by protozoan parasites of the genus Plasmodium. Five species of the
plasmodium parasite can infect humans; the most serious forms of the disease are caused by
Plasmodium falciparum. Malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium
malariae causes milder disease in humans that is not generally fatal. A fifth species, Plasmodium
knowlesi, causes malaria in macaques but can also infect humans. This group of human-pathogenic
Plasmodium species is usually referred to as malaria parasites.
Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only
Anopheles mosquitoes can transmit malaria, and they must have been infected through a previous
blood meal taken on an infected person. When a mosquito bites an infected person, a small amount
of blood is taken, which contains microscopic malaria parasites. About one week later, when the
mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected
into the person being bitten. The parasites multiply within red blood cells, causing symptoms that
include symptoms of anemia (light-headedness, shortness of breath, tachycardia, etc.), as well as
other general symptoms such as fever, chills, nausea, flu-like illness, and, in severe cases, coma, and
death. Malaria transmission can be reduced by preventing mosquito bites with mosquito nets and
insect repellents, or by mosquito control measures such as spraying insecticides inside houses and
draining standing water where mosquitoes lay their eggs. Work has been done on malaria vaccines
with limited success and more exotic controls, such as genetic manipulation of mosquitoes to make
them resistant to the parasite have also been considered.
Although some are under development, no vaccine is currently available for malaria that
provides a high level of protection; preventive drugs must be taken continuously to reduce the risk
of infection. These prophylactic drug treatments are often too expensive for most people living in
endemic areas. Most adults from endemic areas have a degree of long-term infection, which tends
to recur, and also possess partial immunity (resistance); the resistance reduces with time, and such
adults may become susceptible to severe malaria if they have spent a significant amount of time in
non-endemic areas. They are strongly recommended to take full precautions if they return to an
endemic area. Malaria infections are treated through the use of antimalarial drugs, such as quinine
or artemisinin derivatives. However, parasites have evolved to be resistant to many of these drugs.
Therefore, in some areas of the world, only a few drugs remain as effective treatments for malaria.





Tuberculosis
Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and often
deadly infectious disease caused by mycobacteria, in humans mainly Mycobacterium tuberculosis.
Tuberculosis usually attacks the lungs (as pulmonary TB) but can also affect the central nervous
system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal
system, bones, joints, and even the skin. Other mycobacteria such as Mycobacterium bovis,
Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti also cause
tuberculosis, but these species are less common in humans.
The classic symptoms of tuberculosis are a chronic cough with blood-tinged sputum, fever,
night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. The
diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as
microscopic examination and microbiological culture of bodily fluids. Tuberculosis treatment is
difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if
necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant
tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus
Calmette-Gurin (BCG vaccine).
Tuberculosis is spread through the air, when people who have the disease cough, sneeze, or
spit. Onethird of the world's current population has been infected with M. tuberculosis, and new
infections occur at a rate of one per second. However, most of these cases will not develop the full-
blown disease; asymptomatic, latent infection is most common. About one in ten of these latent
infections will eventually progress to active disease, which, if left untreated, kills more than half of
its victims. The proportion of people in the general population who become sick with tuberculosis
each year is stable or falling worldwide but, because of population growth, the absolute number of
new cases is still increasing. In 2004, mortality and morbidity statistics included 14.6 million chronic
active cases, 8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In
addition, a rising number of people in the developed world are contracting tuberculosis because
their immune systems are compromised by immunosuppressive drugs, substance abuse, or AIDS.
The distribution of tuberculosis is not uniform across the globe with about 80% of the population in
many Asian and African countries testing positive in tuberculin tests, while only 5-10% of the US
population test positive. It is estimated that the US has 25,000 new cases of tuberculosis each year,
40% of which occur in immigrants from countries where tuberculosis is endemic.










HIV
Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that
can lead to acquired immunodeficiency syndrome (AIDS), a condition in humans in which the
immune system begins to fail, leading to life-threatening opportunistic infections. Previous names
for the virus include human T-lymphotropic virus-III (HTLV-III), lymphadenopathy-associated virus
(LAV), and AIDS-associated retrovirus (ARV).
Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or
breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within
infected immune cells. The four major routes of transmission are unsafe sex, contaminated needles,
breast milk, and transmission from an infected mother to her baby at birth (Vertical transmission).
Screening of blood products for HIV has largely eliminated transmission through blood transfusions
or infected blood products in the developed world.
HIV infection in humans is now pandemic. In 2005 alone, AIDS claimed an estimated 2.43.3
million lives, of which more than 570,000 were children. A third of these deaths are occurring in sub-
Saharan Africa, retarding economic growth and increasing poverty. According to current estimates,
Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but routine
access to antiretroviral medication is not available in all countries.
HIV primarily infects vital cells in the human immune system such as helper T cells
(specifically CD4
+
T cells), macrophages, and dendritic cells. HIV infection leads to low levels of CD4
+

T cells through three main mechanisms: firstly, direct viral killing of infected cells; secondly,
increased rates of apoptosis in infected cells; and thirdly, killing of infected CD4
+
T cells by CD8
cytotoxic lymphocytes that recognize infected cells. When CD4
+
T cell numbers decline below a
critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible
to opportunistic infections.
Eventually most HIV-infected individuals develop AIDS. These individuals mostly die from
opportunistic infections or malignancies associated with the progressive failure of the immune
system. Without treatment, about 9 out of every 10 persons with HIV will progress to AIDS after 10
15 years. Many progress much sooner. Treatment with anti-retrovirals increases the life expectancy
of people infected with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival
time with antiretroviral therapy (as of 2005) is estimated to be more than 5 years. Without
antiretroviral therapy, death normally occurs within a year.