THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Cholera: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83292-7 1. Cholera-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of cholera.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to cholera. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to cholera, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Anthrax
·
The Official Patient's Sourcebook on Aspergillosis
·
The Official Patient's Sourcebook on Bacterial Waterborne Diseases
·
The Official Patient's Sourcebook on Blastomycosis
·
The Official Patient's Sourcebook on Botulism
·
The Official Patient's Sourcebook on Brainerd Diarrhea
·
The Official Patient's Sourcebook on Brucellosis
·
The Official Patient's Sourcebook on Campylobacteriosis
·
The Official Patient's Sourcebook on Chlamydia Pneumonia
·
The Official Patient's Sourcebook on Coccidioidomycosis
·
The Official Patient's Sourcebook on Cryptococcosis
·
The Official Patient's Sourcebook on Diarrheagenic Escherichia Coli
·
The Official Patient's Sourcebook on Diphtheria
·
The Official Patient's Sourcebook on Drug-resistant Streptococcus Pneumoniae
·
The Official Patient's Sourcebook on Enterotoxigenic E. Coli
·
The Official Patient's Sourcebook on Escherichia Coli
·
The Official Patient's Sourcebook on Food Irradiation
·
The Official Patient's Sourcebook on Foodborne Disease
·
The Official Patient's Sourcebook on Genital Candidiasis
·
The Official Patient's Sourcebook on Glanders
·
The Official Patient's Sourcebook on Group A Streptococcus
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The Official Patient's Sourcebook on Group B Streptococcus
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The Official Patient's Sourcebook on Haemophilus Influenzae Serotype B
·
The Official Patient's Sourcebook on Hansen's Disease
·
The Official Patient's Sourcebook on Helicobacter Pylori Infections
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The Official Patient's Sourcebook on Histoplasmosis
·
The Official Patient's Sourcebook on Invasive Candidiasis
·
The Official Patient's Sourcebook on Legionellosis
·
The Official Patient's Sourcebook on Leptospirosis
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The Official Patient's Sourcebook on Leptospirosis Infection in Pets
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The Official Patient's Sourcebook on Listeriosis
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The Official Patient's Sourcebook on Melioidosis
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The Official Patient's Sourcebook on Meningitis
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The Official Patient's Sourcebook on Mycobacterium Avium Complex
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The Official Patient's Sourcebook on Mycoplasma Pneumoniae
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·
The Official Patient's Sourcebook on Nocardiosis
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The Official Patient's Sourcebook on Oropharyngeal Candidiasis
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The Official Patient's Sourcebook on Other Mycobacterium Species
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The Official Patient's Sourcebook on Pertussis
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The Official Patient's Sourcebook on Pneumonia among Children in Developing Countries
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The Official Patient's Sourcebook on Psittacosis
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The Official Patient's Sourcebook on Salmonella Enteritidis Infection
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The Official Patient's Sourcebook on Salmonellosis
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The Official Patient's Sourcebook on Shigellosis
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The Official Patient's Sourcebook on Sporotrichosis
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The Official Patient's Sourcebook on Streptococcus Pneumoniae Disease
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The Official Patient's Sourcebook on Toxic Shock Syndrome
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The Official Patient's Sourcebook on Trachoma
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The Official Patient's Sourcebook on Travelers Diarrhea
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The Official Patient's Sourcebook on Typhoid Fever
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The Official Patient's Sourcebook on Unexplained Deaths & Critical Illnesses
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The Official Patient's Sourcebook on Urinary Tract Infections
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The Official Patient's Sourcebook on Vibrio Parahaemolyticus
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The Official Patient's Sourcebook on Vibrio Vulnificus
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The Official Patient's Sourcebook on Yersiniosis
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON CHOLERA: GUIDELINES .................. 9
Overview............................................................................................................... 9 What Is Cholera? ................................................................................................ 10 How Does a Person Get Cholera?....................................................................... 11 What Is the Risk or Cholera in the United States? ............................................ 11 What Should Travelers Do to Avoid Getting Cholera? ..................................... 12 Is a Vaccine Available to Prevent Cholera?........................................................ 12 Can Cholera Be Treated? .................................................................................... 13 How Long Will the Current Epidemic Last? ..................................................... 14 What Is the U.S. Government Doing to Combat Cholera?................................ 14 Where Can a Traveler Get Information about Cholera? .................................... 15 Cholera: Technical Notes .................................................................................... 15 Additional Information....................................................................................... 17 More Guideline Sources ..................................................................................... 18 Vocabulary Builder............................................................................................. 22
CHAPTER 2. SEEKING GUIDANCE ....................................................... 25
Overview............................................................................................................. 25 Associations and Cholera.................................................................................... 25 Finding Doctors.................................................................................................. 27 Selecting Your Doctor ........................................................................................ 29 Working with Your Doctor ................................................................................ 29 Broader Health-Related Resources ..................................................................... 31
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 33 CHAPTER 3. STUDIES ON CHOLERA .................................................... 35
Overview............................................................................................................. 35 The Combined Health Information Database ..................................................... 35 Federally-Funded Research on Cholera .............................................................. 37 E-Journals: PubMed Central .............................................................................. 52 The National Library of Medicine: PubMed ...................................................... 59 Vocabulary Builder............................................................................................. 62
CHAPTER 4. PATENTS ON CHOLERA................................................... 71
Overview............................................................................................................. 71
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Contents
Patents on Cholera.............................................................................................. 72 Patent Applications on Cholera.......................................................................... 85 Keeping Current ................................................................................................. 86 Vocabulary Builder............................................................................................. 87
CHAPTER 5. BOOKS ON CHOLERA ...................................................... 89
Overview............................................................................................................. 89 Book Summaries: Federal Agencies .................................................................... 89 Book Summaries: Online Booksellers ................................................................. 91 The National Library of Medicine Book Index ................................................... 93 Chapters on Cholera............................................................................................ 95 General Home References ................................................................................... 98 Vocabulary Builder............................................................................................. 98
CHAPTER 6. MULTIMEDIA ON CHOLERA.......................................... 103
Overview........................................................................................................... 103 Video Recordings .............................................................................................. 103 Bibliography: Multimedia on Cholera .............................................................. 105
CHAPTER 7. PHYSICIAN GUIDELINES AND DATABASES ................... 107
Overview........................................................................................................... 107 NIH Guidelines................................................................................................. 107 NIH Databases.................................................................................................. 108 Other Commercial Databases ........................................................................... 113 The Genome Project and Cholera ..................................................................... 114 Specialized References....................................................................................... 118 Vocabulary Builder........................................................................................... 120
CHAPTER 8. DISSERTATIONS ON CHOLERA ...................................... 121
Overview........................................................................................................... 121 Dissertations on Cholera .................................................................................. 121 Keeping Current ............................................................................................... 123
PART III. APPENDICES .................................................. 125 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 127
Overview........................................................................................................... 127 Your Medications: The Basics .......................................................................... 128 Learning More about Your Medications .......................................................... 129 Commercial Databases...................................................................................... 131 Contraindications and Interactions (Hidden Dangers) ................................... 132 A Final Warning .............................................................................................. 133 General References............................................................................................ 134 Vocabulary Builder........................................................................................... 134
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 135
Overview........................................................................................................... 135 What Is CAM? ................................................................................................. 135 What Are the Domains of Alternative Medicine?............................................ 136
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Can Alternatives Affect My Treatment? ......................................................... 139 Finding CAM References on Cholera............................................................... 140 Additional Web Resources................................................................................ 150 General References............................................................................................ 153 Vocabulary Builder........................................................................................... 155
APPENDIX C. RESEARCHING NUTRITION ......................................... 157
Overview........................................................................................................... 157 Food and Nutrition: General Principles........................................................... 158 Finding Studies on Cholera .............................................................................. 162 Federal Resources on Nutrition........................................................................ 164 Additional Web Resources................................................................................ 165 Vocabulary Builder........................................................................................... 165
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 167
Overview........................................................................................................... 167 Preparation ....................................................................................................... 167 Finding a Local Medical Library ...................................................................... 168 Medical Libraries Open to the Public............................................................... 168
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 175
Overview........................................................................................................... 175 Your Rights as a Patient................................................................................... 175 Patient Responsibilities .................................................................................... 179 Choosing an Insurance Plan............................................................................. 180 Medicare and Medicaid .................................................................................... 182 NORD’s Medication Assistance Programs ..................................................... 185 Additional Resources ........................................................................................ 186 Vocabulary Builder........................................................................................... 187
ONLINE GLOSSARIES.................................................... 189 Online Dictionary Directories.......................................................................... 194
CHOLERA GLOSSARY.................................................... 195 General Dictionaries and Glossaries ................................................................ 210
INDEX................................................................................... 212
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Cholera
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Cholera has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to cholera, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on cholera. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on cholera should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching cholera (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to cholera. It also gives you sources of information that can help you find a doctor in your local area specializing in treating cholera. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with cholera. Part II moves on to advanced research dedicated to cholera. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on cholera. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “freeto-use” options. Part III provides appendices of useful background reading for all patients with cholera or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with cholera. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with cholera.
Scope While this sourcebook covers cholera, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that cholera is often considered a synonym or a condition closely related to the following: ·
Asiatic Cholera
·
Cholera Gravis
·
Epidemic Cholera
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Cholera
·
Rice Water Diarrhea
·
V. Cholera
·
Vibrio
In addition to synonyms and related conditions, physicians may refer to cholera using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for cholera:4 ·
001 cholera
·
001.9 cholera, unspecified
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to cholera. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian.
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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Why “Internet age”? All too often, patients diagnosed with cholera will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with cholera is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. Before beginning your search for information, it is important for you to realize that cholera is considered a relatively uncommon condition. Because of this, far less research is conducted on cholera compared to other health problems afflicting larger populations, like breast cancer or heart disease. Nevertheless, this sourcebook will prove useful for two reasons. First, if more information does become available on cholera, the sources given in this book will be the most likely to report or make such information available. Second, some will find it important to know about patient support, symptom management, or diagnostic procedures that may be relevant to both cholera and other conditions. By using the sources listed in the following chapters, self-directed research can be conducted on broader topics that are related to cholera but not readily uncovered using general Internet search engines (e.g. www.google.com or www.yahoo.com). In this way, we have designed this sourcebook to complement these general search engines that can provide useful information and access to online patient support groups.5 While we focus on the more scientific aspects of cholera, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors For example, one can simply go to www.google.com, or other general search engines (e.g. www.yahoo.com, www.aol.com, www.msn.com) and type in “cholera support group” to find any active online support groups dedicated to cholera.
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on cholera. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of cholera to you or even given you a pamphlet or brochure describing cholera. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON CHOLERA: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on cholera. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on cholera can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.
The National Institutes of Health (NIH)6 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on cholera. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
6
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Cholera
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with cholera and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
·
Centers for Disease Control and Prevention: various fact sheets on infectious diseases at http://www.cdc.gov/health/diseases.htm
Among the above, the National Institute of Allergy and Infectious Diseases (NIAID) is particularly noteworthy. The mission of the NIAID is to provide support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunologic and allergic diseases that afflict people worldwide.7 The NIAID is composed of four extramural divisions: the Division of AIDS; the Division of Allergy, Immunology and Transplantation; the Division of Microbiology and Infectious Diseases; and the Division of Extramural Activities. In addition, NIAID scientists conduct intramural research in laboratories located in Bethesda, Rockville and Frederick, Maryland, and in Hamilton, Montana. The following patient guideline was recently published by the NIAID on cholera.
What Is Cholera?8 Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected This paragraph has been adapted from the NIAID: http://www.niaid.nih.gov/facts/overview.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 8 Adapted from The Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_g.htm. 7
Guidelines 11
persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours. In January 1991, epidemic cholera appeared in South America and quickly spread to several countries. A few cases have occurred in the United States among persons who traveled to South America or ate contaminated food brought back by travelers. Cholera has been very rare in industrialized nations for the last 100 years; however, the disease is still common today in other parts of the world, including the Indian subcontinent and sub-Saharan Africa. Although cholera can be life threatening, it is easily prevented and treated. In the United States, because of advanced water and sanitation systems, cholera is not a major threat; however, everyone, especially travelers, should be aware of how the disease is transmitted and what can be done to prevent it.
How Does a Person Get Cholera? A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The cholera bacterium may also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.
What Is the Risk or Cholera in the United States? In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern sewage and water treatment systems. However, as a result of improved transportation, more persons from the United States travel to parts of Latin America, Africa, or Asia where epidemic cholera is occurring. U.S. travelers to areas with epidemic cholera
12 Cholera
may be exposed to the cholera bacterium. In addition, travelers may bring contaminated seafood back to the United States; foodborne outbreaks have been caused by contaminated seafood brought into this country by travelers.
What Should Travelers Do to Avoid Getting Cholera? The risk for cholera is very low for U.S. travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely. All travelers to areas where cholera has occurred should observe the following recommendations: ·
Only drink water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.
·
Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
·
Avoid undercooked or raw fish or shellfish, including ceviche.
·
Make sure all vegetables are cookedavoid salads.
·
Avoid foods and beverages from street vendors.
·
Do not bring perishable seafood back to the United States.
·
A simple rule of thumb is “Boil it, cook it, peel it, or forget it. “
Is a Vaccine Available to Prevent Cholera? At the present time, the manufacture and sale of the only licensed cholera vaccine in the United States (Wyeth-Ayerst) has been discontinued. It has not been recommended for travelers because of the brief and incomplete immunity if offers. No cholera vaccination requirements exist for entry or exit in any country. Two recently developed vaccines for cholera are licensed and available in other countries (Dukoral®, Biotec AB and Mutacol®, Berna9). Both vaccines appear to provide a somewhat better immunity and fewer side effects than the previously available vaccine. However, neither of these two vaccines is recommended for travelers nor are they available in the United States. Use of trade names is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. 9
Guidelines 13
Further information on these vaccines can be obtained from the manufacturers at10: Dukoral® Active Biotec AB (publ) Postal Address: P.O. Box 724, SE-220 07 Lund, Sweden Office address: Scheelevagen 22 Tel: +46 46 19 20 00 Fax +46 46 19 20 50 E-Mail:
[email protected] Home page: http://www.activebiotech.com Mutacol® Berna, Switzerland Division P.O. Box CH-3001 Berne Domicile: Rehhagstrasse 79e CH-3018 Berne Tel. +41 31 981 22 11 Fax +41 31 981 20 66 E-mail:
[email protected] Home page: http://www.berna.org
Can Cholera Be Treated? Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.
CDC is not responsible for the content of Web pages found at these links. Links to nonfederal organizations are provided solely as a service to our users. These links do not indicate an endorsement of these organizations by CDC or the federal government. 10
14 Cholera
How Long Will the Current Epidemic Last? Predicting how long the epidemic in Latin America will last is difficult. The cholera epidemic in Africa has lasted more than 20 years. In areas with inadequate sanitation, a cholera epidemic cannot be stopped immediately, and there are no signs that the epidemic in the Americas will end soon. Latin American countries that have not yet reported cases are still at risk for cholera in the coming months and years. Major improvements in sewage and water treatment systems are needed in many of these countries to prevent future epidemic cholera.
What Is the U.S. Government Doing to Combat Cholera? U.S. and international public health authorities are working to enhance surveillance for cholera, investigate cholera outbreaks, and design and implement preventive measures. The Centers for Disease Control is investigating epidemic cholera wherever it occurs and is training laboratory workers in proper techniques for identification of V.cholerae. In addition, the Centers for Disease Control is providing information on diagnosis, treatment, and prevention of cholera to public health officials and is educating the public about effective preventive measures. The U.S. Agency for International Development is sponsoring some of the international government activities and is providing medical supplies to affected countries. The Environmental Protection Agency is working with water and sewage treatment operators in the United States to prevent contamination of water with the cholera bacterium. The Food and Drug Administration is testing imported and domestic shellfish for V. cholerae and monitoring the safety of U.S. shellfish beds through the shellfish sanitation program. With cooperation at the state and local, national, and international levels, assistance will be provided to countries where cholera is present, and the risk to U.S. residents will remain small.
Guidelines 15
Where Can a Traveler Get Information about Cholera? The global picture of cholera changes periodically, so travelers should seek updated information on countries of interest. The Centers for Disease Control maintains a travelers’ information telephone line on which callers can receive recent information on cholera and other diseases of concern to travelers. Data for this service are obtained from the World Health Organization. The number is 877-FYI-TRIP (394-8747) or check out http://www.cdc.gov/travel.
Cholera: Technical Notes The Division of Bacterial and Mycotic Diseases of the CDC publishes summary information on cholera for use by healthcare professionals and physicians. The information is presented in the form of notes. The notes are written in a rather technical language. A few medical expressions are particularly noteworthy. “Clinical features” generally cover the signs and symptoms of cholera that can help the doctor with diagnosis. It may also include a discussion of the cause or “etiology” of cholera. “Etiologic agent” signifies the particular organism, typically written in Latin, which causes or is associated with cholera. “Reservoir” indicates the habitat or living environment of the organism. “Incidence” describes the number of people that are diagnosed with cholera within a given population. “Sequelae” includes any related health consequences or secondary pathological conditions and diseases that may result from cholera. “Transmission” describes how a disease spreads. “Risk Groups” are people who are most likely to be diagnosed with cholera. “Surveillance” describes how cholera is monitored by government officials across the population. “Challenges” and “Opportunities” are issues or areas where officials think progress might be made in understanding or combating cholera in the future. The notes that follow were recently published by the CDC.11
Clinical Features Profuse watery diarrhea, vomiting, circulatory collapse and shock. Many infections are milder diarrhea or asymptomatic.
Adapted from The Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_t.htm.
11
16 Cholera
Etiologic Agent Vibrio cholerae serogroup O1 or O139 that produces cholera toxin.
Incidence 0-5 cases per year in the United States. A major cause of epidemic diarrhea throughout the developing world. Ongoing global pandemic in Asia, Africa and Latin America for the last four decades.
Sequelae 25-50% of typical cases are fatal if untreated. Transmission Contaminated drinking water or food. Large epidemics often related to fecal contamination of water supplies or street vended foods. Occasionally transmitted through eating raw or undercooked shellfish that are naturally contaminated.
Risk Groups Virtually none in the United States. Risk extremely low (1 per million) even in travelers. Persons living in poverty in the developing world.
Surveillance All reported cases are laboratory confirmed in states or at CDC. Trends Modest increase in imported cases since 1991 related to ongoing epidemic that began in 1991.
Guidelines 17
Challenges Epidemics are a marker for poverty and lack of basic sanitation. Multiple routes of transmission mean that successful prevention may require different specific measures in different areas. Natural infection and currently available vaccines offer incomplete protection of relatively short duration; no multivalent vaccines available for O139 infections. Simple rehydration treatment saves lives, but logistics of delivery in remote areas remains difficult during epidemic periods. Adjunct antibiotic treatment is helpful but may be difficult because of growing antimicrobial resistance. Natural reservoir in warm coastal waters makes eradication very unlikely.
Opportunities A powerful stimulus to develop needed infrastructure for sanitation and for public health in general, including improvements in sanitation, safer water handling, and public health capacity for surveillance and response to epidemics.
Additional Information Morbidity and Mortality Weekly Report (MMWR) Articles ·
Cholera Associated with Food Transported from El Salvador - Indiana, 1994, MMWR May 26, 1995 / Vol. 44 / No. 20: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00019549.htm
·
Update: Vibrio cholerae O1 - Western Hemisphere, 1991-1994, and V. cholerae O139 - Asia, 1994, MMWR March 24, 1995 / Vol. 44 / No. 11: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00020745.htm
·
Surveillance for Cholera - Cochabamba Department, Bolivia, JanuaryJune 1992, MMWR August 27, 1993 / Vol. 42 / No. 33: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00021052.htm
·
Imported Cholera Associated with a Newly Described Toxigenic Vibrio cholerae O139 Strain - California, 1993, MMWR July 9, 1993 / Vol. 42 / No. 26: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00021431.htm
·
Epidemic Cholera - Burundi and Zimbabwe, 1992-1993, MMWR June 4, 1993 / Vol. 42 / No. 21: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00036609.htm
18 Cholera
·
Update: Cholera - Western Hemisphere, 1992, MMWR February 12, 1993 / Vol. 42 / No. 5: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00037127.htm Links
·
CDC Safe Water System: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_lab_manual.htm
·
Cholera: Basic Facts for Travelers, WHO: http://www.who.int/chd/publications/cholera/cholman.htm
·
Dealing with a Cholera Emergency: Essential Information, WHO: http://www.who.int/chd/publications/cholera/cholguid.htm
·
Guidelines for Cholera Control, WHO: http://www.who.int/chd/publications/cholera/cholemer.htm
·
Management of Patients with Cholera, WHO: http://www.who.int/chd/publications/cholera/chobfact.htm
·
Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera: http://www.cdc.gov/safewater
More Guideline Sources The guideline above on cholera is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to cholera. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with cholera. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this
Guidelines 19
Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on cholera and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Cholera Prevention Source: Atlanta, GA: Centers for Disease Control. National Center for Infectious Disease. May 1992. 4 p. Contact: Available from Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease control, Mailstop C09, 1600 Clifton Road, Atlanta, GA 30333. (404) 488-4605. Price: Single copy free. Summary: Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. This brochure reviews the problem of cholera and how it can be prevented. Written in a question and answer format, the brochure covers topics including a definition of the disease; how a person gets cholera; the risk for cholera in the United States; what travelers should do to avoid getting cholera; the use of a vaccine to prevent cholera; how cholera is treated; the current cholera
20 Cholera
epidemics in Latin America and Africa; U.S. government activities aimed at combatting cholera; and how to get more information about cholera. One sidebar summarizes recommendations for travelers to help them avoid contracting cholera.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “cholera” or synonyms. The following was recently posted: ·
Diagnosis and management of foodborne illnesses: a primer for physicians. Source: Centers for Disease Control and Prevention/American Medical Association/Food Safety and Inspection Service/Center for Food Safety and Applied Nutrition.; Reprint released 2001 January; 88 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1933&sSearch_string=cholera
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
FAQ - About Cholera Summary: This brochure answers commonly asked questions about cholera, an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. Also available in other languages. Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6250
Guidelines 21
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to cholera. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on cholera, simply go to the following hyperlink: http://www.rarediseases.org/cgi-bin/nord/alphalist. A complete guide on cholera can be purchased from NORD for a nominal fee.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
22 Cholera
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any
Guidelines 23
disease, injury, or other health-related event occurring in such outbreaks. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Hepatitis: Inflammation of the liver. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Intravenous: Within a vein or veins. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mycotic: Pertaining to a mycosis; caused by fungi. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the
24 Cholera
duodenum. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Translating: Conversion from one language to another language. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH]
Seeking Guidance 25
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with cholera. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.12 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with cholera. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Cholera As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.13 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 13 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 12
26 Cholera
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about cholera. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “cholera” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “cholera”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making
Seeking Guidance 27
these selections and typing in “cholera” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with cholera. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “cholera” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with cholera must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:14 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
14
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
28 Cholera
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 15 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 15
Seeking Guidance 29
Selecting Your Doctor16 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about cholera?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for cholera?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor17 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
16 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 17 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
30 Cholera
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 31
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:18 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
18
33
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on cholera. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on cholera. In Part II, as in Part I, our objective is not to interpret the latest advances on cholera or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with cholera is suggested.
Studies 35
CHAPTER 3. STUDIES ON CHOLERA Overview Every year, academic studies are published on cholera or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on cholera. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on cholera and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and cholera, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “cholera” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Hope in the Time of Cholera: How A Simple Solution is Rescuing Millions of Children From Cholera and Other Deadly Diarrheas Source: Harvard Public Health Review. 3(1): 20-27. Fall 1991-Winter 1992. Summary: This article focuses on the diarrheal diseases, including cholera, dysentery, and diarrhea caused by rotavirus, salmonella, and E. coli. The author reviews the differences in management of these diseases in the developed countries compared with the developing countries. Spread primarily through human and animal feces, diarrhea and dysentery are prevalent wherever waste disposal, water treatment, and personal and food hygiene practices are inadequate. The bulk of the article describes oral rehydration therapy (ORT), used to remedy the dehydrating effects of diarrhea. Topics include the principles of ORT, the magnitude of the problem, why ORT has not solved the morbidity and mortality caused by diarrhea, local and cultural obstacles to effective diarrhea management, public health education, the continuing overuse of antibiotics and antispasmodics in treating diarrhea, current research being performed by Harvard faculty members in this area, and the importance of training physicians and other health care workers about ORT.
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Impact of Health Education Programme on Knowledge, Attitude and Practice (KAP) of People in Cholera Affected Areas of Luapula Province--Zambia Source: Medical Journal of Zambia (Ndola). 17(2):32-38, April 1983. Summary: The impact of a health education program on the knowledge, attitudes, and practices of people in cholera-affected areas of Zambia was evaluated. Three valley districts (Kawambwa, Mwense, and Nchelenge) in Luapula province of Zambia were affected by cholera outbreaks that started in late December 1981 and continued at intervals until March 1983. These districts reported a total of 1,380 cases and 122 deaths. The outbreak necessitated intensive health education programming. Two other districts (Mansa and Samfya) were not affected, and health education activities in these districts were on a much smaller scale than in
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the valley districts. Interviews with 442 heads of households in the valley districts and with 131 heads of households in control districts were conducted to assess the impact of the health education activities. Results suggest that health education had a positive impact on health knowledge and practices of people in the community. 8 references.
Federally-Funded Research on Cholera The U.S. Government supports a variety of research studies relating to cholera and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to cholera and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore cholera and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for cholera: ·
Project Title: Accessory Cholera Enterotoxin, Ace, Mechanism of Action Principal Investigator & Institution: Trucksis, Michele M.; Medicine; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2000; Project Start 5-FEB-2000; Project End 1-AUG2000 Summary: (Adapted from applicant's abstract): Three toxins of V. cholerae that increase short circuit current in Ussing chambers have been identified. They include cholera toxin (CT), Zot (zonula occludens toxin)
19 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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which acts by disrupting tight junctions, and Ace (accessory cholera enterotoxin), the subject of this proposal. The investigator has identified, cloned and sequenced the ace gene. Preliminary studies using crude toxin extracts in animal models indicated that Ace acts by increasing transcellular ion transport. Ace increased short- circuit current in Ussing chambers and caused fluid secretion in ligated rabbit ileal loops, characteristic of a classic enterotoxin. The predicted protein sequence of Ace shows striking similarity to the product of the cystic fibrosis bene. Based on activity and structural correlates, the investigator proposes to examine two hypotheses for the mechanism of action of Ace. The "second messenger" model is that Ace binds to a receptor on the epithelial cell membrane and activates a second messenger which increases chloride secretion via an endogenous channel. The "pore-forming" model is that Ace forms a new channel by inserting into the epithelial cell membrane. The specific aims are to: 1) compare native and recombinant Ace by purifying and characterizing both proteins: 2) determine the presence and protective function of an immune response to Ace: 3) study the effects of Ace on cellular function to distinguish between the "second messenger" and "pore- forming" hypotheses of Ace activity; 4) identify protein domains contributing to Ace activity; and 5) study the role of each of the V. cholerae toxins in virulence by constructing isogenic chromosomal mutants. The investigator will use bacterial and molecular genetic and cell physiology methods to examine the mechanism(s) of action of Ace on the gastrointestinal epithelial cell. The long term objectives of the proposal are to enhance understanding of the role of Ace in cholera pathogenesis, to identify possible new mechanisms of action of toxins, and to determine how the toxins of V. cholerae interact to cause disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: ARF Binding in the Action of Cholera and E Coli Toxins Principal Investigator & Institution: Kahn, Richard A.; Professor; Biochemistry; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 1-DEC-1998; Project End 0-NOV2002 Summary: (Adapted from the applicant's abstract): Cholera, and related diarrheal diseases, are the #3 cause of all deaths worldwide. Both cholera and the less virulent "travelers diarrhea" result from bacterial infections (by Vibrio cholerae and E. coli, respectively) and colonization of the gut where exotoxins are produced that cause all of the clinically important symptoms of the diseases. Cholera toxin (CT) and E. coli heat labile toxin (LT) are structurally (>80% identity), immunologically, and
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mechanistically very closely related. The key pathophysiological step in this process, the ADP-ribosylation of Gs, can be performed in vitro using purified components and requires a proteinaceous co-factor, termed the ADP-ribosylation factor or Arf. Arfs are ubiquitous, essential, GTPbinding regulators in eukaryotes of most (perhaps all) steps of vesicular membrane transport and are potent activators of phospholipase D. Entry of the CT/LT toxins occurs through a "reverse secretory" pathway from endosomes to Golgi to ER and back out to Golgi, where A and B subunits dissociate and the active A subunit presumably enters the cytosol. These surprising observations, that this regulator of membrane traffic, Arf, is required for ADP-ribosylation by the toxins in vitro and that the ADPribosylation toxins must transit the length of the secretory pathway before gaining access to the cytosol has prompted this detailed examination of the relationship between Arf and CT/LT. Another reason for doing so comes from the recent observations that CT/LT are very potent mucosal adjuvants, with potential applications against a host of human pathogens, including sexually transmitted viruses, e.g., herpes, papilloma, and HIV. The development of toxin based adjuvants has been limited by the toxicity of the toxins alone. The principal goal is to determine the importance of Arf binding to toxins in intact cells with respect to the activation of adenyl cyclase and to the mode of entry of toxins into cell cytosol. Finding mutants that retain adjuvant properties but reduced or absent cellular toxicities may prove essential to the development of these agents as adjuvants. This proposal has three specific aims: (1) Create and characterize point mutants of LTA that have partial or complete loss of the ability to bind and be activated by human Arf proteins. Results will begin to define the LTA-Arf binding surface. (2) Co-crystallize the Arf- GTP-LTA complex and solve the structure. Preliminary data make this a feasible approach and offer a rapid advance in our understanding of this protein interaction. (3) LT/CT mutants, defective in the ability to interact productively with Arf, will be examined for their ability to activate adenyl cyclase, transit the "reverse secretory" pathway, localize to appropriate intracellular locales, and intoxicate mammalian cells. These studies will address for the first time the relevance of toxin-Arf interaction in live cells and provide important new mechanistic and structural information on this protein interaction that can either support or refute the potential use of loss-of-Arf-binding mutants of LT or CT as adjuvants, as antigens in vaccine development, or other uses. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Development of a Live Oral Cholera Vaccine Principal Investigator & Institution: Kaper, James B.; Professor; Microbiology and Immunology; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 1-JAN-1983; Project End 1-JAN2006 Summary: (Adapted from the Applicant's Abstract): An ideal vaccine for the prevention of cholera is not yet available. Previous work in this project has resulted in the development of an attenuated live oral cholera vaccine, V. cholerae CVD 103-HgR. This vaccine confers strong protective immunity against experimental challenge with virulent V. cholerae O1 after a single dose. Although this vaccine is highly protective in North American volunteers and has been licensed in several highly developed countries for protection of travelers to cholera endemic countries, a recent field trial of this vaccine in Indonesia failed to show efficacy. The development of attenuated cholera vaccines has been plagued by the fact that V. cholerae strains deleted of the ctx genes encoding cholera toxin can still produce varying amounts of diarrhea and non-diarrheal symptoms such as headache, fever, abdominal cramps, and malaise in many individuals. Such symptoms are not seen with CVD 103-HgR, in all probability because this strain colonizes the human intestine at greatly reduced levels compared to the reactogenic, avidly colonizing ctxnegative strains. Although the reduced colonization of CVD 103-HgR was still sufficient to engender a protective immune response in North American volunteers whose small bowel intestinal flora is relatively sparse, it was not sufficient to induce a protective immune response in a cholera-endemic population with a heavy burden of small bowel intestinal flora which would compete against a live oral vaccine strain. The ability to construct a better-colonizing strain is hampered by the uncertainty as to what bacterial factor is responsible for the reactogenicity. Thus, the next period of support for this project will focus on characterizing the response of epithelial cells to adherent V. cholerae, establishing the role in reactogenicity of various cytolysins, proteases, other degradative enzymes, and other potential toxins revealed by the recently completed genome sequence of V. cholerae, and determining the V. cholerae genes that are specifically expressed during the course of human infection. These studies will use the broadest possible range of models to study host-pathogen interactions, including intestinal epithelial cell lines, freshly harvested human intestinal tissue, animal models, and human volunteer studies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Genetic Analysis of Cholera Toxin Structure and Function Principal Investigator & Institution: Holmes, Randall K.; Professor and Chair; Microbiology; University of Colorado Hlth Sciences Ctr 4200 E 9Th Ave Denver, Co 80262 Timing: Fiscal Year 2002; Project Start 1-FEB-1992; Project End 1-JAN2007 Summary: (Adapted from the Applicant's Abstract): Approximately 1.5 billion cases of diarrhea cause 4 million deaths annually in children under 5 years old, and 5-7 million cases of cholera cause about100,000 deaths. Cholera toxin (CT) from Vibrio cholerae causes the massive watery diarrhea of cholera. Enterotoxigenic E. coli (ETEC) cause up to 20 percent of diarrheal disease in developing countries, and produce heatlabile enterotoxins called LTI and LTII that are closely related to CT in structure and function. The best current vaccines against cholera provide only moderate protection for short periods of time and are not licensed in the United States, and there are no vaccines for human use against ETEC. CT and related enterotoxins are potent immunogens and mucosal adjuvants, and they are also used widely as tools to investigate the role of heterotrimeric G proteins in signal transduction, the role of gangliosides in endocytosis and vesicular trafficking, the mapping and/or ablation of neural pathways, and many other cell functions. We study the structure and function of CT and use LTI and LTII in comparative studies to explore the molecular basis for functional differences between them. Our long term goals are to elucidate the molecular basis for biological activities of CT and related enterotoxins, and to use that knowledge to design novel structure-based vaccines and therapeutics to prevent or treat enterotoxic diarrheas. CT, LTI or LTII are also being studied widely as vaccine components, adjuvants or immunomodulators to prevent or treat diseases unrelated to enterotoxic diarrheas. Important issues concerning structure and function of CT that are not yet understood include identifying and characterizing: conformational changes that activate the catalytic capacity of CT-A1 after nicking and reduction of CT holotoxin; motifs on CT-A1 that determine its interactions with Gsalpha/beta/gamma as a substrate for ADP ribosylation and with ADP-ribosylation factors (ARFs) as stimulators of catalytic activity; features of CT-A and CT-B that enable them to assemble spontaneously into CT holotoxin; mechanisms by which binding of enterotoxins to plasma membrane receptors determines their trafficking within target cells; and pathway(s) by which CT-A1 is translocated from the ER to the cytoplasm to reach its intracellular target and cause toxicity. During the next project period we will use a wide variety of novel methods from microbiology, genetics, biochemistry, cell biology and structural biology
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to investigate these important current issues concerning the structure and function of cholera toxin. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Immune Responses to V. Cholerae Infection in Bangladesh Principal Investigator & Institution: Calderwood, Stephen B.; Physician/Chief; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 1-AUG2005 Summary: (adapted from application abstract): Vibrio cholerae causes a severe, dehydrating, and occasionally fatal diarrhea in humans. There are an estimated 5-7 million cases worldwide of cholera, with more than 100,000 deaths. Much of the impact of cholera occurs in developing areas of the world, particularly in South and Southeast Asia such as Bangladesh and India. Infection with V. cholerae induces long-lasting protective immunity to subsequent cholera, although the immune responses mediating protection are not fully understood. Many of the previous field studies of immune responses to V. cholerae infection were done in the 1970s, prior to the advent of more modern techniques for measuring mucosal immune responses, such as the use of antibodysecreting cell assays. More recent studies of V. cholerae infection in normal volunteers, many done in the United States, have provided important information on immune responses to infection with this pathogen, but these responses may differ substantially than those in patients in endemic areas, particularly as relates to the influence of age, morbidity, malnutrition and prior exposure to related antigens. Much work has been done recently on development of effective live, oral, attenuated V. cholerae vaccines, both for prevention of clinical cholera and as vectors for expressing heterologous antigens to protect against other infections at mucosal surfaces. This proposal would establish a long-term collaboration between scientists in the US and at the International Centre for Diarrhoeal Disease Research in Bangladesh to elucidate immune responses and protection from cholera infection in an endemic population. The Long-Term Goals of this project are to better understand mucosal immune responses after V. cholerae infection and vaccination, and to assess the effect of patient and microbial factors on these responses that may explain differences observed between patients from endemic areas and normal human volunteers. The Specific Aims of the proposal are: 1) determine the full range of immune responses, particularly mucosal antibody responses, in patients with cholera in
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Bangladesh, comparing vibriocidal and mucosal antibody responses and stratifying these responses by patient and microbial characteristics. We will test the hypothesis that the serum vibriocidal response represents a surrogate marker for a mucosal response to a relevant antigen or antigens that is actually protective: 2) correlate mucosal anti-V cholerae antibody levels on exposure to the organism with protection from subsequent clinical cholera. We will examine the hypothesis that pre-existing secretory immunity to LPS. CtxB, MSHA and/or TcpA at the time of colonization of V. cholerae protects against subsequent illness: 3) assess immune responses to CtxB at distant (non-intestinal) mucosal sites after clinical cholera, as a model for immune responses to heterologous antigens expressed by live, oral, attenuated V. cholerae vaccine vectors. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Killed Oral Cholera Vaccine Effectiveness Trial--Vietnam Principal Investigator & Institution: Ivanoff, Bernard; World Health Organization 1211 Avenue Appia Geneva, Timing: Fiscal Year 2000; Project Start 1-DEC-1996; Project End 0-NOV2001 Summary: This is a randomized, double-blind effectiveness trial of a bivalent, killed oral cholera vaccine developed in Vietnam. The trial will be conducted in the Khanh boa Province of Vietnam The general aim of the trial is to simulate a public health program of vaccination against cholera and to estimate the costs and effects of this vaccination strategy. Specific objectives are to assess the impact of vaccination on the incidence of cholera and on the overall incidence of treated episodes of diarrhea; to evaluate the cost-effectiveness of this vaccine; and to assess community beliefs about vaccines and the prevention of cholera, as well as the community's experience with vaccination and reasons for nonvaccination. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Sigma54 and Vibrio Cholerae Pathogenesis Principal Investigator & Institution: Klose, Karl E.; Assistant Professor; Microbiology; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2000; Project Start 1-MAR-1999; Project End 9-FEB2004 Summary: (Adapted from the Applicant's Abstract): Vibrio cholerae, the causative agent of the human diarrheal disease cholera, can be considered to have a pathogenic cycle consisting of a highly motile phase
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outside the host when no virulence factors are produced, and a colonizing phase within the host intestine when high levels of virulence factors are expressed. Little is known about the requirements for colonization or the environmental conditions which induce virulence factor expression. The investigators have recently found that the alternative sigma factor, sigma 54, and a sigma 54-dependent transcriptional activator protein, FlrC, are required for the expression of distinct sets of genes during both phases of the pathogenic cycle. Moreover, FlrC apparently plays a crucial role in this cycle by simultaneously activating motility genes and repressing virulence factor expression. The experiments in this proposal are focused on the characterization of sigma 54 and FlrC-mediated transcription in V. cholerae, given their important role in the cholera pathogenic cycle. Such studies will provide insights into the molecular mechanisms of pathogenicity, which may lead to novel methods for treatment and prevention of cholera, as well as other infectious diseases. Studies of FlrC function are designed to characterize its 1) phosphorylation, ii) enzymatic (ATPase) activity, iii) DNA-binding, iv) cooperative interactions and v) transcriptional activity. A series of genetic experiments are designed to identify the interactions between FlrC and the virulence regulatory proteins that lead to 1) repression of virulence factor expression and 2) repression of motility gene transcription. Finally, FlrC-controlled genes will be identified by first identifying FlrC binding sites, which lie near the genes FlrC controls, utilizing a technique which involves cycles of selection for FlrC-bound chromosomal fragments followed by PCR amplification. Sequencing the DNA surrounding the selected FlrC binding sites will identify those motility and colonization genes under FlrC control, and the mechanism whereby flrC represses virulence factor production will be revealed. Identification of sigma 54 and FlrCdependent colonization genes and promoters may be useful in the development of live attenuated cholera vaccines, and manipulation of virulence factor repression could have practical applications for anticholera therapy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Validation of Cholera Challenge in Volunteers Principal Investigator & Institution: Cohen, Mitchell B.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2000 Summary: The long-term goal of this study is to test an oral vaccine(s) for strain 0139 cholera organisms. The immediate goal is to validate the use of a standardized frozen inoculum when challenging volunteers with
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virulent cholera bacteria. This will allow the development of a multicenter vaccine study. Healthy volunteers were recruited for an inpatient, dose-escalation challenge with live virulent cholera organisms (V. cholerae, 0139, strain 4260B). The study goal was to identify a dose at which the attack rate was greater than or equal to 80%, and the geometric mean purge rate exceeded 3L during the defined study period. We have completed five inpatient studies. In the first two studies, the volunteers were challenged with 105 organisms of frozen, reconstituted, virulent V. cholerae, 0139, strain 4260B. Although the attack rate was 8/10, the geometric mean purge was insufficient (2175 g). Therefore, we escalated the dose for subsequent challenges to achieve 1 x 106 organisms, as described in the protocol. At this higher dose, the disease severity was adequate to establish a challenge model. We demonstrated an attack rate of 14/15 at a dose of .1 x 106 CFU. The geometric mean purge of 5621 mL was also adequate by protocol criteria (> 3L). Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Vibrio Cholerae Pathogenicity Island Principal Investigator & Institution: Karaolis, David K.; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2000; Project Start 5-JUN-1999; Project End 1-MAY2004 Summary: (Adapted from the Applicant's Abstract): Cholera is an ancient disease that results in significant morbidity and mortality. The broad aim and focus of this project is to understand the pathogenesis of Vibrio cholera pathogenicity island phage (VPIphage) and its genes in the emergence, virulence, and spread of epidemic cholera. Cholera is traditionally caused by V. cholerae serogroup 01 strains which are divided into two biotypes, classical and El Tor. Although recent emergence of V. cholerae 0139 Bengal has demonstrated that virulent non-01 strains can occur, this strain appears to have evolved from an existing toxigenic 01 strain by substitution of 01 antigen genes to 0139. Thus, the factors involved in the emergence of virulent V. cholerae strains and the epidemic potential of non-01 serogroups are not well understood. Toxigenic V. cholerae appears to emerge via a multi-step process following the sequential infection of two bacteriophages, initially by VPIphage (whose genome represents a large pathogenicity island) then CTXphage (encoding cholera toxin) which uses VPIphage as its receptor. The VPIphage encodes genes which function as virulence factors, genes that regulate virulence factor expression, and a number of open reading frames (orfs) of unknown function. The VPIphage-encoded tcpA gene
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was thought to encode the major subunit of the toxin co-regulated pilus (TCP) "type IV" pilus, but it now appears that the VPIphage itself is the major V. cholerae colonization factor and that TcpA is the major structural coat protein of VPIphage. The central hypothesis of this proposal is that the VPIphage is critical for the emergence, pathogenesis, and spread of epidemic cholera as 1) the VPIphage is essential for colonization; 2) VPIphage encodes proteins which act as the CTXphage receptor; 3) VPIphage encodes genes which regulate virulence; d) VPIphage encodes genes for transfer of the VPIphage between strains. The specific aims of this proposal are to 1) test the virulence of the VPI in a non-pathogenic host background; 2) analyze the function of cryptic genes on the VPI; 3) to characterize the structure and regulation of a potential VPI-encoded regulon. It is hoped that the proposed experiments will increase the knowledge of the mechanisms leading to the emergence of epidemic strains of cholera and or the emergence of other pathogens that have pathogenicity islands and type IV pili. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Vibrio Cholerae Plankton Colonization Principal Investigator & Institution: Azam, Farooq; Marine Biology Research Div; University of California San Diego 9500 Gilman Dr San Diego, Ca 92093 Timing: Fiscal Year 2000; Project Start 1-MAR-2000; Project End 8-FEB2005 Summary: The human pathogen Vibrio cholerae is widely distributed along many coastlines including those of the United States. Environmental factors play a major role in determining the distribution of toxigenic V. cholerae. For example, the introduction of the seventh pandemic of cholera to Latin America in 1991 has been suggested to have been correlated with marine plankton blooms triggered by a climate change event such as that initiated by El Nino. In a effort to better understand marine vectors and conditions influencing the spread of cholera, we propose to examine the association of a variety of clinical and environmental strains of V. cholerae with marine plankton. Marine mesocosm experiments will be performed in which V. cholerae will be identified by marking cells with a modified version of the green fluorescent protein gene. growth of V. cholerae in the mesocosm will be followed using the frequency of dividing cells technique coupled to an image analysis method. Using selected marine model systems V. cholerae plankton colonization will be further examined, and the possible role of chemotaxis in plankton or phytodetritus association will be assessed. We will also isolate and characterize, or obtain mutants deficient in plankton
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colonization. The genetic defects will be identified, and the relationship, if any, between colonization of plankton and of mammals will be ascertained. Finally, the effect of biological and physiochemical factors on V. cholerae growth and distribution in mesocosms will be determined and the possibility of cholera toxin phage production and toxin gene exchange among cells in the marine environment will be explored. By understanding how biological, chemical, and physical factors influence the distribution, abundance and virulence of V. cholerae, together with the elucidation of the genetic requirements for its persistence with plankton in coastal ecosystems, it will be possible to better predict when environmental change is likely to present a cholera public health risk. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Vibrio Cholerae TCP and LPS Subunit Vaccine Principal Investigator & Institution: Wade, William F.; Associate Professor; Microbiology; Dartmouth College Hanover, Nh 03755 Timing: Fiscal Year 2000; Project Start 1-APR-2000; Project End 1-MAR2005 Summary: Cholera is an acute diarrheal disease caused by the gramnegative bacterium, Vibrio cholerae. Following ingestion of contaminated food or water, bacteria colonize the small intestine and secrete cholera toxin, which is responsible for the extensive loss of fluid and electrolytes from infected individuals. Cholera remains a worldwide problem. Although a number of live, attenuated or killed whole cell vaccine formulations have been tested, none have proven successful enough to result in their widespread use. This grant proposal focuses on new approaches to develop a cholera subunit vaccine formulation based on the current understanding of V. cholerae colonization, pathogenesis, and human immune responses to infection. The strategy will incorporate features of the highly successful Haemophilus influenzae type b and pertussis vaccines that utilize defined surface virulence determinants, colonization factors, and toxoids to achieve long-lasting protection. The present proposal will focus on formulations that include the toxin coregulated pilus (TCP) colonization factor, detoxified LPS, and the adjuvant cholerae toxin. The general goal for these studies is to define the most effective combination of TCP and LPS antigens that provide for protective humoral responses. We will characterize in detail the B cell epitopes for these antigens and determine which epitopes are minimally required for effective immunity. Studies will extend this information to human sera and demonstrate that the epitopes we have identified are operational in the field. Using a well- established mouse model, we will quickly be able to define the immunization regimen and immunogens
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that are likely candidates for extension into human trials. The proposed research formally brings together the expertise from two research groups at Dartmouth Medical School. Dr. William Wade is a molecular immunologist with training in structural and functional analyses of proteins as they relate to antigen presentation. His research focuses on methodologies to optimize the immunogenicity and delivery of antigens. Dr. Ronald Taylor's research focuses on the molecular basis of V. cholerae pathogenesis. He discovered TCP and his group has been instrumental in characterizing the tcpA gene and corresponding pilin protein as well as demonstrating that TCP is the major V. cholerae colonization factor and a protective antigen. Together, the expertise of these two research groups will provide a unique opportunity to develop and evaluate V: cholerae subunit vaccines using new approaches. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: ADP Ribosylation of a Potent Inducer of Proliferation Principal Investigator & Institution: Francis, Mark L.; Internal Medicine; Southern Illinois University Sch of Med Box 3926 Springfield, Il 62702 Timing: Fiscal Year 2000; Project Start 1-JAN-1998; Project End 1-DEC2002 Summary: (Adapted from Investigator's abstract): The broad goal of the proposed study is to improve understanding of signal transduction pathways involved in B cell activation. This knowledge will provide important understanding of both normal physiology and unregulated cell growth. Abnormalities of signal transduction proteins have been identified in both cancer and immunodeficiencies. Bacterial toxins have been useful tools to dissect the function of G proteins, a group of signal transduction proteins. Using NAD as a source, bacterial toxins add adenosine diphosphate ribose (ADP-ribose) to proteins, a process called ADP-ribosylation. This modification can alter the function of signal transduction proteins in a manner that mimics their physiologic function. Based on his previous work, the applicant hypothesizes that cholera toxin ADP-ribosylates a non-Gs protein that regulates B cell activation. The goals are to identify this protein and to determine its physiologic function. In Specific Aim 1, the ability of cholera toxin to ADP-ribosylate proteins in intact B cells will be used to block subsequent ADPribosylation of these proteins in vitro in the presence of [32P]NAD. While this reverse labeling technique has identified a single, non-Gs protein that is ADP-ribosylated by cholera toxin, other candidate proteins will be sought. Specific Aim 2 is designed to develop the necessary tools to study the physiologic function of the ADP-ribosylated proteins. Following microsequencing, the sequence information will be used to clone the
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corresponding cDNA. At each step, sequence information will be compared to known amino acid and nucleic acid data bases 1) to help identify the protein or any functional motifs and 2) to determine which proteins to pursue for further analysis. Finally, antibodies will be generated. Specific Aim 3 will begin to address the physiologic function of these proteins. Using antibodies, the investigator will determine whether and how these proteins are physiologically modulated by B cell stimulants, such as anti-Ig. In particular, he will determine whether these proteins are phosphorylated or dephosphorylated. If more than one candidate protein remains, these studies will establish which is the target protein. Conversely, selective activation of this protein by cholera toxin will permit him to explore the downstream effects that are specifically mediated by this protein. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Bioerodible Microparticulate Systems for Booster Delivery of Vaccines Principal Investigator & Institution: Owusu-Ababio, Godfried K.; Florida Agricultural and Mechanical Univ Tallahassee, Fl 32307 Timing: Fiscal Year 2001; Project Start 5-JUN-2000; Project End 0-APR2005 Summary: The current administration of many vaccines requires several injections of a given amount of antigen at specified time interval to achieve a booster immune response. In some cases, frequent immunization is necessary because of short-lived immunological memory is necessary because of short-lived immunological memory coupled with a long interval between the initial vaccination and the subsequent natural challenge. In addition, the painful and inconvenience associated with multiple injections can make compliance a problem. The broad long-term objectives of this project are to use cholera and influenza antigens to formulate single injection multiple dose biodegradable controlled release booster delivery system to provide not only the priming antigen, but one or more booster challenges at specified time intervals. The specific aims of the project are: (1) to use agents that could stabilize the cholera and influenza antigens while encapsulated for prolonged periods of time; (2) to design controlled released microcapsules of cholera and influenza antigens in conjunction with stabilizers by the solvent evaporation/extraction procedure; (3) to conduct in vitro release of antigens from the microcapsules by following the pulsed nature of the release and stability of the antigens; (4) to evaluate the immune response in rabbits following intramuscular or subcutaneous administration of encapsulated antigens. Cholera,
50 Cholera
influenza types A and B antigens, and stabilizers will be encapsulated in biodegradable poly (D,L-lactide-co-glycolide), poly-dl- lactic acid, and poly (epsilon-caprolactone) of different molecular weights by the solvent evaporation/extraction technique. The microcapsules containing the antigens will be characterized morphologically, biochemically, and immunochemically. The stability and pulsed delivery of the antigens from the microcapsules of carefully selected polymer compositions will be followed in vitro. For in vivo studies, microcapsules containing antigens, and control microcapsules without antigens, will be administered by a single intramuscular or subcutaneous injection into rabbits. At specific time intervals, blood samples will be collected, and analyzed for the presence of specific antibodies of the immunoglobulin G (IgG), M (IgM), and A (IgA) classes, respectively. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Dendritic Cell Role in Adjuvant DNA Vaccines Principal Investigator & Institution: Barratt-Boyes, Simon M.; Assistant Professor; Powderject Vaccines, Inc. 585 Science Dr Madison, Wi 53711 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 9-SEP-2002 Summary: A rational approach to long-term containment of HIV infection is the combination of HAART with DNA vaccination aimed at stimulating virus-specific cytotoxic T lymphocytes (CTL) and T helper responses. Moreover, addition of novel adjuvants such as cholera-like toxins to DNA vaccines is likely to augment immune responses, and induce both systemic and mucosal immunity. The adjuvant effect of cholera-like toxins is apparent even when delivered to the skin, suggesting a novel mechanism of immune stimulation. Dendritic cells (DC) are an essential target for DNA-based vaccines and are likely to play a key role in the adjuvant effect of cholera-like toxins. The investigators hypothesize that cholera-like toxins alter the function of DC through the processes of maturation of trafficking, or both, such that systemic and mucosal T cell responses are generated. This could potentially occur through the stimulation of DC trafficking not only to peripheral lymph nodes but also to mucosal microenvironments. The overall goal of Project 4 is to elucidate the mechanism whereby adjuvanted DNA vaccines elicit augmented T cell responses. The investigators will address this goal in four specific aims: (1) To determine the capacity for cholera-line toxins to alter DC maturation and trafficking function in vivo: Murine studies, (3) To determine the capacity for cholera-like toxins to alter DC maturation and trafficking. The aims are closely related to the overall program goal of designing and evaluating a therapeutic DNA vaccine for HIV. The studiers in Project 4 are highly interactive with other projects, including
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Project 1 (provision of DNA, studies of adjuvants in mice, monkey vaccination and immunotherapy studies), project 2 (monkey vaccination and immunotherapy studioes), and Project 3 (chemokine studies). Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Molecular Biology and Virulence of CTX Phage Principal Investigator & Institution: Waldor, Matthew K.; Scientist; New England Medical Center Hospitals 750 Washington St Boston, Ma 02111 Timing: Fiscal Year 2000; Project Start 1-JAN-1998; Project End 1-DEC2002 Summary: (Adapted from the applicant's abstract): Cholera toxin is the principal virulence factor of Vibrio cholerae, the Gram-negative bacterium that causes the severe diarrheal disease cholera. The investigators recently discovered that this potent enterotoxin is encoded by a novel filamentous bacteriophage designated CTX. The CTX phage is the first filamentous phage known to result in the lysogenic conversion of a host bacterium. The CTX phage can integrate into the V. cholerae chromosome and form stable lysogens or, after induction, excise from the chromosome and replicate as a plasmid. During this replicative stage of the phage life-cycle, cholera toxin can be expressed independently of the factors which were believed to be essential for its expression. Our demonstration of the induction of CTX phage from V. cholerae lysogens within the host gastrointestinal tract suggests the possibility that in vivo CTX phage induction plays a significant role in the virulence of V. cholerae. The objectives of the proposed studies are to understand the life-cycle of the CTX phage at the molecular level and to assess the significance of this bacteriophage in the pathogenesis of cholera. These studies will establish the molecular biology of a mechanism of horizontal transfer of virulence genes and thereby further our understanding of the emergence of pathogens. The study of the intraintestinal induction of CTX phage from lysogens, could establish a new paradigm for understanding the regulation of the expression of phage encoded virulence factors in a variety of bacterial pathogens that are lysogenized with converting phage. This work will also have important ramifications for the design of safer live attenuated V. cholerae vaccine strains. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “cholera” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for cholera in the PubMed Central database: ·
A cholera toxoid-insulin conjugate as an oral vaccine against spontaneous autoimmune diabetes by Isabelle Bergerot, Corinne Ploix, Jacob Petersen, Valerie Moulin, Carola Rask, Nicole Fabien, Marianne Lindblad, Anne Mayer, Cecil Czerkinsky, Jan Holmgren, and Charles Thivolet; 1997 April 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20771
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A Cytotoxin-Producing Strain of Vibrio cholerae Non-O1, Non-O139 as a Cause of Cholera and Bacteremia after Consumption of Raw Clams by Hassan Namdari, Christine R. Klaips, and Joan L. Hughes; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87425&ren dertype=external
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A mutant cholera toxin B subunit that binds GM1- ganglioside but lacks immunomodulatory or toxic activity by A. T. Aman, S. Fraser, E. A. Merritt, C. Rodigherio, M. Kenny, M. Ahn, W. G. J. Hol, N. A. Williams, W. I. Lencer, and T. R. Hirst; 2001 July 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=37471
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A nontoxic mutant of cholera toxin elicits Th2-type responses for enhanced mucosal immunity by Shingo Yamamoto, Hiroshi Kiyono, Masafumi Yamamoto, Koichi Imaoka, Miho Yamamoto, Kohtaro Fujihashi, Frederik W. Van Ginkel, Masatoshi Noda, Yoshifumi Takeda, and Jerry R. McGhee; 1997 May 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24667
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20
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A Survey of Stool Culturing Practices for Vibrio Species at Clinical Laboratories in Gulf Coast States by Nina N. Marano, Nicholas A. Daniels, Alyssa N. Easton, Andre McShan, Beverly Ray, Joy G. Wells, Patricia M. Griffin, and Frederick J. Angulo; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86778&ren dertype=external
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A Vibrio cholerae pathogenicity island associated with epidemic and pandemic strains by David K. R. Karaolis, Judith A. Johnson, Camella C. Bailey, Edgar C. Boedeker, James B. Kaper, and Peter R. Reeves; 1998 March 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19707
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Accessory Cholera Enterotoxin (Ace), the Third Toxin of a Vibrio cholerae Virulence Cassette by M Trucksis, JE Galen, J Michalski, A Fasano, and JB Kaper; 1993 June 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46697
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Accumulation of cholera toxin and GM1 ganglioside in the early endosome of Niemann --Pick C1-deficient cells by Yuko Sugimoto, Haruaki Ninomiya, Yuki Ohsaki, Katsumi Higaki, Joanna P. Davies, Yiannis A. Ioannou, and Kousaku Ohno; 2001 October 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60064
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Altered expression of the ToxR-regulated porins OmpU and OmpT diminishes Vibrio cholerae bile resistance, virulence factor expression, and intestinal colonization by Daniele Provenzano and Karl E. Klose; 2000 August 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27820
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Changes in Human Ecology and Behavior in Relation to the Emergence of Diarrheal Diseases, Including Cholera by MM Levine and OS Levine; 1994 March 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43377
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Characterization of a Periplasmic Thiol: Disulfide Interchange Protein Required for the Functional Maturation of Secreted Virulence Factors of Vibrio Cholerae by JA Peek and RK Taylor; 1992 July 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=49468
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Cholera in Vietnam: Changes in Genotypes and Emergence of Class I Integrons Containing Aminoglycoside Resistance Gene Cassettes in Vibrio cholerae O1 Strains Isolated from 1979 to 1996 by A. Dalsgaard, A. Forslund, N. V. Tam, D. X. Vinh, and P. D. Cam; 1999 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84539&ren dertype=external
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Cholera Toxin B Subunit: An Efficient Transmucosal Carrier-Delivery System for Induction of Peripheral Immunological Tolerance by J Sun, J Holmgren, and C Czerkinsky; 1994 November 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45112
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Class 1 Integron-Borne, Multiple-Antibiotic Resistance Encoded by a 150-Kilobase Conjugative Plasmid in Epidemic Vibrio cholerae O1 Strains Isolated in Guinea-Bissau by Anders Dalsgaard, Anita Forslund, Andreas Petersen, Derek J. Brown, Francisco Dias, Serifo Monteiro, Kare Molbak, Peter Aaby, Amabelia Rodrigues, and Anita Sandstrom; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87474&ren dertype=external
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Clinical and Environmental Isolates of Vibrio cholerae Serogroup O141 Carry the CTX Phage and the Genes Encoding the Toxin-Coregulated Pili by A. Dalsgaard, O. Serichantalergs, A. Forslund, W. Lin, J. Mekalanos, E. Mintz, T. Shimada, and J. G. Wells; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88491&ren dertype=external
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Concomitant Infection of Enterotoxigenic Escherichia coli in an Outbreak of Cholera Caused by Vibrio cholerae O1 and O139 in Ahmedabad, India by Subhra Chakraborty, J. S. Deokule, Pallavi Garg, S. K. Bhattacharya, R. K. Nandy, G. Balakrish Nair, S. Yamasaki, Y. Takeda, and T. Ramamurthy; 2001 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88325&ren dertype=external
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CP-96,345, a Substance P Antagonist, Inhibits Rat Intestinal Responses to Clostridium difficile Toxin A but not Cholera Toxin by C Pothoulakis, I Castagliuolo, JT Lamont, A Jaffer, JC O'Keane, RM Snider, and SE Leeman; 1994 February 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43070
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Crystal structure of an anti-carbohydrate antibody directed against Vibrio cholerae O1 in complex with antigen: Molecular basis for serotype specificity by S. Villeneuve, H. Souchon, M.-M. Riottot, J.-C.
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Mazie , P.-s. Lei, C. P. J. Glaudemans, P. Kovac , J.-M. Fournier, and P. M. Alzari; 2000 July 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26965 ·
CTX[phi] immunity: Application in the development of cholera vaccines by Harvey H. Kimsey and Matthew K. Waldor; 1998 June 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22729
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Cyclic AMP and its receptor protein negatively regulate the coordinate expression of cholera toxin and toxin-coregulated pilus in Vibrio cholerae by Karen Skorupski and Ronald K. Taylor; 1997 January 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19310
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Delineation and Comparison of Ganglioside-Binding Epitopes for the Toxins of Vibrio cholerae, Escherichia coli, and Clostridium tetani: Evidence for Overlapping Epitopes by J Angstrom, S Teneberg, and K Karlsson; 1994 December 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45335
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Detection of RTX Toxin Gene in Vibrio cholerae by PCR by K. H. Chow, T. K. Ng, K. Y. Yuen, and W. C. Yam; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88191&ren dertype=external
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Development and Evaluation of a Phage Typing Scheme for Vibrio cholerae O139 by A. K. Chakrabarti, A. N. Ghosh, G. Balakrish Nair, S. K. Niyogi, S. K. Bhattacharya, and B. L. Sarkar; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86014&ren dertype=external
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Differential Expression of the ToxR Regulon in Classical and El Tor Biotypes of Vibrio cholerae is Due to Biotype-Specific Control over toxT Expression by VJ DiRita, M Neely, RK Taylor, and PM Bruss; 1996 July 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38862
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Directed polar secretion of protease from single cells of Vibrio cholerae via the type II secretion pathway by Maria E. Scott, Zain Y. Dossani, and Maria Sandkvist; 2001 November 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61152
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Effects of changes in membrane sodium flux on virulence gene expression in Vibrio cholerae by Claudia C. Hase and John J. Mekalanos; 1999 March 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15916
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Emergence of Vibrio cholerae O1 Biotype El Tor Serotype Inaba from the Prevailing O1 Ogawa Serotype Strains in India by Pallavi Garg, Ranjan K. Nandy, Papiya Chaudhury, Nandini Roy Chowdhury, Keya De, T. Ramamurthy, Shinji Yamasaki, S. K. Bhattacharya, Yoshifumi Takeda, and G. Balakrish Nair; 2000 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87574&ren dertype=external
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Endemic and epidemic dynamics of cholera: the role of the aquatic reservoir by Claudia Torres Codeco; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29087
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Expression of ToxR, the Transcriptional Activator of the Virulence Factors in Vibrio cholerae, is Modulated by the Heat Shock Response by C Parsot and JJ Mekalanos; 1990 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=55281
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Genetic Diversity and Population Structure of Vibrio cholerae by Pilar Beltran, Gabriela Delgado, Armando Navarro, Francisca Trujillo, Robert K. Selander, and Alejandro Cravioto; 1999 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84478&ren dertype=external
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High-Resolution FRET Microscopy of Cholera Toxin B-Subunit and GPI-anchored Proteins in Cell Plasma Membranes by Anne K. Kenworthy, Nadezda Petranova, and Michael Edidin; 2000 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=14873
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Identification of a Vibrio cholerae RTX toxin gene cluster that is tightly linked to the cholera toxin prophage by Wei Lin, Karla Jean Fullner, Rebecca Clayton, Jessica A. Sexton, Marc B. Rogers, Kerstin E. Calia, Stephen B. Calderwood, Claire Fraser, and John J. Mekalanos; 1999 February 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15352
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Identification of motifs in cholera toxin A1 polypeptide that are required for its interaction with human ADP-ribosylation factor 6 in a bacterial two-hybrid system by Michael G. Jobling and Randall K. Holmes; 2000 December 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18975
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Inhibitors of COP-mediated Transport and Cholera Toxin Action Inhibit Simian Virus 40 Infection by Ayanthi A. Richards, Espen Stang, Rainer Pepperkok, and Robert G. Parton; 2002 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=111141
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Molecular Characterization of a New Ribotype of Vibrio cholerae O139 Bengal Associated with an Outbreak of Cholera in Bangladesh by Shah M. Faruque, A. K. Siddique, Manujendra N. Saha, Asadulghani, M. Mostafizur Rahman, K. Zaman, M. John Albert, David A. Sack, and R. Bradley Sack; 1999 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84761&ren dertype=external
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Pulsed-Field Gel Electrophoresis-Based Molecular Comparison of Vibrio cholerae O1 Isolates from Domestic and Imported Cases of Cholera in Japan by Eiji Arakawa, Toshiyuki Murase, Shigeru Matsushita, Toshio Shimada, Shiro Yamai, Takeshi Ito, and Haruo Watanabe; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88740&ren dertype=external
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Rapid Method for Species-Specific Identification of Vibrio cholerae Using Primers Targeted to the Gene of Outer Membrane Protein OmpW by Bisweswar Nandi, Ranjan K. Nandy, Sarmishtha Mukhopadhyay, G. Balakrish Nair, Toshio Shimada, and Asoke C. Ghose; 2000 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87555&ren dertype=external
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Regulatory Cascade Controls Virulence in Vibrio cholerae by VJ DiRita, C Parsot, G Jander, and JJ Mekalanos; 1991 June 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51881
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Role of Platelet Activating Factor in the Intestinal Epithelial Secretory and Chinese Hamster Ovary Cell Cytoskeletal Responses to Cholera Toxin by RL Guerrant, GD Fang, NM Thielman, and MC Fonteles; 1994 September 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44872
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Selective Amplification of an mRNA and Related Pseudogene for a Human ADP- Ribosylation Factor, a Guanine Nucleotide-Dependent Protein Activator of Cholera Toxin by L Monaco, JJ Murtagh, KB Newman, S Tsai, J Moss, and M Vaughan; 1990 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53655
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Special Feature:From the Cover:Climate and infectious disease: Use of remote sensing for detection of Vibrio cholerae by indirect measurement by Brad Lobitz, Louisa Beck, Anwar Huq, Byron Wood, George Fuchs, A. S. G. Faruque, and Rita Colwell; 2000 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26452
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Specific Detection of Pasteurella multocida in Chickens with Fowl Cholera and in Pig Lung Tissues Using Fluorescent rRNA In Situ Hybridization by Paul Gichohi Mbuthia, Henrik Christensen, Mette Boye, Kamille Majken Dumong Petersen, Magne Bisgaard, Phillip Njeru Nyaga, and John Elmerdahl Olsen; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88196&ren dertype=external
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TcpP protein is a positive regulator of virulence gene expression in Vibrio cholerae by Claudia C. Hase and John J. Mekalanos; 1998 January 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18489
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Thapsigargin-Induced Transport of Cholera Toxin to the Endoplasmic Reticulum by K Sandvig, O Garred, and BV Deurs; 1996 October 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=37992
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The Vibrio cholerae genome contains two unique circular chromosomes by Michele Trucksis, Jane Michalski, Ying Kang Deng, and James B. Kaper; 1998 November 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24396
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The Vibrio cholerae O139 Serogroup Antigen Includes an O-Antigen Capsule and Lipopolysaccharide Virulence Determinants by MK Waldor, R Colwell, and JJ Mekalanos; 1994 November 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45236
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ToxR Regulates the Production of Lipoproteins and the Expression of Serum Resistance in Vibrio cholerae by C Parsot, E Taxman, and JJ Mekalanos; 1991 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51080
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Transcytosis of Cholera Toxin Subunits Across Model Human Intestinal Epithelia by WI Lencer, S Moe, PA Rufo, and JL Madara; 1995 October 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40742
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Treatment of Experimental Autoimmune Encephalomyelitis by Feeding Myelin Basic Protein Conjugated to Cholera Toxin B Subunit by J Sun, C Rask, T Olsson, J Holmgren, and C Czerkinsky; 1996 July 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38959
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Vibrio cholerae Produces a Second Enterotoxin, which Affects Intestinal Tight Junctions by A Fasano, B Baudry, DW Pumplin, SS Wasserman, BD Tall, and JM Ketley; 1991 June 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51848
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with cholera, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “cholera” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “cholera” (hyperlinks lead to article summaries): ·
The "blessed turf": cholera and popular panic in Ireland, June 1832. Author(s): Connolly SJ. Source: Ir Hist Stud. 1983; 23(9): 214-32. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11614660&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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The 1904 epidemic of cholera in Persia: some aspects of Qajar society. Author(s): Burrell RM. Source: Bull Sch Orient Afr Stud. 1988; 51(2): 258-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11616738&dopt=Abstract
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The aggregational status of cholera enterotoxin fragment A following biochemical fractionation. Author(s): Knoop FC. Source: Biochem Exp Biol. 1978; 14(2): 125-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=753371&dopt=Abstract
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The effect of needle stimulation of acupuncture loci Tienshu (St-25) Chung-Wan (CV-12) on the immune response in sensitized mice against experimental cholera. Author(s): Kuan TK, Lee SP, Lin JG, Shen M. Source: Am J Chin Med. 1986; 14(1-2): 73-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3962918&dopt=Abstract
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The effect of stimulating somatic afferents on cholera secretion in the rat small intestine. Author(s): Cassuto J, Larsson P, Yao T, Jodal M, Thoren P, Andersson S, Lundgren O. Source: Acta Physiologica Scandinavica. 1982 December; 116(4): 443-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7171003&dopt=Abstract
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The erratic evolution of cholera therapy: from folklore to science. Author(s): Carpenter CC. Source: Clinical Therapeutics. 1990; 12 Suppl A: 22-7; Discussion 28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2187609&dopt=Abstract
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The homoeopathic treatment of cholera; a historical study. Author(s): Raj N.
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Source: Bull Indian Inst Hist Med Hyderabad. 1978; 8(1-4): 39-43. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11613634&dopt=Abstract ·
The homoepathic management of cholera in the nineteenty century with special reference to the epidemic in London, 1854. Author(s): Leary B. Source: Med Ges Gesch. 1997; 16: 125-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11623647&dopt=Abstract
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The lysis of cholera and El Tor Vibrios. Author(s): Adhikari PC, Raychaudhuri C, Chatterjee SN. Source: J Gen Microbiol. 1969 November; 59(1): 91-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4983467&dopt=Abstract
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The search for a better oral rehydration solution for cholera. Author(s): Rabbani GH. Source: The New England Journal of Medicine. 2000 February 3; 342(5): 345-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10655535&dopt=Abstract
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The serological properties of the cell surface proteins of Vibrio cholerae. Author(s): Kabir S. Source: J Gen Microbiol. 1983 July; 129 (Pt 7): 2199-206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6415227&dopt=Abstract
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Transcellular fluid secretion induced by cholera toxin and vasoactive intestinal polypeptide in the small intestine of the rat. Author(s): Sjoqvist A, Fihn BM. Source: Acta Physiologica Scandinavica. 1993 August; 148(4): 393-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8213194&dopt=Abstract
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Unique properties of the follicle-stimulating hormone- and cholera toxin-sensitive adenylyl cyclase of immature granulosa cells. Author(s): Hunzicker-Dunn M, LaBarbera AR. Source: Endocrinology. 1986 January; 118(1): 302-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3000740&dopt=Abstract
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Usefulness of a medicinal plant (Bragantia wallichi) in experimental cholera. Author(s): Panse MV, Nayak KP. Source: The Indian Journal of Medical Research. 1971 August; 59(8): 11903. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4943617&dopt=Abstract
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Vibrio cholerae soluble hemagglutinin/protease is a metalloenzyme. Author(s): Booth BA, Boesman-Finkelstein M, Finkelstein RA. Source: Infection and Immunity. 1983 November; 42(2): 639-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6417020&dopt=Abstract
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Why cholera still takes lives in rural Bangladesh. Study of an epidemic. Author(s): Siddique AK, Akram K, Islam Q. Source: Trop Doct. 1988 January; 18(1): 40-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3341090&dopt=Abstract
Vocabulary Builder Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode
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of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteriophages: Viruses whose host is a bacterial cell. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Electrolyte: A substance that dissociates into ions when fused or in solution,
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and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Encephalomyelitis: A general term indicating inflammation of the brain and spinal cord, often used to indicate an infectious process, but also applicable to a variety of autoimmune and toxic-metabolic conditions. There is significant overlap regarding the usage of this term and encephalitis in the literature. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endocytosis: Cellular uptake of extracellular materials within membranelimited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endosomes: Cytoplasmic vesicles formed when coated vesicles shed their clathrin coat. Endosomes internalize macromolecules bound by receptors on the cell surface. [NIH] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH]
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Exotoxins: Toxins produced, especially by bacterial or fungal cells, and released into the culture medium or environment. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Folklore: The common orally transmitted traditions, myths, festivals, songs, superstitions, and stories of all peoples. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Immunization: The induction of immunity. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
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Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intramuscular: Within the substance of a muscle. [EU] Islam: A monotheistic religion promulgated by the Prophet Mohammed with Allah as the deity. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Motility: The ability to move spontaneously. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH]
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Pasteurella: The oldest recognized genus of the family pasteurellaceae. It consists of several species. Its organisms occur most frequently as coccobacillus or rod-shaped and are gram-negative, nonmotile, facultative anaerobes. Species of this genus are found in both animals and humans. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Porins: Protein molecules situated in the outer membrane of gram-negative bacteria that, in dimeric or trimeric form, constitute a water-filled transmembrane channel allowing passage of ions and other small molecules. Porins are also found in bacterial cell walls, and in plant, fungal, mammalian and other vertebrate cell and mitochondrial membranes. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Regulon: In eukaryotes, a genetic unit consisting of a noncontiguous group of genes under the control of a single regulator gene. In bacteria, regulons are global regulatory systems involved in the interplay of pleiotropic regulatory domains. These regulatory systems consist of several operons. [NIH]
Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH]
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Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Substrate: A substance upon which an enzyme acts. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoids: Preparations of pathogenic organisms or their derivatives made nontoxic and intended for active immunologic prophylaxis. They include deactivated toxins. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or
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RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 4. PATENTS ON CHOLERA Overview You can learn about innovations relating to cholera by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with cholera within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with cholera. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
24Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Cholera By performing a patent search focusing on cholera, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on cholera: ·
Process for the isolation of a nontoxinogenic vibrio cholerae strain and a process for preparing cholera vaccine from said vibrio cholerae strain Inventor(s): Muthukumarappa; Thungapathra (Union Territory, IN), Ghosh; Amit (Union Territory, IN), Sharma; Charu (Union Territory, IN), Gupta; Naveen (Union Territory, IN), Mukhopadhyay; Asish (Calcutta, IN), Kole; Hemanta (Calcutta, IN), Nair; Gopinath Balakrish (Calcutta, IN), Ghosh; Ranajit Kumar (Calcutta, IN) Assignee(s): Council of Scientific & Industrial Research (New Delhi, IN), National Institute of Cholera and Enteric Diseases (Calcutta, IN), Department of Biotechnology (New Delhi, IN) Patent Number: 6,106,843 Date filed: February 3, 1999 Abstract: A process for the isolation of nontoxinogenic V. cholerae strain and a process for preparing a cholera vaccine from said V. cholerae strain, said process comprising (a) isolating V. cholerae from the stool of a patient suffering from cholera by spreading the stool on a selector medium specific for V. cholerae, (b) separating the non-toxinogenic V. cholerae strain from the population of the V. cholerae strains isolated in step (a), and (c) incorporating immunogenic cholera toxin (ctx) B subunit gene into the chromosome of the strain by conventional methods to produce the vaccine. Excerpt(s): The present invention relates to a process for the isolation of a non-toxinogenic Vibro cholerae strain and its use in the preparation of cholera vaccine. The present invention also, particularly, relates to a process for the preparation of cholera vaccine using V. cholerae strain having ATCC Accession No. 202010. The vaccine prepared by the process of the invention has proved efficacious in animal trials. If proved
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successful in human trials, it can be used to control the disease cholera, since an effective and safe cholera vaccine is still not available. The present invention specifically relates to a process for the preparation of cholera vaccine using V. cholerae strain having the ATCC Accession No. 202010 as a parent strain. ... Cholera is a lethal diarrheal disease caused by the gram negative bacterium Vibrio cholerae (V. cholerae). This disease, which has killed millions of people, continues to be a major health hazard worldwide affecting about one-half million people every year. Today almost every country in the world is affected by it. Furthermore, according to World Health Organization (WHO), even Europe, which had been reporting only imported cases of cholera, registered a 30 fold increase in indigenous cholera cases in 1994. ... The severe diarrhea that occurs during cholera disease is the result of a host reaction to an extracellular enterotoxin known as cholera toxin. The cholera toxin consists of two different protein subunits which are encoded by the genes ctxA and ctxB. These genes form a single operon called ctx AB (or the ctx operon). A single A subunit and five B subunits make up the complete toxin molecule. It is the A subunit of the cholera toxin which is responsible for the fluid loss characterized by the disease by upsetting the fine control of water and electrolyte balance of the intestinal epithelial cells. The B subunits bind to the host intestinal membrane and perhaps aid the entry of the catalytic A subunit into the host mucosal cells. The B subunit is also immunogenic and is capable of eliciting antitoxic immunity in the host. Web site: http://www.delphion.com/details?pn=US06106843__ ·
Hybrid molecules between heat-labile enterotoxin and cholera toxin B subunits Inventor(s): Holmgren; Jan (Korvettgatan 1 D, VastraFrolunda, SE), Lebens; Michael R. (S-413 22 Drive Belfrages Vag 20, Goborg, SE) Assignee(s): none reported Patent Number: 6,019,973 Date filed: January 5, 1998 Abstract: Hybrid molecules between heat-labile enterotoxin B subunit (LTB) and cholera toxin B subunit (CTB) are disclosed. Such a hybrid molecule comprises an amino-acid sequence which is composed of the amino-acid sequence of mature CTB in which such amino-acid residues are substituted with the corresponding amino-acid residues of mature LTB which impart LTB-specific epitope characteristics to said immunogenic mature CTB, or vice versa. In addition, a structural gene
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coding for such a hybrid molecule, a plasmid containing such a structural gene, and an immunogenic protein comprising such a hybrid molecule and optionally an immunoreactive amino-acid sequence of a prokaryotic or eukaryotic cell or a virus, are disclosed. Disclosed is also a vaccine, e.g. against enterotoxin-induced illness, comprising such an immunogenic protein, and a method of preventing or treating enterotoxin-induced illness in an individual. Excerpt(s): The present invention relates to hybrid molecules between heat-labile enterotoxin B subunit (LTB) and cholera toxin B subunit (CTB). Immunogenic proteins comprising such hybrid molecules, optionally fused to immunoreactive amino-acid sequences of or from cells or viruses, may be used as immunogenic components in vaccines, e.g. in a broad spectrum vaccine against enterotoxin-induced diarrhoea. ... Cholera remains an important cause of illness in many developing countries and has been estimated to result in more than 200,000 deaths each year. Infection with enterotoxigenic E. coli (ETEC) is the most frequent cause of diarrhoea in the developing world and amongst travellers; it is responsible for more than one billion diarrhoeal episodes and one million deaths annually. Infection with ETEC is also an important cause of disease in animals For both cholera and ETEC infections there is a great need for effective vaccines. ... In both cholera and ETEC infections, the primary cause of diarrhoea is the action of an enterotoxin released by the infecting organisms in the intestine; in the case of cholera cholera toxin (CT) and in the case of ETEC heat-labile enterotoxin (LT). The two toxins are closely related both structurally and functionally, each consisting of a toxic A subunit (CTA or LTA respectively) surrounded by five identical B subunits (CTB or LTB respectively) (Spangler, 1992). The B subunit pentamers are responsible for the binding of the toxin to GM1 ganglioside receptors present on the surface of intestinal epithelial cells (Holmgren, 1981); LT can also bind to structurally related galactoprotein receptors (Holmgren and Fredman, et al., 1982). Web site: http://www.delphion.com/details?pn=US06019973__ ·
Method for purifying cholera toxin Inventor(s): Dertzbaugh; Mark (Fairfield, PA) Assignee(s): The United States of America as represented by the Secretary of the Army (Washington, DC) Patent Number: 6,008,329 Date filed: March 6, 1998
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Abstract: The invention relates to a method of purifying cholera toxin using a matrix with at least one ion chosen from among matrix with Ni.sup.+2, Co.sup.+2, Cd.sup.2 or Zn.sup.+2 immobilized thereon. It is possible thereby to selectively elute the B subunit for cholera toxin from the matrix. Excerpt(s): This invention relates to affinity matrix with the Ni.sup.+2, Co.sup.+2, Cd.sup.+2 or Zn.sup.+2 ion immobilized thereon which binds cholera toxin. The matrix may be used in purification of cholera toxin and for performing separation of the B subunit from the A subunit when the linkage between the units has been broken. ... Cholera toxin (CT) is composed of two subunits: a toxigenic A subunit (CTA), and a binding B subunit (CTB). The latter mediates binding of CTA to the surface of eukaryotic cells via its interaction with the monosialoganglioside GM1. The type I heat-labile enterotoxin of Escherichia coli (LT) is closely related to CT. It has an identical subunit structure and function, and shares 80% amino acid homology with CT. Although LT is very similar to CT in structure and function, it binds to a broader array of ligands than CT, including glycolipids and glycoproteins. ... It is the purpose of this invention to provide means for purifying cholera toxin using affinity matrix with the Ni.sup.+2, Co.sup.+2, Cd.sup.+2 or Zn.sup.+2 ion immobilized thereon to bind the toxin. It is also a purpose of this invention to provide a means of isolating the B subunit of cholera toxin when the linkage between the subunits has been broken. The toxins could be administered as vaccines. The invention provides compositions of matter comprising a matrix with at least one ion chosen from among the Ni.sup.+2, Co.sup.+2, Cd.sup.+2 or Zn.sup.+2 ions immobilized thereon bound to a site on the B unit of cholera toxin. The method of purifying cholera toxin comprises: 1. applying a composition containing the B subunit of cholera toxin to a matrix with Ni.sup.+2, Co.sup.+2, Cd.sup.+2 or Zn.sup.+2 immobilized thereon, 2. retaining the elute containing the B subunit of the cholera toxin on said matrix, 3. removing unbound material from the matrix of step 2, and 4. eluting the B subunit from the matrix. Web site: http://www.delphion.com/details?pn=US06008329__
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·
Modified cholera toxin based on mutagenized subunit A Inventor(s): Burnette; W. Neal (Thousand Oaks, CA), Kaslow; Harvey R. (Los Angeles, CA) Assignee(s): Amgen Inc. (Thousand Oaks, CA), University of Southern California (Los Angeles, CA) Patent Number: 5,770,203 Date filed: May 24, 1995 Abstract: The development of subunits and subunit analogs of the cholera exotoxin by recombinant DNA techniques provides vaccine products that can retain their biological activity and immunogenicity, and can confer protection against disease challenge. Geneticallyengineered modifications of the subunits result in products that retain immunogenicity, yet are reduced in, or are essentially free of, enzymatic activity associated with toxin reactogenicity. Excerpt(s): The present invention relates to the recombinant expression of analog subunits of cholera exotoxin, and to vaccines based on such analogs. More particularly, genetically engineered modifications of the exotoxin provide analogs of cholera toxin having the capability to elicit a protective response with reduced or essentially no catalytic activity which can contribute to the reactogenicity of cholera vaccines. ... The term "cholera" refers to the disease caused by infection with the etiologic agent Vibrio cholerae, most commonly occurring in geographical areas where poor hygienic conditions prevail. Cholera remains a major cause of morbidity and mortality in many parts of the world(1,2). Experience has shown that contraction of the disease usually confers long-lasting protection against subsequent exposure to the etiologic agent(3). Consequently, considerable effort has been devoted to the development of a vaccine that would be similarly protective. A parenteral whole cell cholera vaccine has been produced, but some no longer regard it as useful, particularly for young children who are at greatest risk from the disease(1). ... As for many other infectious diseases, a biological exotoxin (in this case, "cholera toxin" or "CTX") encoded by the genome of the infectious agent and secreted by it, contributes significantly to the ability of the microorganism to colonize the infected host(4). Moreover, exposure to the toxin causes severe diarrhea and vomiting which result in dehydration, a life-threatening condition of the disease(3,5). These experiences suggest that a vaccine which elicits an immunologic response (e.g., antibodies) sufficient to neutralize the toxin would thus significantly help to prevent or reduce bacterial colonization and attendant symptoms such as diarrhea and vomiting. Thus, substantial effort has been applied toward developing a vaccine containing a non-
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toxic analog of the toxin, i.e., a "toxoid"(1,3-13). It is known that cholera toxin is a multi-subunit macromolecule consisting of a subunit termed "A", containing a catalytic region called "A1" which ADP-ribosylates Gproteins in target cells, and a "B" oligomer which binds the holotoxin to the target cells(6). Non-toxic analogs of cholera toxin have been produced for purposes of vaccine development by various means. These methods include chemical treatment of the holotoxin or toxin subunits, deletion of the A subunit and use of the remaining B oligomer, and synthesis or isolation of peptide fragments of toxin subunits(l,3-13). Web site: http://www.delphion.com/details?pn=US05770203__ ·
Genetically stable cholera vaccines with deletions of ctxA, recA and attRS1 Inventor(s): Mekalanos; John J. (Cambridge, MA) Assignee(s): President and Felllows of Harvard College (Cambridge, MA) Patent Number: 5,631,010 Date filed: March 14, 1995 Abstract: The invention features a nontoxigenic genetically stable mutant strain of V. cholerae which lacks any functional attRS1 sequences is useful as a live, oral vaccine for inducing immunological protection against cholera and a method for making same. The invention also features a killed, oral cholera vaccine comprising at least a first and a second V. cholerae strain, wherein at least one of the strains is a different serotype, and the vaccine also contains cholera toxin B subunit, produced by at least one of the serotypes. Excerpt(s): The field of invention is Vibrio cholerae vaccines. ... After more than 100 years of research on cholera, there remains a need for an effective cholera vaccine. There have been six pandemics of this disease caused by strains of V. cholera belonging to the "Classical" biotype. The etiological agents of the current (seventh) pandemic belong to the "El Tor" biotype (Finkelstein, Crit. Rev. Microbiol 2:553-623, 1973, Wachsmuth et al., The Lancet 337:1097-1098, 1991). Recently the seventh pandemic has extended to a new locale, that of South America. Beginning in January of 1991, an epidemic of cholera resulted in greater than 250,000 cases and over 2,000 deaths in Peru, Ecuador, Columbia, and Chile. Before this epidemic it was estimated that over 200,000 cases of cholera occurred per year mainly in India, Bangladesh, Africa and Western Asia (Tacket et al., Cholera Vaccines. In Vaccines: New Approaches to Immunological Problems, Ellis, R. W., editor, Butterworth-Heinemann, Boston, 1992). ... Because natural infection by and recovery from cholera induces
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immunity lasting at least 3 years (Tacket et al., Supra; Levine et al., J. Infect. Dis. 143:818-820, 1981; Cash et al., J. Infect. Dis. 130:325-333, 1974), much effort has been made to produce live, attenuated cholera vaccines that when administered orally would mimic the disease in its immunization properties but would not cause adverse symptoms or reactions in the immunized individual (i.e., display low reactogenicity). Vaccines of this type involve deletion mutations that inactivate the gene encoding the A subunit of cholera toxin, a protein which is responsible for most of the diarrhea seen in this disease (Mekalanos et al., Proc. Natl. Acad. Sci. USA 79:151-155, 1982; Mekalanos et al., Nature 306:551-557, 1983; Kaper et al., Nature 308:655-658, 1984; Kaper et al., Biotechnology 2:345, 1984; Pierce et al., Infect. Immun. 55:477-481, 1987; Taylor et al., Vaccine 6:151-154, 1988; Levine et al., Infn. Immun. 56: 161-167, 1988; Herrington et al. J. Exper. Med. 168:1487-1492, 1988; Levine et al., Lancet ii:467-470, 1988; Kaper et al., Res. Microbiol. 141:901-906, 1990; Pearson et al., Res. Microbiol. 141:893-899, 1990). See also Mekalanos, U.S. Pat. Nos. 5,098,998 and 4,882,278, and Kaper et al., U.S. Pat. No. 4,935,364, hereby incorporated by reference. The major issues associated with cholera vaccines are safety, stability and their degree of antigenicity. Web site: http://www.delphion.com/details?pn=US05631010__ ·
Method of treating clostridium difficile colitis and cholera Inventor(s): Guerrant; Richard L. (Charlottesville, VA), Fang; Guodong (Charlottesville, VA), Fonteles; Manasses C. (Charlottesville, VA) Assignee(s): The University of Virginia Patent Foundation (Charlottesville, VA) Patent Number: 5,436,239 Date filed: April 1, 1993 Abstract: The invention relates to the treatment of antibiotic associated colitis, typically due to Clostridium difficile using the Platelet Activating Factor antagonists WEB 2170, SR 27417 or BN 52021, or the cyclooxygenase antagonist indomethacin. The PAF antagonists BN 52021 and SR 27417 and the cyclooxygenase antagonist indomethacin were effective in inhibiting the secretory effects caused by C. difficile Toxin A and by Cholera toxin. Excerpt(s): The invention relates to the treatment of antibiotic associated colitis, typically due to Clostridium difficile using Platelet Activating Factor antagonists, such as WEB 2170, SR 27417 or BN 52021, or the cyclooxygenase antagonists, such as indomethacin. The PAF antagonists BN 52021 and SR 27417 and the cyclooxygenase antagonist indomethacin
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were effective in inhibiting the secretory effects caused by C. difficle Toxin A and even by Cholera toxin. ... The fluid secretion caused by Cholera toxin in ligated intestinal segments can be blocked by administering an effective amount of a Platelet Activating Factor inhibitor selected from the group consisting of BN52021 and SR27417 or the cyclooxygenase inhibitor indomethacin. The combination of the cyclooxygenase inhibitor indomethacin and at least one Platelet Activating Factor antagonist from the group consisting of SR 27417 and BN 52021 also blocks the hemorrhagic fluid secretion caused by Cholera toxin. ... The foregoing PAF inhibitors, BN and SR and Indomethacin, have been found to significantly reduce the enterotoxin Cholera toxin (choleragen) produced by Vibrio cholerae, as well as C. difficile. Choleragen acts on the epithelial cells in the small intestine to cause secretion of large quantities of isotonic fluid from the mucosal surface. Choleragen is affected by the PAF inhibitors similarly to the toxin A created by Clostridium difficile. The Cholera related diarrhea results in massive gastrointestinal fluid loss and saline depletion, acidosis and shock. The ability to control the effects of the diarrhea would allow the body to absorb badly needed fluids, nutrients and medication, and eliminate the further depletion of the body's resources and resulting deficiencies. Web site: http://www.delphion.com/details?pn=US05436239__ ·
Method of treating cholera Inventor(s): Platt; Frances M. (Oxford, GB), Neises; Gabrielle R. (Chesterfield, MO), Dwek; Raymond A. (Oxford,, GB), Butters; Terry D. (Oxford,, GB) Assignee(s): Monsanto Company (St. Louis, MO) Patent Number: 5,399,567 Date filed: May 13, 1993 Abstract: This invention discloses a method of treating cholera infection in a human by administering an effective amount of 1,5-dideoxy-1,5imino-D-glucitol or a derivative thereof. Excerpt(s): The inhibition of glycolipid biosynthesis by these N-alkyl derivatives of DNJ is further demonstrated herein by the reduction of the binding of cholera toxin to these four illustrative cell lines when cultured in the presence on N-butyl DNJ. These compounds thus are also useful as anti-microbial agents by inhibiting the surface expression on glycolipid receptors for bacteria and bacterial toxins as illustrated hereinafter in Tables 1 and 2, respectively. ... Quantitative analysis of cholera toxin
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binding to human cell lines following three days treatment with NB-DNJ. Methods: Cells were maintained in logarithmic phase growth in RPMI1640 medium. Cholera toxin B chain (Sigma) was conjugated to fluorescein isothyocyanate (Sigma) and flow cytometric analysis was carried out by conventional procedure as described by Platt et al., supra. Analysis was performed on a FACScan Cytometer (Becton Dickinson, Sunnyvale Calif., USA). Data on viable cells were collected on a four decade log.sub.10 scale of increasing fluorescence intensity. The data are presented as mean copy number of cholera toxin bindings sites per cell on the y-axis against the four cell line on the x-axis, in the presence or absence of 0.5 mM NB-DNJ. The specificity of cholera toxin:cell surface binding was established by inhibiting this interaction with a one hundred fold molar excess of GM1 derived oligosaccharide, Gal.beta.GalNAc.beta.4(NeuAc.alpha.3)Gal.beta.4Glc.beta.3Cer. Seventy to ninety percent inhibition was achieved depending on the individual cell line. A control oligosaccharide (lacto-N-tetarose) was not inhibitory. Web site: http://www.delphion.com/details?pn=US05399567__ ·
Recombinant systems for expression of cholera B-sub-unit with the aid of foreign promoters and/or leader peptides Inventor(s): Holmgren; Jan (Korvettgatan 1D, Vastra Frolunda S-421 74, SE), Sanches Castillo; Joaquin (Col. San Anton, Cuernavaca, Morelos 62020, MX) Assignee(s): none reported Patent Number: 5,268,276 Date filed: July 8, 1992 Abstract: Disclosed herein are procedures whereby with the aid of recombinant DNA methods, the expression of the binding subunit protein of cholera toxin (CTB) or derivatives thereof including hybrid gene fusion proteins to CTB has been brought under the control of a foreign (non-cholera toxin) promoter and/or the CTB protein or its derivatives being synthesized with a foreign rather than the natural leader peptide to facilitate translocation across cell membranes. Excerpt(s): Vibrio cholerae of serogroup 01 may induce severe diarrhoeal disease when multiplying in the gut of infected individuals by releasing cholera toxin (CT) which induces active electrolyte and water secretion from the intestinal epithelium. By analogous mechanisms several other bacteria, for instance Escherichia coli, may also cause diarrhoea by releasing other enterotoxins that may be related or unrelated to CT. CT is the prototype bacterial enterotoxin. It is a protein built from two types of
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subunits: a single A subunit of molecular weight 28,000 and five B subunits, each with a molecular weight of 11,600. The B subunits are aggregated in a ring by tight noncovalent bonds; the A subunit is linked to and probably partially inserted in the B pentamer ring through weaker noncovalent interactions. The two types of subunits have different roles in the intoxication process: the B subunits are responsible for cell binding and the A subunit for the direct toxic activity. The molecular aspects of toxin binding to intestinal and other mammalian cells and of the subsequent events leading to activation of adenylate cyclase through the intracellular action of the A subunit (and its A1 fragment) have been clarified in considerable detail (see J Holmgren, Nature 292:413-417, 1981). More recently information has also become available on the genetics and biochemistry of cholera toxin synthesis, assembly and secretion by V. cholerae bacteria. CT is encoded by chromosomal structural genes for the A and B subunits, respectively. These genes have been cloned from several strains, and their nucleotide sequences have been determined. The genes for the A and B subunits of CT are arranged in a single transcriptional unit with the A cistron (ctxA) preceeding the B cistron (ctxB). Studies on the organization of CT genes in V. cholerae strains of classical and El Tor biotypes have suggested that there are two copies of CT genes in classical biotype strains while there is only one copy in most El Tor strains (J. J. Mekalanos et al, Nature 306:551-557, 1983). The synthesis of CT is positively regulated by a gene, toxR that increases ctx expression manifold (V. L. Miller and J. J. Mekalanos, Proc Natl Acad Sci USA, 81:3471-3475, 1984). ToxR acts at the transcriptional level, and is present in strains of both classical and El Tor biotypes. ToxR probably increases ctx transcription by encoding a regulatory protein that interacts positively with the ctx promoter region. Studies on heat-labile enterotoxin (LT) in Escherichia coli (the subunit structure and function of LT is closely similar but not identical to CT) have shown that the A and B subunits are initially synthesized as precursors with a leader peptide preceeding the mature subunit proteins. These precursors are rapidly processed (i.e. the leader peptide is being removed) and translocated across the inner membrane into the periplasm, where unassembled monomeric B subunits pentamerize and associate with A subunit with a half-time of 1-2 min. The pathway of toxin assembly appears to proceed via A subunit association with B monomers or small oligomers. Once the complete toxin has assembled, in V. cholerae (in contrast to E. coli where the toxin remains in the periplasm the toxin is being translocated (secreted) across the V. cholerae 01 outer membrane through some sort of interaction of B subunit domains with the outer membrane (T. R. Hirst & J. Holmgren, Proc Natl Acad Sci USA, 84:7418-7422, 1987; S. J. S. Hardy et al, ibid, in press, 1988). If the B subunits of CT or LT are being expressed
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in the absence of any A subunit (several such strains have been prepared by chemical mutagenesis or deletions by recombinant DNA methods in the ctxA or eltA cistrons) the B subunits form pentamers which are then secreted from V. cholerae via the same pathway as for the intact toxin except for an apparently slightly slower assembly process in the periplasm (T. R. Hirst et al, Proc Natl Acad Sci USA 81:2645-2649, 1984; S. J. S. Hardy et al, ibid, in press, 1988). Because vaccination against cholera by parenteral injection has yielded only modest and short-term protection (usually less than 50% protection for less than 6 months), attention has turned to development of oral vaccines that stimulate intestinal immunity more efficiently. Special attention has been drawn to CTB pentamers as one component of such oral cholera vaccines (J. Holmgren et al., Nature 269:602-604, 1977). CTB is an effective oral immunizing agent which in a large field trial has been shown to afford protection against both cholera and diarrhoea caused by LT enterotoxigenic E. coli (J. Clemens et al, Lancet ii:124-127, 1986; J Infect Dis, in press, 1988). The separation of B subunit from A excludes any risk of reversion to toxicity, and CTB has been administered orally to more than 25,000 people without any side effects. These features have made CTB an important component, together with killed whole cholera vibrios, of a new oral cholera vaccine. Moreover, CTB has attracted much interest recently as an immunogenic carrier for various other peptide or carbohydrate antigens and has also been used as a receptor-blocking and receptor-modulating agent for short-term prophylaxis of cholera and E. coli diarrhoea (R. I. Glass et al, J Infect Dis 149:495-500, 1984; ST Donta et al, ibid 157:557-564, 1988; S. J. McKenzie and JF Halsey, J Immunol 133:1818-1824, 1984; A-M Svennerholm et al J Clin Microbiol 24:585-590, 1986). ... Therefore, with the aid of strategies and procedures described in this application we have constructed overexpression systems for CTB and CTB fusion proteins in which the CTB gene (or the gene for the hybrid fusion protein) is under control of strong foreign (non-cholera toxin) promoters. Our success in this regard contrasts with previous attempts by different procedures by J. J. Mekalanos et al (Nature 306:551-557, 1983) to attain this goal using one of the promoters (tacP) described in one of our examples, as these attempts were reported to fail since they resulted in expression of less CTB than achieved with the natural ctx promoter. ... By use of recombinant DNA methods we have achieved overexpression systems for the B subunit of cholera toxin (CTB) or CTB derivatives, including fusion proteins of CTB. Characteristically in these systems expression of the gene encoding CTB or CTB derivative proteins has been brought under the control of a strong foreign (non-cholera toxin) promoter in wide-host range plasmid vectors. The gene constructions described are independant of the natural CT promoter and toxR
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expression regulatory systems. Two such overexpression systems are exemplified, one in which CTB is expressed in an inducible or constitutive manner under the control of the tacP promoter, and another in which CTB expression is controlled by the T7 RNA polymerase dependent promoter. In those examples the gene constructions allowing overexpression are present in wide-host range plasmids. This allows production of high levels of CTB or CTB derivatives from different bacterial species, e.g. E. coli and V. cholerae, harbouring these plasmids. The acessibility of the foreign promoter overexpression systems for production of CTB derivatives in the form of fusion proteins is also being exemplified through the fusion of a synthetic DNA sequence encoding a non-toxic decapeptide, derived from the E. coli heat-stable enterotoxin (STa), to the CTB gene and expression of the gene fusion protein in V. cholerae under the control of the tacP promoter. Web site: http://www.delphion.com/details?pn=US05268276__ ·
Inhibition of malignant cells having G.sub.M1 ganglo-side sites by administration of cholera toxin Inventor(s): Viallet; Jean (723 Owens St., Rockville, MD 20850), Sausville; Edward (1114 Nora Dr., Silver Spring, MD 20904), Minna; John D. (8520 Howell Rd., Bethesda, MD 20817) Assignee(s): none reported Patent Number: 5,214,029 Date filed: September 30, 1991 Abstract: The invention is to a method of treating malignancies with cholera toxin after determining if labelled beta subunit cholera toxin binds to the tissue. Excerpt(s): This invention relates to treatment of certain malignancies characterized by presence of G.sub.M1 ganglioside on the cell membrane. While it had previously been known that growth of some maligant cells could be inhibited by exposure to cholera toxin (CT), the use of that toxin as a therapeutic agent was not previously considered as a practical approach to treatment. Part of the difficulty arose from lack of means of predicting which malignancies would respond to such treatment. The instant invention provides means of identifying malignancies that would respond to treatment with cholera toxin along with dosage requirements and means of administration of the active agent. ... Cholera has been known for many centuries as a deadly disease whose victims die after bouts of severe diarrhea from dehydration and malnutrition. The causative organism replicates in the intestine. In response to the toxins
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produced, the intestine excretes large amounts of water. However, in tissue culture, cholera toxin stimulates growth of epithelial cells. (TaylorPapadimitriou, et al., J. Cell. Physiol. 102: 317-321 (1980) and Chopra, et al., Gastroenterology 92: 891-904 (1987)) It had, furthermore, been known that growth of some malignant cells was inhibited by treatment with cholera toxin. (Cho-Chung, et al. Cancer Res. 43: 1473-1476 (1987)). It was assumed, by Cho-Chung and her co-workers that the response to the toxin was due to stimulation of the intracellular cAMP system. (Her work was primarily concerned with mammary cancers and lymphomas.) However, the work of Cho-Chung did not lead to a means of treating malignancies in patients, since no means of predicting efficacy in treating a particular patient could be predicted and no method for therapeutic treatment was described. ... As previous studies in multiple tissues have suggested that hormonal activation of phospholipase C may be mediated by a guanine nucleotide binding protein (G protein), a study was begun to evaluate the effects of bacterial toxins known to modulate G protein function on GRP stimulated signal transduction pathways in the SCLC cell line NCI-H345. It was found that pretreatment with cholera toxin (CT) at 1 ug/ml for 18 hours resulted in a substantial inhibition in basal and GRP stimulated intracellular calcium and inositol trisphosphate (IP.sub.3), as well as the production of GRP stimulated inositol monophospates. Web site: http://www.delphion.com/details?pn=US05214029__ ·
Method for controlling chronic respiratory disease, fowl cholera and necrotic enteritis in avian species Inventor(s): Carter; Guy T. (Suffern, NY), Greenstein; Michael (Suffern, NY), Goodman; Joseph J. (Spring Valley, NY), Borders; Donald B. (Suffern, NY), Maiese; William M. (Bridgewater, NJ), Testa; Raymond T. (Cedar Grove, NJ) Assignee(s): American Cyanamid Company (Stamford, CT) Patent Number: 4,968,493 Date filed: June 19, 1989 Abstract: This invention provides a method for treating chronic respiratory disease, fowl cholera and necrotic enteritis in infected birds, by orally administering thereto a pharmaceutically effective amount of antibiotic LL-E19020.alpha., antibiotic LL-E19020.beta. or a physiologically acceptable salt thereof. Excerpt(s): This invention relates to a method of treating birds infected with a causative agent for necrotic enteritis, chronic respiratory disease or
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fowl cholera, to reduce and/or eliminate the infections in said birds. More particularly, the invention relates to a method for orally administering to poultry, game birds raised in captivity, avian pets or avian zoological specimens infected with Clostridium perfringes, Mycoplasma gallisepticum or Pasturella multocida, a pharmaceutically effective amount of antibiotic LL-E19020.alpha., antibiotic LLE19020.beta. or a physiologically acceptable salt thereof, to reduce and/or eliminate these infections in said birds. ... Surprisingly, we have also found that these antibiotics are useful for treating bacterial infections in avian species. In particular, the above-said antibiotics are useful for reducing or eliminating necrotic enteritis, chronic respiratory disease and fowl cholera from infected birds. ... The above-said pathogens are the causative agents for necrotic enteritis, chronic respiratory disease and fowl cholera; diseases that continually plague the poultry industry and are annually responsible for multi-million dollar losses to poultry growers and egg producers. Web site: http://www.delphion.com/details?pn=US04968493__
Patent Applications on Cholera As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to cholera: ·
Immunogenic detoxified mutants of cholera toxin Inventor(s): Pizza, Mariagrazia ; (Siena, IT), Fontana, Maria Rita ; (Siena, IT), Giannelli, Valentina ; (Monteroni d'Arbia, IT), Rappuoli, Rino ; (Castelnuovo Berardenga, IT) Correspondence: Alisa A. Harbin, Esq.; CHIRON CORPORATION; Intellectual Property; P.O. Box 8097; Emeryville; CA; 94662-8097; US Patent Application Number: 20020044939 Date filed: March 28, 2001 Abstract: An immunogenic detoxified protein comprising the amino acid sequence of subunit A of a cholera toxin (CT-A) or a fragment thereof or the amino acid sequence of subunit A of an Escherichia coli heat labile toxin (LT-A) or a fragment thereof wherein the amino acids at, or in positions corresponding to Ser-63 and Arg-192 are replaced with another
25
This has been a common practice outside the United States prior to December 2000.
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amino acid. The immunogenic detoxified protein is useful as vaccine for Vibrio cholerae or an enterotoxigenic strain of Escherichia coli and is produced by recombinant DNA means by site-directed mutagenesis. Excerpt(s): The present invention relates to immunogenic detoxified proteins of cholera toxins (CT), or of heat labile toxins (LT) produced by the enterotoxigenic strains of Escherichia coli (E. coli) wherein the amino acids at, or in positions corresponding to, Ser-63 and Arg-192 are replaced with another amino acid and to their use in vaccines which are useful for the prevention or treatment of cholera or enterotoxigenic E. coli infections and as mucosal adjuvants for other immunogenic proteins. The detoxified immunogenic proteins can be suitably produced using recombinant DNA techniques by site-directed mutagenesis of DNA encoding the wild type toxins. ... Cholera is a contagious disease widely distributed in the world, in particular in the Third World, where, in certain areas, it is endemic. The serious disorders which develop in the intestinal system prove fatal in a high percentage of the recorded cases of the disease. ... The etiological agent of cholera is the Gram-negative microorganism Vibrio cholerae (V. cholerae). This colonises the intestinal tract of individuals who have come into contact with it through ingestion of contaminated food or water, and multiplies to very high concentrations. The principal symptom is severe diarrhoea as a result of which the patient can lose as much as 10-15 liters of liquids per day via the faeces. As a result of the severe dehydration and loss of electrolytes, the patient does not withstand the infection in 50-60% of cases, and dies. The diarrhoea caused by V. cholerae is due to the secretion of cholera toxin, CT, which acts by stimulating the activity of the adenylate cyclase enzyme so as to induce disturbances at cell level. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with cholera, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “cholera” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on cholera. You can also use this procedure to view pending patent applications
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concerning cholera. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Chronic: Persisting over a long period of time. [EU] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Lethal: Deadly, fatal. [EU] Lymphoma:
Any neoplastic disorder of the lymphoid tissue, the term
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lymphoma often is used alone to denote malignant lymphoma. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mammary: Pertaining to the mamma, or breast. [EU] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU]
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CHAPTER 5. BOOKS ON CHOLERA Overview This chapter provides bibliographic book references relating to cholera. You have many options to locate books on cholera. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on cholera include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “cholera” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on cholera:
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·
Health in the Americas Source: Washington, DC: Pan American Health Organization. 1998. 2v., [890 p.]. Contact: Available from Pan American Health Organization, Sales and Distribution Center. P.O. Box 27, Annapolis Junction, MD 20701-0027. (301) 617-7806. Fax (301) 206-9789. E-mail:
[email protected]. Website: www.paho.org. Price: $60.00 in the United States; $44.00 in Latin America and the Caribbean; plus shipping and handling. ISBN: 9275115699 for English version; 9275315698 for Spanish version. Summary: This two-volume reference set offers information on health indicators and trends affecting the 800 million inhabitants of the Americas and the Caribbean. The set includes the most recent data on socioeconomic conditions, demographic characteristics, existing and emerging diseases, environmental issues, and the health sector's response. Volume I explores the health situation regionwide. The regional analysis examines public health trends, the health status of various population groups, major diseases and health problems, the health sector's response to these conditions, and the status of external technical and financial cooperation destined for health. Volume II contains country reports that present the most current data for each of the region's 45 countries and territories from the perspective of each country's socioeconomic and demographic context and then sketches health prospects for the immediate future. The country reports all cover the general health situation and trends (including socioeconomic perspectives, mortality, and morbidity), specific health problems (including analysis by population groups, diseases and health impairments, and risk factors), and the response of the health systems (including health policies and programs, health research and technology, and costs and financing of services). The set offers statistical presentations of the major diseases and health impairments, mortality and morbidity trends, and health services, as well as the impact of environmental factors and economic conditions on health. The digestive system diseases discussed are hepatitis, cholera, schistosomiasis, malaria, nutritional diseases, and diseases of metabolism. Each chapter offers extensive charts, tables, figures, and references.
·
Rational Use of Drugs in the Management of Acute Diarrhoea in Children Source: Geneva, Switzerland: World Health Organization. 1990. 75 p.
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Contact: Available from WHO Publications Center USA. 49 Sheridan Avenue, Albany, NY 12210. (518) 436-9686. Fax (518) 436-7433. Price: $12.60. ISBN: 9241561424. Order number 1150355. Summary: This book provides information about the rational use of drugs in the management of acute diarrhea in infants and young children, and tackles the problems posed by the prescribing of clinically useless and potentially dangerous drugs. The authors argue against the widespread use of medicines that have no established clinical benefits, are frequently harmful, and may delay or replace effective treatment measures. A table of drugs judged effective lists four first-choice antimicrobials, and six alternatives, useful in the management of cholera, shigella dysentery, amoebiasis, and giardiasis. Apart from these cases of specific etiology, readers are informed that antidiarrheal drugs and antiemetic should never be used for children, as none has any proven practical value and some are frankly dangerous. This statement is substantiated through a thorough review of data on eleven antidiarrheal drugs widely used in paediatric practice. The book concludes that none of these preparations has any documented benefits, some actually prolong diarrhoea, and others have been shown to produce severe and sometimes fatal side-effects. Specific compounds covered include diphenoxylate hydrochloride, loperamide, streptomycin and dihydrostreptomycin, neomycin, hydroxyquinolines, nonabsorbable sulfonamides, kaolin and pectin, activated charcoal, and attapulgite and smectite. Each chapter includes numerous references. (AA-M).
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to cholera (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Cholera Problem by Oscar Felsenfeld (1967); ISBN: 0875270085; http://www.amazon.com/exec/obidos/ASIN/0875270085/icongroupin terna
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Cholera and Related Diarrheas: Molecular Aspects of a Global Health Problem: (Proceedings of The) 43rd Nobel Symposium, Stockholm, August 6-11, 1978 by J. Holmgren (Editor), et al (1980); ISBN: 3805530609;
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http://www.amazon.com/exec/obidos/ASIN/3805530609/icongroupin terna ·
Advances in Research on Cholera and Related Diarrheas (New Perspectives in Clinical Microbiology : 6) by S. Kuwahara (Editor), N. F. Pierce (Editor) (1983); ISBN: 089838592X; http://www.amazon.com/exec/obidos/ASIN/089838592X/icongroupi nterna
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Advances in Research on Cholera and Related Diarrheas: Proceedings of the 18th Joint Conference on (New Perspectives in Clinical Miccrobiology, Vol) by S. Kuwahara (Editor), N. F. Pierce (Editor) (1985); ISBN: 0898386802; http://www.amazon.com/exec/obidos/ASIN/0898386802/icongroupin terna
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The Cholera Years: The United States in 1832, 1849, and 1866 by Charles E. Rosenberg (1987); ISBN: 0226726770; http://www.amazon.com/exec/obidos/ASIN/0226726770/icongroupin terna
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Cholera, Fever & English Medicine 1825-65 by Margaret Pelling (1989); ISBN: 0198218729; http://www.amazon.com/exec/obidos/ASIN/0198218729/icongroupin terna
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Confronting Cholera: The Development of a Hemispheric Response to the Epidemic by Henry Hamman (Editor) (1991); ISBN: 0935501398; http://www.amazon.com/exec/obidos/ASIN/0935501398/icongroupin terna
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Cholera (Current Topics in Infectious Disease) by William B. Greenough (Editor), D. Barua (Editor) (1992); ISBN: 0306440776; http://www.amazon.com/exec/obidos/ASIN/0306440776/icongroupin terna
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Guidelines for Cholera Control (1993); ISBN: 924154449X; http://www.amazon.com/exec/obidos/ASIN/924154449X/icongroupi nterna
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Cholera on the American Continents by A. F. De Castro (Editor), W. F. Almeida (Editor) (1993); ISBN: 094439812X; http://www.amazon.com/exec/obidos/ASIN/094439812X/icongroupi nterna
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Vibrio Cholerae and Cholera: Molecular to Global Perspectives by I. Kaye Wachsmuth (Editor), et al (1994); ISBN: 1555810675; http://www.amazon.com/exec/obidos/ASIN/1555810675/icongroupin terna
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Cholera and Famine in British India, 1870-1930 by Maureen Sibbons (1995); ISBN: 0906250307; http://www.amazon.com/exec/obidos/ASIN/0906250307/icongroupin terna
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Cholera in Post-Revolutionary Paris: A Cultural History (Studies on the History of Society and Culture, 25) by Catherine J. Kudlick (1996); ISBN: 0520202732; http://www.amazon.com/exec/obidos/ASIN/0520202732/icongroupin terna
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Naples in the Time of Cholera, 1884-1911 by Frank M. Snowden (2002); ISBN: 0521893860; http://www.amazon.com/exec/obidos/ASIN/0521893860/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “cholera” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 ·
Assessment of epidemic cholera in the Gaza Strip, November 1994. Author: C. Dalton, J. Haratani, J. Murray; Year: 1994; Arlington, Virginia, Partnership for Child Health Care, BASICS, 1994
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Cholera in the Islamic Federal Republic of the Comoros: mission report, 5 Feb.-15 Feb. 1998. Author: L. Kuppens; Year: 1998; Geneva: World Health Organisation, Global Cholera Task Force, [1998]
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
26
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Cholera, diarrhoea, and dysentery: homoeopathic prevention and cure. Author: by John H. Clarke; Year: 1893; New Delhi: B. Jain, 1996
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Cholera, its nature, cause, and cure: or A weapon wherewith to oppose the pestilence. Author: by W. Dale ..; Year: 1855; [Glasgow: s.n., 1855?]
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Epidemiology of an outbreak of cholera in Senegal (West Africa) in 1985: modes of transmission and mortality. Author: O. Fontaine ... [et al.]; Year: 1986; [1986]
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Evaluation plan for proposal, INCAP long-distance learning course in cholera-diarrhea, June 5-11, 1994. Author: B. Burkhalter; Year: 1994; Arlington, Virginia, Partnership for Child Health Care, 1994
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Finalizing the evaluation and validity studies of the INCAP cholera. Author: diarrhea distance education course, Guatemala City, Guatemala, November 30 - December 10, 1997 / B.R. Burkhalter; Year: 1997; Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1997
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Homoeopathic therapeutics of diarrhoea, dysentery, cholera, cholera morbus, cholera infantum, and all other loose evacuations of the bowels. Author: by James B. Bell; Year: 1933; New Delhi: B. Jain, 1997; ISBN: 8170216044
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Implementation and evaluation of a distance education course on the management of cholera and diarrheal diseases. Author: R. Flores, J. Robles, B.R. Burkhalter; Year: 1998; Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1998
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International health statecraft: foreign policy and public health in Peru's cholera epidemic. Author: Ulysses B. Panisset; Year: 2000; Lanham [Md.]: University Press of America, c2000; ISBN: 0761816011 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0761816011/icongroupin terna
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Lectures on cholera and its homoeopathic treatment [microform]. Author: by L. Salzer; Year: 1883; Calcutta: Berigny & Co., 1883
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Monitoring the effect of behavior change activities on cholera: a review in Chimborazo and Cotopaxi, Ecuador. Author: L. Whiteford, C. Laspina, M. Torres; Year: 1996; Arlington, Virginia, Camp Dresser and McKee International Environmental Health Project, 1996
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Notes on cholera. Author: by Hahnemann and other masters of homoeopathy; New Delhi: Indian Books & Periodicals Syndicate, [19-]
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Pathology and treatment of Asiatic cholera, so called. Author: by A.L. Cox ..; Year: 1849; New York: John Wiley ..., 1849
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Planning for the follow-up survey and a special validation study for the evaluation of the INCAP Cholera. Author: Diarrhea Distance Education Course, April 14-18, 1996, Guatemala City, Guatemala / B.R. Burkhalter; Year: 1996; Arlington, Virginia, Partnership for Child Health Care, 1996
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Potential use of oral cholera vaccines in emergency situations: report of a WHO meeting, Geneva, Switzerland, 12-13 May 1999. Author: World Health Organization, Department of Communicable Disease Surveillance and Response, Department of Vaccines and Other Biolo; Year: 1999; Geneva: World Health Organization, c1999
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Preliminary baseline analysis and recommendations for modification of the evaluation plan for the INCAP cholera. Author: diarrhea distance education course, Guatemala City, Guatemala, November 26 - December 1, 1995 / B.R. Burkhalter; Year: 1995; Arlington, Virginia, Partnership for Child Health Care, 1995
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Preliminary results from the evaluation of the INCAP cholera. Author: diarrhea distance education course, Guatemala City, Guatemala, December 1-11, 1996 / B.R. Burkhalter; Year: 1996; Arlington, Virginia, Partnership for Child Health Care, BASICS, 1996
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Preparation of an evaluation plan for a cholera. Author: diarrhea distance education course in Guatemala. Guatemala, Guatemala, April 27, 1995 / B.R. Burkhalter; Year: 1995; Arlington, Virginia, Partnership for Child Health Care, 1995
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Treatise on cholera asiatica [microform]. Author: by J. N. Majumdar; Year: 1911; Calcutta: S.C. Paul, 1911
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Water quality assessment in Ecuador. Author: J.P. Chudy, E. Arniella, E. Gil; Year: 1993; [Arlington, Virginia], CDM and Associates, Water and Sanitation for Health Project [WASH], 1993
Chapters on Cholera Frequently, cholera will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with cholera, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and cholera using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search
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by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “cholera” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on cholera: ·
Routes of Transmission of Pathogenic Microorganisms Source: in Joneja, J.M. and Bielory, L. Understanding Allergy, Sensitivity, and Immunity: A Comprehensive Guide. New Brunswick, NJ: Rutgers University Press. 1990. p. 20-25. Contact: Available from Rutgers University Press. 109 Church Street, New Brunswick, NJ 08901. (201) 932-7037. Price: $35 (cloth) or $13.95 (paperback). ISBN: 0813515203 (cloth) or 0813515211 (paperback). Summary: This chapter, from a comprehensive guide to understanding allergy, sensitivity, and immunity, discusses the routes of transmission of pathogenic microorganisms, notably the digestive route. Microorganisms in food, water, and other beverages are introduced into the digestive tract during eating and drinking. They may cause infections of the alimentary system alone or in other organ systems after dissemination from the initial infection site. Cholera, typhoid fever, and shigellosis are intestinal infections caused by bacteria that can be transmitted in contaminated water supplies. Hepatitis A virus can be transmitted in the same manner. Escherichia coli, a normal inhabitant of the healthy intestinal tract, but which can cause gastroenteritis, is commonly present in water contaminated with feces. The authors also discuss the variety of ways that food can be contaminated.
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Socioeconomic, Ethnic and Geographical Health Issues Source: in Scully, C. and Cawson, R.A. Medical Problems in Dentistry. 4th ed. Woburn, MA: Butterworth-Heinemann. 1998. p. 529-547. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Woburn, MA 01801-2041. (800) 366-2665 or (781) 904-2500. Fax (800) 446-6520 or (781) 933-6333. E-mail:
[email protected]. Website: www.bh.com. Price: $110.00. ISBN: 0723610568. Summary: This chapter on socioeconomic, ethnic, and geographical health issues is from a text that covers the general medical and surgical conditions relevant to the oral health care sciences. The authors discuss mainly the relevant imported diseases, problems related to social deprivation, and those which religious or ethnic groups may present during oral health care. Topics include infections, including typhoid, paratyphoid, cholera, nonvenereal treponematoses, yaws (framboesia),
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granuloma inguinale (donovanosis), lymphogranuloma vereneum, blood-borne viruses, arboviruses, arenaviruses, rhabdoviruses (Ebola, rabies), systemic mycoses, Aspergillosis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, mucormycosis, rhinosporidiosis, sporotrichosis, systemic candidosis, parasitic infestations, scabies, lice, fleas, malaria, toxoplasmosis, leishmaniasis, trichinosis, echinococcosis, cysticercosis, myiasis, larva migrans, filariasis, trichuriasis, gnathostomiasis, and oral submucous fibrosis. For each condition, the authors discuss general aspects, diagnosis and management issues, dental aspects, and patient care strategies. The chapter includes a summary of the points covered. 9 tables. 45 references. ·
Toxigenic Diarrheas, Congenital Diarrheas, and Cystic Fibrosis: Disorders of Intestinal Ion Transport Source: in Hoffman, J.F. and De Weer, P., eds. Annual Review of Physiology. Palo Alto, CA: Annual Reviews Inc. 1993. Volume 55: 631655. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. E-mail:
[email protected]. Price: $46.00. ISBN: 0824303555. ISSN: 00664278. Individual chapter reprints available from Annual Reviews Preprints and Reprints. (800) 347-8007 or (415) 259-5017. Base price $13.50 per article. Summary: This entry from the Annual Review of Physiology discusses the pathophysiology of enterotoxic diarrheas, congenital diarrheas, and cystic fibrosis (CF). The authors begin with a brief summary of the ion transport properties of the intestine as they relate to the active secretion of electrolytes. Other topics include Vibrio Cholerae enterotoxins, including the cholera toxin and the enteric nervous system; heat-stable Escherichia Coli enterotoxin and guanylin; congenital defects of intestinal electrolyte transport; and directions for future research. 3 figures. 128 references.
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General Home References In addition to references for cholera, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Bacteria Menace: Todays Emerging Infections and How to Protect Yourself by Skye Weintraub; Paperback - 350 pages (May 2002), Woodland Publishing; ISBN: 1580543529; http://www.amazon.com/exec/obidos/ASIN/1580543529/icongroupinterna · Bacterial Infections by Axel Dalhoff (Editor); Paperback (April 1999), S. Karger Publishing; ISBN: 380556841X; http://www.amazon.com/exec/obidos/ASIN/380556841X/icongroupinterna
· Encyclopedia of Infectious Diseases (Encyclopedia of Infectious Diseases, 1998) by Carol Turkington, Bonnie Ashby; Library Binding - 384 pages (September 1998), Facts on File, Inc.; ISBN: 0816035121; http://www.amazon.com/exec/obidos/ASIN/0816035121/icongroupinterna · Epidemic! The World of Infectious Disease by Rob Desalle (Editor), American Museum of Natural History; Paperback - 246 pages, 1st edition (September 1999), New Press; ISBN: 1565845463; http://www.amazon.com/exec/obidos/ASIN/1565845463/icongroupinterna · I Know How We Fight Germs (Sam’s Science) by Kate Rowan, et al; School & Library Binding - 32 pages (January 1999), Candlewick Press; ISBN: 0763605034; http://www.amazon.com/exec/obidos/ASIN/0763605034/icongroupinterna · Outbreak Alert: Responding to the Increasing Threat of Infectious Diseases by Jason Eberhart-Phillips, M.D.; Paperback - 292 pages (July 2000), New Harbinger Publications; ISBN: 1572242019; http://www.amazon.com/exec/obidos/ASIN/1572242019/icongroupinterna
Vocabulary Builder Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]
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Aspergillosis: Infections with fungi of the genus aspergillus. [NIH] Blastomycosis: A fungal infection that may appear in two forms: 1) a primary lesion characterized by the formation of a small cutaneous nodule and small nodules along the lymphatics that may heal within several months; and 2) chronic granulomatous lesions characterized by thick crusts, warty growths, and unusual vascularity and infection in the middle or upper lobes of the lung. [NIH] Cryptococcosis: Infection with a fungus of the species cryptococcus neoformans. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH] Echinococcosis: An infection caused by the infestation of the larval form of tapeworms of the genus Echinococcus. The liver, lungs, and kidney are the most common areas of infestation. [NIH] Evacuation: An emptying, as of the bowels. [EU] Filariasis: Infections with nematodes of the superfamily filarioidea. The presence of living worms in the body is mainly asymptomatic but the death of adult worms leads to granulomatous inflammation and permanent fibrosis. Organisms of the genus Elaeophora infect wild elk and domestic sheep causing ischaemic necrosis of the brain, blindness, and dermatosis of the face. [NIH] Fleas: Parasitic, blood-sucking, wingless insects comprising the order Siphonaptera. [NIH] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH]
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Hydroxyquinolines: The 8-hydroxy derivatives inhibit various enzymes and their halogenated derivatives, though neurotoxic, are used as topical anti-infective agents, among other uses. [NIH] Larva: Wormlike or grublike stage, following the egg in the life cycle of insects, worms, and other metamorphosing animals. [NIH] Myiasis: The invasion of living tissues of man and other mammals by dipterous larvae. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU] Sporotrichosis: The commonest and least serious of the deep mycoses, characterized by nodular lesions of the cutaneous and subcutaneous tissues. It is caused by inhalation of contaminated dust or by infection of a wound. [NIH]
Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH]
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Toxoplasmosis: An acute or chronic, widespread disease of animals and humans caused by the obligate intracellular protozoon Toxoplasma gondii, transmitted by oocysts containing the pathogen in the feces of cats (the definitive host), usually by contaminated soil, direct exposure to infected feces, tissue cysts in infected meat, or tachyzoites (proliferating forms) in blood. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Yaws: A systemic non-venereal infection of the tropics caused by Treponema pallidum subspecies pertenue. [NIH]
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CHAPTER 6. MULTIMEDIA ON CHOLERA Overview Information on cholera can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on cholera. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on cholera is the Combined Health Information Database. You will need to limit your search to “video recording” and “cholera” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “cholera” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on cholera:
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Plagued Contact: Filmakers Library, Incorporated, 124 East 40th St, New York, NY, 10016, (212) 808-4980. Summary: This videorecording is a four-part series that documents historic information on the occurrence and origins of epidemics and pandemics worldwide, not only as infectious diseases, but as products of societal, political, and economic forces that encourage the spread of disease. It draws the parallel with the rise in the incidence of HIV and AIDS, and asserts that AIDS will continue to be an increasing problem unless societies learn the lessons of history. Part 1, "The Origins of Disease," investigates how new diseases arise. It profiles Korean hemorrhagic fever, well-documented during the Korean War. This disease is now infecting rats on the Baltimore docks. The second segment, "Epidemics," takes up the theme that epidemics are the products of progress, and that despite medical advances, individuals are still vulnerable to old diseases that still exist. It focuses on the incidence of plague, which is endemic in the rodent population of the Western United States, and cholera, found in the Chesapeake Bay and coastal waters off Alabama. The third segment, "Invisible Armies," examines the epidemic of measles in the Hispanic population of Los Angeles. It explores the connections between the immune system and history, and the genetic reasons that Africa and Jamaica have primarily Black populations, while the United States and Australia are predominantly European. The last segment poses the question "Will We Ever Learn?" and draws together the themes from the first three segments to illustrate that unless society learns from the epidemics of the past, new diseases will continue to arise, and old diseases will re-emerge. It examines the incidence of congenital syphilis in New York, and that of sexually transmitted diseases (STDs) in general.
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The Health Century, Episode One: The Fight Against Infectious Disease; From Yellow Fever to AIDS Contact: Maryland Public Television, Public Broadcasting System Video, 11767 Owings Mills Blvd, Owings Mills, MD, 21117, (301) 356-5600. Summary: This videorecording, part of a series broadcast on Maryland Public Television, examines the history of infectious diseases up through the current epidemic of Acquired immunodeficiency syndrome (AIDS). Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), and Cecil Fox, a senior scientist at the National Institutes of Health (NIH), appear in an opening segment that discusses AIDS and the work being done on developing a vaccine. NIH's work in funding research programs is discussed. After pointing out that
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AIDS research is also feeding results back into other fields, the videorecording turns to the history of NIH, which goes back to the cholera epidemic of 1878, when a one-man staff began work in a New York City laboratory. Moving on through history, the videorecording looks at epidemics of pellagra, influenza, and polio, examining the research that went into developing penicillin and the massive efforts that went into producing the polio vaccine. During the last 15 minutes of the program, Dr. Michael Clement of San Francisco General Hospital talks about azidothymidine (AZT) and treating persons with Human immunodeficiency virus (HIV) infection, and Dr. Robert Gallo, codiscoverer of HIV, talks about research methods.
Bibliography: Multimedia on Cholera The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in cholera (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on cholera. For more information, follow the hyperlink indicated: ·
Cholera "a problem": water & salt. Source: McMaster University, Health Sciences; Year: 1978; Format: Slide; [Hamilton, Ont.]: The University, c1978
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Cholera can be conquered. Source: [Byron; presented by] the United States Navy; Year: 1946; Format: Motion picture; United States: Byron, c1946
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Cholera today : bedside evaluation and treatment. Source: Southeast Asia Treaty Organization Cholera Research Program of the National Institutes of Health and the Agency for International Development; produced by Public HealthService Audiovisua; Year: 1971; Format: Motion picture; Atlanta: National Medical Audiovisual Center, [1971]
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Cholera today . Part II: Practical laboratory diagnosis. Source: Agency for International Development and National Institutes of Health; produced by National Medical Audiovisual Center; Year: 1966; Format: Motion picture; [Atlanta]: National Medical Audiovisual Center, [1966]
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Cholera. Source: a presentation of Films for the Humanities & Sciences; Year: 1996; Format: Videorecording; Princeton, N.J: Films for the Humanities & Sciences, c1996
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·
Cholera. Source: presented by Trainex Corporation; Year: 1980; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1980
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Cholera. Source: Instructional Systems Division, Center for Disease Control; Year: 1974; Format: Slide; [Atlanta]: The Center, [1974?]
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Epidemics and the environment. Source: a presentation of Films for the Humanities & Sciences; a production of the Economic Development Institute; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1998
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Immunization against infectious diseases. Source: produced with the support of Lederle Laboratories Division, American Cyanamid Company; originally prepared by the Department of Pediatrics and Communicable Diseases, University of Michigan Medic; Year: 1966; Format: Motion picture; United States: Fordel Films, [1966?]
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National Institutes of Health : a short history. Source: produced by A.V. Branch, Office of Communications; edited by T.V. Unit, A.V. Section, TASB, National Institutes of Health; Format: Videorecording; [Bethesda, Md.: National Institutes of Health, between 1982 and 1999]
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Plagued. Source: [presented by] Filmakers Library, Inc.; a Film Australia production for Channel 4 and Film Australia; Year: 1992; Format: Videorecording; [Australia]: Film Australia; [England?]: Channel Four, c1992
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Plagues. Source: from WHYY ; Year: 1987; Format: Videorecording; Alexandria, VA: PBS Video, c1987
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Traveller's diarrhea, Campylobacter gastroenteritis and cholera in the U.S.A. Source: presented by Department of Medicine, Emory University, School of Medicine; Year: 1982; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1982
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Work of the Public Health Service. Source: [presented by] the United States Public Health Service; produced by the Bray Studios Inc; Year: 1936; Format: Motion picture; [United States]: The Service, c1936
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CHAPTER 7. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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·
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/health/diseases.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27
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·
Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat cholera, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and cholera using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “cholera” (or synonyms) into the “For
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these words:” box above, you will only receive results on fact sheets dealing with cholera. The following is a sample result: ·
Travel to Developing Countries Source: New York, NY: Nidus Information Services, Inc. 1996. 8 p. Contact: Available from Nidus Information Services, Inc. 175 Fifth Avenue, Suite 2338, New York, NY 10010. (800) 334-9355 or (212) 2604268. Fax (212) 529-2349. E-mail:
[email protected]. Price: $5.95; discounts available for orders of 15 or more reports. Summary: This health report provides advice for travelers planning to visit developing countries. Topics include general health precautions; general guidelines for immunizations; health insurance considerations; precautions for specific travel situations, including motion sickness, air travel, cruise ships, high altitude, and below sea level (scuba diving); and health problems that may concern the traveler to developing countries, including traveler's diarrhea, malaria, cholera, yellow fever, typhoid fever, hepatitis, rabies, poliomyelitis, measles, meningococcal disease, Japanese B encephalitis, insect-and other vector-borne disease, diptheria, plague, and AIDS. The report describes each disease and gives recommendations for prevention, including immunization where appropriate. The report concludes with a section describing how travelers with special health problems such as diabetes, cardiac or pulmonary disease, or pregnancy, should protect themselves. A list of information resource organizations is appended.
·
1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed Source: Elk Grove Village, IL: American Academy of Pediatrics. 1997. 764 p. Contact: Available from American Academy of Pediatrics. Publications, P.O. Box 747, Elk Grove Village, IL 60009-0747. (800) 433-9016 or (847) 228-5005. Fax (847) 228-1281. E-mail:
[email protected]. Price: Single copy free to members, with additional copies $74.95 each; $79.95 for nonmembers. ISBN: 091076185x. Publication number MA0001. Summary: This monograph contains the 24th edition of the report of the Committee on Infectious Diseases, the group responsible for formulating and revising guidelines of the American Academy of Pediatrics for the control of infectious diseases in children. Five sections present guidelines in the areas of active and passive immunization; recommendations for the care of children in special circumstances, including children in day care, infection control for hospitalized children, and medical evaluation
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of internationally adopted children; summaries of infectious diseases; antimicrobial prophylaxis; and antimicrobials and related therapy. Infectious diseases that can affect the digestive system include amebiasis, campylobacter infections, cholera, Escherichia coli, diarrhea, giardia lamblia, helicobacter pylori, hepatitis, HIV, malaria, parasitic diseases, salmonellosis, schistosomiasis, shigellosis, vibrio infections, and yersinia infections. A summary of major changes in the 1997 edition is provided; changes include the addition of recent information on Escherichia coli diarrhea (E coli 0157:H7 infection) and its complication of hemolyticuremic syndrome, and expanded information about Hepatitis A, B, and C. A subject index concludes the volume. 9 appendices. The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.31 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “cholera” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 31 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 29 30
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Results Summary Category Items Found Journal Articles 344414 Books / Periodicals / Audio Visual 2563 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 350462
HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.34 Simply search by “cholera” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 35 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 32 33
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recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 36
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The Genome Project and Cholera With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to cholera. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “cholera” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for cholera: ·
Abo Blood Group Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?110300
·
Adp-ribosylation Factor 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?103180
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
38
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·
Adp-ribosylation Factor 3 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?103190
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Adp-ribosylation Factor 4 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601177
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Adp-ribosylation Factor 5 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?103188
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Adp-ribosylation Factor 6 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600464
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Adp-ribosylation Factor-like 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?603425
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Adp-ribosylation Factor-like 3 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?604695
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Adp-ribosyltransferase 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601625
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Albright Hereditary Osteodystrophy Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300800
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever,
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immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html ·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “cholera” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html.
Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
39
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The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “cholera” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in cholera (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · 2002 Pocket Book of Infectious Disease Therapy by John G. Bartlett; Paperback - 348 pages, 11th edition (November 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781734320; http://www.amazon.com/exec/obidos/ASIN/0781734320/icongroupinterna · Bacterial Infections of Humans: Epidemiology and Control by Alfred S. Evans (Editor), et al; Hardcover - 887 pages, 3rd edition (July 15, 1998), Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
40
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Plenum Publishing Corporation; ISBN: 0306453207; http://www.amazon.com/exec/obidos/ASIN/0306453207/icongroupinterna · Cellular Microbiology : Bacteria-Host Interactions in Health and Disease by Brian Henderson, et al; Hardcover - 478 pages (May 28, 1999), John Wiley & Sons; ISBN: 047198678X; http://www.amazon.com/exec/obidos/ASIN/047198678X/icongroupinterna · The Comprehensive Sourcebook of Bacterial Protein Toxins by Joseph E. Alouf (Editor), John H. Freer (Editor); Hardcover - 718 pages, 2nd edition (August 15, 1999), Academic Press; ISBN: 0120530759; http://www.amazon.com/exec/obidos/ASIN/0120530759/icongroupinterna · Current Diagnosis & Treatment in Infectious Diseases by Walter R. Wilson (Editor), et al; Paperback - 985 pages, 1st edition (June 22, 2001), McGraw-Hill Professional Publishing; ISBN: 0838514944; http://www.amazon.com/exec/obidos/ASIN/0838514944/icongroupinterna · Hunter’s Tropical Medicine and Emerging Infectious Diseases by George W. Hunter (Editor), et al; Hardcover - 1192 pages, 8th edition (January 15, 2000), W B Saunders Co; ISBN: 0721662234; http://www.amazon.com/exec/obidos/ASIN/0721662234/icongroupinterna · Infectious Disease by Barbara Bannister, et al; Paperback - 506 pages, 2nd edition (August 15, 2000), Blackwell Science Inc.; ISBN: 0632053194; http://www.amazon.com/exec/obidos/ASIN/0632053194/icongroupinterna · Infectious Disease Epidemiology: Theory and Practice by Kenrad E. Nelson, et al; Hardcover - 600 pages (May 2000), Aspen Publishers, Inc.; ISBN: 083421766X; http://www.amazon.com/exec/obidos/ASIN/083421766X/icongroupinterna · Laboratory Diagnosis of Bacterial Infections (Infectious Disease and Therapy, Vol 26) by Nevio Cimolai (Editor); Hardcover (August 2001), Marcel Dekker; ISBN: 0824705890; http://www.amazon.com/exec/obidos/ASIN/0824705890/icongroupinterna · Mandell, Douglas, and Bennett’s Principles & Practice of Infectious Diseases (2 Vol. Set) by Gerald L. Mandell (Editor), et al; Hardcover - 3263 pages, 5th edition (June 15, 2000), Churchill Livingstone; ISBN: 044307593X; http://www.amazon.com/exec/obidos/ASIN/044307593X/icongroupinterna
· Molecular Bacteriology: Protocols and Clinical Applications by Neil Woodford (Editor), Alan Johnson (Editor); Hardcover - 682 pages, 1st edition (June 15, 1998), Humana Press; ISBN: 0896034984; http://www.amazon.com/exec/obidos/ASIN/0896034984/icongroupinterna
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· Molecular Epidemiology of Infectious Diseases by R. C. Andrew Thompson; Hardcover - 326 pages, 1st edition (October 15, 2000), Edward Arnold; ISBN: 0340759097; http://www.amazon.com/exec/obidos/ASIN/0340759097/icongroupinterna · Persistent Bacterial Infections by James P. Nataro (Editor), et al; Hardcover (June 2000), American Society for Microbiology; ISBN: 1555811590; http://www.amazon.com/exec/obidos/ASIN/1555811590/icongroupinterna
Vocabulary Builder Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Cardiac: Pertaining to the heart. [EU] Diving: An activity in which the organism plunges into water. It includes scuba and bell diving. Diving as natural behavior of animals goes here, as well as diving in decompression experiments with humans or animals. [NIH] Encephalitis: Inflammation of the brain. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Osteodystrophy: Defective bone formation. [EU] Pulmonary: Pertaining to the lungs. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
Dissertations 121
CHAPTER 8. DISSERTATIONS ON CHOLERA Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to cholera. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Cholera ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to cholera. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with cholera: ·
Analysis of Coordinate Virulence Gene Regulation in Vibrio Cholerae by the Transcription Activator Toxt by Yu, Rosa Rong-ying; Phd from University of Michigan, 2001, 173 pages http://wwwlib.umi.com/dissertations/fullcit/3016989
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·
Cholera in the Large Towns of the West and East Ridings, 1848-1893 (west Riding, East Riding, England, Yorkshire) by Sigsworth, Michael, Phd from Council for National Academic Awards (united Kingdom), 1991, 420 pages http://wwwlib.umi.com/dissertations/fullcit/DX98080
·
Communicating Cholera: News and Health Information for Andean Peasants (quichua, Ecuador) by Mullen, Joel Pink, Phd from The University of Utah, 1996, 226 pages http://wwwlib.umi.com/dissertations/fullcit/9627130
·
Construction and Characterization of Molecular Chimeras of Cholera Toxin and the Heat-labile Enterotoxin of Escherichia Coli by Bowman, Christal Camille; Phd from Tulane University, 2001, 107 pages http://wwwlib.umi.com/dissertations/fullcit/3026120
·
Disease, Public Health and Urban Social Relations: Perceptions of Cholera and the Paris Environment, 1830-1850 by Kudlick, Catherine Jean, Phd from University of California, Berkeley, 1988, 279 pages http://wwwlib.umi.com/dissertations/fullcit/8902168
·
Ecology and Pathogenesis of Fowl Cholera in Turkeys by Pabs-garnon, Leonard F; Advdeg from University of Guelph (canada), 1970 http://wwwlib.umi.com/dissertations/fullcit/NK07177
·
Epidemic Proportions: Cholera in the British West Indies, 1850-1855 by Higgins, Brian Thomas, Phd from Bowling Green State University, 1993, 362 pages http://wwwlib.umi.com/dissertations/fullcit/9334554
·
From Yellow Fever to Cholera: a Study of French Government Policy, Medical Professionalism and Popular Movements in the Epidemic Crises of the Restoration and the July Monarchy by Sussman, George David, Phd from Yale University, 1971, 388 pages http://wwwlib.umi.com/dissertations/fullcit/7131018
·
Genetic Fusion of the Respiratory Syncytial Virus F Protein with the Cholera Toxin Gene Ctxa(2)b: Cloning, Expression and Purification of the Chimeric Protein by Singh, Shree Ram; Phd from Auburn University, 2001, 110 pages http://wwwlib.umi.com/dissertations/fullcit/3028884
·
International Cooperation and Pandemic Diseases: Regimes and the Role of Epistemic Communities in Combating Cholera, Smallpox and Aids (immune Deficiency) by Mcfadden, David Fancher, Phd from The Claremont Graduate University, 1995, 273 pages http://wwwlib.umi.com/dissertations/fullcit/9612315
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to cholera is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with cholera and related conditions.
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APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with cholera. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for cholera. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of cholera. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of cholera. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with cholera take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for cholera. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
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How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
41
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
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·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for cholera). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
·
Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for cholera. One such source is
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the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of cholera. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to cholera: Doxycycline ·
Dental - U.S. Brands: Atridox http://www.nlm.nih.gov/medlineplus/druginfo/doxycyclineden tal203716.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
42
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Furazolidone ·
Oral - U.S. Brands: Furoxone http://www.nlm.nih.gov/medlineplus/druginfo/furazolidoneora l202252.html
Trimethoprim ·
Systemic - U.S. Brands: Proloprim; Trimpex http://www.nlm.nih.gov/medlineplus/druginfo/trimethoprimsy stemic202579.html
Yellow Fever Vaccine ·
Systemic - U.S. Brands: YF-Vax http://www.nlm.nih.gov/medlineplus/druginfo/yellowfevervacc inesystemic202689.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with cholera (including those with contraindications):43 ·
Trimethoprim Sulfamethoxazole http://www.reutershealth.com/atoz/html/Trimethoprim_Sulfamethox azole.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. 43
Adapted from A to Z Drug Facts by Facts and Comparisons.
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Information can be obtained at the following http://www.genrx.com/Mosby/PhyGenRx/group.html.
hyperlink:
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with cholera--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat cholera or potentially create deleterious side effects in patients with cholera. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These
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precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with cholera. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with cholera. The FDA warns patients to watch out for44: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
· If it sounds too good to be true, it probably isn’t true. If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
44
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Interactions in Infectious Diseases (Infectious Disease) by Stephen C. Piscitelli (Editor), et al; Hardcover - 372 pages (September 2000), Humana Press; ISBN: 0896037509; http://www.amazon.com/exec/obidos/ASIN/0896037509/icongroupinterna · Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance by Arch G. Mainous, Ph.D. (Editor), et al; Hardcover - 350 pages, 1st edition (January 15, 2001), Humana Press; ISBN: 0896038211; http://www.amazon.com/exec/obidos/ASIN/0896038211/icongroupinterna · Manual of Antibiotics and Infectious Diseases: Treatment and Prevention by John E. Conte; Paperback - 755 pages, 9th edition (December 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781723167; http://www.amazon.com/exec/obidos/ASIN/0781723167/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Yellow Fever Vaccine: Vaccine used to prevent yellow fever. It consists of a live attenuated 17D strain of the yellow fever virus. [NIH]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to cholera. Finally, at the conclusion of this chapter, we will provide a list of readings on cholera from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
46
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47
47
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Cholera Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for cholera. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “cholera” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Microbiological Screening of Indian Medicinal Plants With Special Reference to Enteropathogens Source: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy. 3(1): 13-20. 1997.
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Summary: This journal article describes a study of 10 medicinal plants from India screened for antibacterial activity specific to enteropathogens. Plants whose parts were investigated included sweet flag, garlic, neem, svet kanchan, tea, garden spurge, velvet leaf, guava, globe thistle, and sweet indrajao. Bacterial strains used included Escherichia coli (EPEC), Eschericia coli (ETEC), Shigella flexneri, Shigella sonnei, Shigella boydii, Vibrio cholerae, and Klebsiella pneumoniae. The authors collected and prepared the plant material, and then screened the extracts using the Agar dilution streak method, the Agar overlay method, and the tube dilution method. The results suggest relatively high antibacterial activity in some plants and very little antibacterial activity in others. The pathogens displayed varying degrees of susceptibility to the plant extracts. The authors found that garlic, tea, and garden spurge showed highest activity, giving a minimum bacterial concentration of less than 100 micrograms per microliter and producing inhibition zones of more than 2 centimeters. The authors also found that the pathogens Vibrio cholerae and Shigella flexneri showed highest susceptibility. This journal article contains 2 figures, 4 tables, and 32 references. National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to cholera and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “cholera” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to cholera: ·
"I'm not dog, no!": cries of resistance against cholera control campaigns. Author(s): Nations MK, Monte CM. Source: Social Science & Medicine (1982). 1996 September; 43(6): 1007-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8888470&dopt=Abstract
·
A note on the basis of differentiation of cholera and eltor vibrios. Author(s): Chatterjee SN, Adhikari PC, Das J, Maiti M, Roychaudhuri C, Sur P, Datta MC.
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Source: Bull Calcutta Sch Trop Med. 1971 October; 19(4): 96-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5005625&dopt=Abstract ·
A second guanyl nucleotide-binding site associated with adenylate cyclase. Distinct nucleotides activate adenylate cyclase and permit ADP-ribosylation by cholera toxin. Author(s): Gill DM, Meren R. Source: The Journal of Biological Chemistry. 1983 October 10; 258(19): 11908-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6311828&dopt=Abstract
·
Absence of concurrent permeability changes of intestinal mucosa in association with cholera toxin-induced secretion. Author(s): Scherer RW, Harper DT, Banwell JG, Hendrix TR. Source: Johns Hopkins Med J. 1974 March; 134(3): 156-67. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4206092&dopt=Abstract
·
ADP-ribosylation of thylakoid membrane polypeptides by cholera toxin is correlated with inhibition of thylakoid GTPase activity and protein phosphorylation. Author(s): Millner PA, Robinson PS. Source: Cellular Signalling. 1989; 1(5): 421-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2561911&dopt=Abstract
·
Amylase-resistant starch plus oral rehydration solution for cholera. Author(s): Ramakrishna BS, Venkataraman S, Srinivasan P, Dash P, Young GP, Binder HJ. Source: The New England Journal of Medicine. 2000 February 3; 342(5): 308-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10655529&dopt=Abstract
·
An epidemic of Vibrio cholerae el tor Inaba resistant to several antibiotics with a conjugative group C plasmid coding for type II dihydrofolate reductase in Thailand.
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Author(s): Tabtieng R, Wattanasri S, Echeverria P, Seriwatana J, Bodhidatta L, Chatkaeomorakot A, Rowe B. Source: Am J Trop Med Hyg. 1989 December; 41(6): 680-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2641646&dopt=Abstract ·
Biochemical characterization of extracellular proteases from Vibrio cholerae. Author(s): Young DB, Broadbent DA. Source: Infection and Immunity. 1982 September; 37(3): 875-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6752027&dopt=Abstract
·
Cholera in Mali and popular reactions to its first appearance. Author(s): Imperato PJ. Source: J Trop Med Hyg. 1974 December; 77(12): 290-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4449142&dopt=Abstract
·
Cholera toxin activation of adenylate cyclase. Roles of nucleoside triphosphates and a macromolecular factor in the ADP ribosylation of the GTP-dependent regulatory component. Author(s): Enomoto K, Gill DM. Source: The Journal of Biological Chemistry. 1980 February 25; 255(4): 1252-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6766444&dopt=Abstract
·
Cholera toxin and its B subunit do not change cytosolic free calcium concentration. Author(s): Astashkin EI, Surin AM, Mikhna MG, Nikolaeva IS, Lazarev AV, Gukovskaya AS. Source: Cell Calcium. 1990 June-July; 11(6): 419-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2393900&dopt=Abstract
·
Cholera toxin as a mucosal adjuvant: III. Antibody responses to nontarget dietary antigens are not increased. Author(s): Nedrud JG, Sigmund N.
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Source: Reg Immunol. 1990-91; 3(5): 217-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1966580&dopt=Abstract ·
Cholera toxin B-gold, a retrograde tracer that can be used in light and electron microscopic immunocytochemical studies. Author(s): Llewellyn-Smith IJ, Minson JB, Wright AP, Hodgson AJ. Source: The Journal of Comparative Neurology. 1990 April 8; 294(2): 17991. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1692043&dopt=Abstract
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Cholera, the flickering flame. Author(s): Bryceson AD. Source: Proc R Soc Med. 1977 May; 70(5): 363-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=327482&dopt=Abstract
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Coca chewing and cholera. Author(s): Feldmeier H, Krantz I. Source: Lancet. 1991 June 1; 337(8753): 1342. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1674310&dopt=Abstract
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Comparative study of the effect of cholera toxin and sodium deoxycholate on the paracellular permeability and on net fluid and electrolyte transfer in the rat colon. Author(s): Goerg KJ, Gross M, Nell G, Rummel W, Schulz L. Source: Naunyn-Schmiedeberg's Archives of Pharmacology. 1980 May; 312(1): 91-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6771659&dopt=Abstract
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Composition and immunochemical properties of the cell surface proteins of Vibrio cholerae. Author(s): Kabir S. Source: J Gen Microbiol. 1986 August; 132 ( Pt 8): 2235-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3794649&dopt=Abstract
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Congruences in Chinese and Western medicine from 1830-1911: smallpox, plague and cholera. Author(s): Summers WC. Source: Yale J Biol Med. 1994 January-April; 67(1-2): 23-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7544052&dopt=Abstract
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Cutting edge: the mucosal adjuvant cholera toxin redirects vaccine proteins into olfactory tissues. Author(s): van Ginkel FW, Jackson RJ, Yuki Y, McGhee JR. Source: Journal of Immunology (Baltimore, Md. : 1950). 2000 November 1; 165(9): 4778-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11045998&dopt=Abstract
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Effect of cholera toxin on passive transepithelial transport of 51Crethylenediaminetetraacetic acid and 14C-mannitol in rat jejunum. Author(s): Fihn BM, Sjoqvist A, Jodal M. Source: Acta Physiologica Scandinavica. 2001 February; 171(2): 153-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11350275&dopt=Abstract
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Effect of ethylenediamine tetra-acetic acid (EDTA) on cholera and el tor vibrios. Author(s): Adhikary P, Chatterjee SN. Source: Bull Calcutta Sch Trop Med. 1969 January; 17(1): 6-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4990154&dopt=Abstract
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Effect of oral pancreatic enzymes on the course of cholera in proteindeficient vervet monkeys. Author(s): Gyr K, Felsenfeld O, Zimmerli-Ning M. Source: Gastroenterology. 1978 March; 74(3): 511-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=415928&dopt=Abstract
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Effects of Hange-shashin-to on cholera toxin-induced fluid secretion in the small intestine of rats. Author(s): Kase Y, Saitoh K, Yuzurihara M, Ishige A, Komatsu Y.
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Source: Biol Pharm Bull. 1998 February; 21(2): 117-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9514604&dopt=Abstract ·
Epidemic cholera in Burundi: patterns of transmission in the Great Rift Valley Lake region. Author(s): Birmingham ME, Lee LA, Ndayimirije N, Nkurikiye S, Hersh BS, Wells JG, Deming MS. Source: Lancet. 1997 April 5; 349(9057): 981-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9100624&dopt=Abstract
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Epidemiology of eltor cholera in rural Bangladesh: importance of surface water in transmission. Author(s): Hughes JM, Boyce JM, Levine RJ, Khan M, Aziz KM, Huq MI, Curlin GT. Source: Bulletin of the World Health Organization. 1982; 60(3): 395-404. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6982775&dopt=Abstract
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Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children. Author(s): Dutta D, Bhattacharya MK, Deb AK, Sarkar D, Chatterjee A, Biswas AB, Chatterjee K, Nair GB, Bhattacharya SK. Source: Acta Paediatrica (Oslo, Norway : 1992). 2000 July; 89(7): 787-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10943958&dopt=Abstract
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Extinction of Vibrio cholerae in acidic substrata: contaminated cabbage and lettuce treated with lime juice. Author(s): Mata L, Vargas C, Saborio D, Vives M. Source: Rev Biol Trop. 1994 December; 42(3): 487-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7501870&dopt=Abstract
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Extinction of Vibrio cholerae in acidic substrata: contaminated fish marinated with lime juice (ceviche). Author(s): Mata L, Vives M, Vicente G.
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Source: Rev Biol Trop. 1994 December; 42(3): 479-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7501869&dopt=Abstract ·
His chastening rod: cholera epidemics and the Mormons. Author(s): Divett RT. Source: Dialogue. 1979 Fall; 12(3): 6-15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11614397&dopt=Abstract
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Identification in traditional herbal medications and confirmation by synthesis of factors that inhibit cholera toxin-induced fluid accumulation. Author(s): Oi H, Matsuura D, Miyake M, Ueno M, Takai I, Yamamoto T, Kubo M, Moss J, Noda M. Source: Proceedings of the National Academy of Sciences of the United States of America. 2002 March 5; 99(5): 3042-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11854470&dopt=Abstract
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Identification of a CHO cell-elongating factor produced by Vibrio cholerae O1. Author(s): McCardell BA, Kothary MH, Hall RH, Sathyamoorthy V. Source: Microbial Pathogenesis. 2000 July; 29(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10873485&dopt=Abstract
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Immigrants, cholera and the Saint John Sisters of Charity, 1854-64. Author(s): Kennedy E. Source: Study Sess Can Cathol Hist Assoc. 1977; 44: 25-44. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11615183&dopt=Abstract
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Indicator dilution studies in the small bowel of patients with cholera diarrhea. II. Comparisons of absorbable and "poorly absorbable" substances. Author(s): Brigham KL, Banwell JG, Pierce NF, Mitra RC, Fedson DS, Mondal A.
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Source: Johns Hopkins Med J. 1970 August; 127(2): 107-18. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4990568&dopt=Abstract ·
Is starch the answer for cholera? Author(s): Bhatnagar S. Source: Natl Med J India. 2000 September-October; 13(5): 252-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11190054&dopt=Abstract
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Letter: Palmerston on cholera. Author(s): Don G. Source: British Medical Journal. 1973 November 10; 4(5888): 359. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4586040&dopt=Abstract
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Localization of the GM1 ganglioside in the vestibular system using cholera toxin. Author(s): Mancini P, Santi PA. Source: Hearing Research. 1993 January; 64(2): 151-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8432686&dopt=Abstract
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Microtubule assembly in cultivated Greene melanoma cells is stimulated by dibutyryl adenosine 3':5'-cyclic monophosphate or cholera toxin. Author(s): DiPasquale AM, McGuire J, Moellmann G, Wasserman SJ. Source: The Journal of Cell Biology. 1976 December; 71(3): 735-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=186462&dopt=Abstract
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Plasma membrane-associated component(s) that confer(s) cholera toxin sensitivity to adenylate cyclase. Author(s): Pinkett MO, Anderson WB. Source: Biochimica Et Biophysica Acta. 1982 February 2; 714(2): 337-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7055618&dopt=Abstract
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Properties of the cholera phage PL 163/10. Author(s): Chanda PK, Chatterjee SN. Source: Acta Virol. 1975 May; 19(3): 197-203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=239574&dopt=Abstract
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Protection from cholera by adding lime juice to food - results from community and laboratory studies in Guinea-Bissau, West Africa. Author(s): Rodrigues A, Sandstrom A, Ca T, Steinsland H, Jensen H, Aaby P. Source: Tropical Medicine & International Health : Tm & Ih. 2000 June; 5(6): 418-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10929141&dopt=Abstract
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Providence, prayer and cholera: the English general fast of 1832. Author(s): Janet RJ. Source: Hist Mag Protestant Episcop Church. 1982; 51(3): 297-317. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11620183&dopt=Abstract
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Rapid detection of Vibrio cholerae with a new selective enrichment medium and polymerase chain reaction. Author(s): Kida N, Suzuki S, Taguchi F. Source: Kansenshogaku Zasshi. 1995 July; 69(7): 826-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7561254&dopt=Abstract
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Regulation of follicle-stimulating hormone binding to receptors on bovine calf testis membranes by cholera toxin-sensitive guanine nucleotide binding protein. Author(s): Zhang SB, Dattatreyamurty B, Reichert LE Jr. Source: Molecular Endocrinology (Baltimore, Md.). 1988 February; 2(2): 148-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2840571&dopt=Abstract
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Religion and medicine: the cholera pamphlets of Oxford, 1832, 1849 and 1854. Author(s): Morris RJ.
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Source: Med Hist. 1975 July; 19(3): 256-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1095865&dopt=Abstract ·
Risk factors for cholera infection in the initial phase of an epidemic in Guinea-Bissau: protection by lime juice. Author(s): Rodrigues A, Brun H, Sandstrom A. Source: Am J Trop Med Hyg. 1997 November; 57(5): 601-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9392602&dopt=Abstract
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Sensitivity to injected cholera toxin of the sodium efflux in single barnacle muscle fibers. Author(s): Bittar EE, Nwoga J. Source: Comp Biochem Physiol C. 1984; 78(1): 89-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6146489&dopt=Abstract
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Socio-cultural aspects of a cholera epidemic in Trengganu, Malaysia. Author(s): Chen PC. Source: Trop Geogr Med. 1971 September; 23(3): 296-303. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5099001&dopt=Abstract
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Somatic nerve stimulation and cholera-induced net fluid secretion in the small intestine of the rat: evidence for an opioid effect. Author(s): Jonsdottir IH, Sjoqvist A, Lundgren O, Thoren P. Source: Journal of the Autonomic Nervous System. 1999 October 8; 78(1): 18-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10589819&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to cholera; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Food Poisoning Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html
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Herbs and Supplements Barberry Alternative names: Berberis vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Barberry.htm
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Berberis Alternative names: Barberry; Berberis sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Doxycycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Doxycycline.htm Eleuthero Alternative names: Siberian Ginseng, Eleuthero; Acanthopanax/Eleutherococcus senticosus Rupr. & Maxim. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Ginger Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000166.html Goldenseal Alternative names: Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldensealc h.html Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldensealc h.html L. Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lacto bacillusacidophiluscs.html Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lacto bacillusacidophiluscs.html Oregon Grape Alternative names: Berberis aquifolium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oregon_Grape.htm Prickly Ash Alternative names: Zanthoxylum clava-herculis, Zanthoxylum americanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Prickly_Ash.htm Sanguinaria Alternative names: Bloodroot; Sanguinaria canadensis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Terminalia Alternative names: Myrobalans; Terminalia arjuna Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Tetracycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tetracycline.htm Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and
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alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Herbal Antibiotics : Natural Alternatives for Treating Drug-Resistant Bacteria (Storey Medicinal Herb Guide) by Stephen Harrod Buhner; Paperback - 128 pages (September 1999), Storey Books; ISBN: 1580171486; http://www.amazon.com/exec/obidos/ASIN/1580171486/icongroupinterna · Natural Alternatives to Antibiotics by John McKenna; Paperback - 176 pages (November 1998), Avery Penguin Putnam; ISBN: 0895298392; http://www.amazon.com/exec/obidos/ASIN/0895298392/icongroupinterna · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
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· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microgram: A unit of mass (weight) of the metric system, being onemillionth of a gram (10-6 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Tetracycline:
An
antibiotic
originally
produced
by
Streptomyces
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viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with cholera. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with cholera may be given different recommendations. Some recommendations may be directly related to cholera, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of cholera. We will then show you how to find studies dedicated specifically to nutrition and cholera.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
·
Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
48
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 161
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49
162 Cholera
the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Cholera The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
52
Researching Nutrition 163
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “cholera” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “cholera” (or a synonym): ·
Characterization of non-membrane-damaging cytotoxin of nontoxigenic Vibrio cholerae O1 and its relevance to disease. Author(s): National Institute of Cholera and Enteric Diseases, Calcutta, India. Source: Mitra, R Saha, P K Basu, I Venkataraman, A Ramakrishna, B S Albert, M J Takeda, Y Nair, G B FEMS-Microbiol-Lett. 1998 December 15; 169(2): 331-9 0378-1097
·
Cholera from raw seaweed transported from the Philippines to California. Author(s): California Department of Health Services, Berkeley, CA. Source: Vugia, D.J. Shefer, A.M. Douglas, J. Greene, K.D. Bryant, R.G. Werner, S.B. Journal-of-clinical-microbiology (USA). (January 1997). volume 35(1) page 284-285. seaweeds contamination cholera philippines california 0095-1137
·
Cholera toxin increases intracellular pH in B lymphoma cells and decreases their antigen-presenting ability. Author(s): Department of Immunology, Toho University School of Medicine, Tokyo, Japan. Source: Tanaka, Y Nakano, H Ishikawa, F Yoshida, M Gyotoku, Y Kakiuchi, T Eur-J-Immunol. 1999 May; 29(5): 1561-70 0014-2980
·
Lactoferrin binding properties of Vibrio cholerae. Author(s): Department of Medical Microbiology, University of Lund, Sweden. Source: Ascencio, F Ljungh, A Wadstrom, T Microbios. 1992; 70(283): 10317 0026-2633
·
Reversal of hypotension induced by Vibrio vulnificus lipopolysaccharide in the rat by inhibition of nitric oxide synthase. Author(s): Department of Biology, University of North Carolina, Charlotte 28223. Source: Elmore, S P Watts, J A Simpson, L M Oliver, J D Microb-Pathog. 1992 November; 13(5): 391-7 0882-4010
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·
The mucosal adjuvant effects of cholera toxin and immune-stimulating complexes differ in their requirement for IL-12, indicating different pathways of action. Author(s): Department of Medical Microbiology and Immunology, University of Goteborg, Sweden. Source: Grdic, D Smith, R Donachie, A Kjerrulf, M Hornquist, E Mowat, A Lycke, N Eur-J-Immunol. 1999 June; 29(6): 1774-84 0014-2980
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
·
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Researching Nutrition 165
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
·
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
·
WebMDÒHealth: http://my.webmd.com/nutrition
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other
166 Cholera
animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 167
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53
53
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
168 Cholera
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
54
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 169
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
170 Cholera
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 171
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 173
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 175
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with cholera faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.55 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
55Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
176 Cholera
·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 177
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
178 Cholera
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
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healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.56
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”57 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 57 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 56
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.58 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.59 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 59 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 58
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
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contact information on how to find more in-depth information about Medicaid.60
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.61 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:62 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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Vocabulary Builder Cyanosis: A bluish discoloration, applied especially to such discoloration of skin and mucous membranes due to excessive concentration of reduced haemoglobin in the blood. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Oliguria: Secretion of a diminished amount of urine in relation to the fluid intake. Called also hypouresis and oligouresis. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Tachycardia: Excessive rapidity in the action of the heart; the term is usually applied to a heart rate above 100 per minute and may be qualified as atrial, junctional (nodal), or ventricular, and as paroxysmal. [EU]
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to cholera and keep them on file. The NIH, in particular, suggests that patients with cholera visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Cholera Cholera Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000303.htm Vibrio Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000303.htm
·
Signs & Symptoms for Cholera Abdominal cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Bowel sounds Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003137.htm Cyanosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm Decreased skin turgor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003281.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Dry mucus membranes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003250.htm Dry skin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003250.htm
Online Glossaries 191
Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Heart sounds Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003266.htm Hypotension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Lethargy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Low urine output Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003147.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Oliguria Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003147.htm Rapid pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm Seizures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm
192 Cholera
Skin turgor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003281.htm Sleepiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Tachycardia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm Thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Thirst, excessive Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Tiredness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm ·
Diagnostics and Tests for Cholera ADH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003702.htm Blood culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003744.htm
Online Glossaries 193
BUN Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm Creatinine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm Heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Hgb Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003645.htm Hyperplasia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003441.htm Stool culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003758.htm WBC count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003643.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm ·
Background Topics for Cholera Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Asymptomatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002217.htm
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Electrolytes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm Endemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002362.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Shellfish Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002851.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 195
CHOLERA GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins,
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etc. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antispasmodic: An agent that relieves spasm. [EU] Aspergillosis: Infections with fungi of the genus aspergillus. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteriophages: Viruses whose host is a bacterial cell. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Blastomycosis: A fungal infection that may appear in two forms: 1) a primary lesion characterized by the formation of a small cutaneous nodule and small nodules along the lymphatics that may heal within several months; and 2) chronic granulomatous lesions characterized by thick crusts, warty growths, and unusual vascularity and infection in the middle or upper lobes of the lung. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form
Glossary 197
water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Colitis: Inflammation of the colon. [EU] Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Cryptococcosis: Infection with a fungus of the species cryptococcus neoformans. [NIH] Cyanosis: A bluish discoloration, applied especially to such discoloration of skin and mucous membranes due to excessive concentration of reduced haemoglobin in the blood. [EU]
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Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH] Diving: An activity in which the organism plunges into water. It includes scuba and bell diving. Diving as natural behavior of animals goes here, as well as diving in decompression experiments with humans or animals. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU] Echinococcosis: An infection caused by the infestation of the larval form of tapeworms of the genus Echinococcus. The liver, lungs, and kidney are the most common areas of infestation. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]
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Encephalitis: Inflammation of the brain. [EU] Encephalomyelitis: A general term indicating inflammation of the brain and spinal cord, often used to indicate an infectious process, but also applicable to a variety of autoimmune and toxic-metabolic conditions. There is significant overlap regarding the usage of this term and encephalitis in the literature. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endocytosis: Cellular uptake of extracellular materials within membranelimited vacuoles or microvesicles. endosomes play a central role in endocytosis. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endosomes: Cytoplasmic vesicles formed when coated vesicles shed their clathrin coat. Endosomes internalize macromolecules bound by receptors on the cell surface. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH]
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Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exotoxins: Toxins produced, especially by bacterial or fungal cells, and released into the culture medium or environment. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Filariasis: Infections with nematodes of the superfamily filarioidea. The presence of living worms in the body is mainly asymptomatic but the death of adult worms leads to granulomatous inflammation and permanent fibrosis. Organisms of the genus Elaeophora infect wild elk and domestic sheep causing ischaemic necrosis of the brain, blindness, and dermatosis of the face. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of
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the genes. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hydroxyquinolines: The 8-hydroxy derivatives inhibit various enzymes and their halogenated derivatives, though neurotoxic, are used as topical anti-infective agents, among other uses. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU]
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Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunization: The induction of immunity. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intramuscular: Within the substance of a muscle. [EU] Intravenous: Within a vein or veins. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This
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genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Larva: Wormlike or grublike stage, following the egg in the life cycle of insects, worms, and other metamorphosing animals. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microgram:
A unit of mass (weight) of the metric system, being one-
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millionth of a gram (10-6 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Midwifery: The practice of assisting women in childbirth. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Mycotic: Pertaining to a mycosis; caused by fungi. [EU] Myiasis: The invasion of living tissues of man and other mammals by dipterous larvae. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Oliguria: Secretion of a diminished amount of urine in relation to the fluid intake. Called also hypouresis and oligouresis. [EU] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the
Glossary 205
form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteodystrophy: Defective bone formation. [EU] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pasteurella: The oldest recognized genus of the family pasteurellaceae. It consists of several species. Its organisms occur most frequently as coccobacillus or rod-shaped and are gram-negative, nonmotile, facultative anaerobes. Species of this genus are found in both animals and humans. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino
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acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Porins: Protein molecules situated in the outer membrane of gram-negative bacteria that, in dimeric or trimeric form, constitute a water-filled transmembrane channel allowing passage of ions and other small molecules. Porins are also found in bacterial cell walls, and in plant, fungal, mammalian and other vertebrate cell and mitochondrial membranes. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Pulmonary: Pertaining to the lungs. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Regulon: In eukaryotes, a genetic unit consisting of a noncontiguous group of genes under the control of a single regulator gene. In bacteria, regulons are global regulatory systems involved in the interplay of pleiotropic regulatory domains. These regulatory systems consist of several operons. [NIH]
Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU]
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Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood
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on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sporotrichosis: The commonest and least serious of the deep mycoses, characterized by nodular lesions of the cutaneous and subcutaneous tissues. It is caused by inhalation of contaminated dust or by infection of a wound. [NIH]
Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tachycardia: Excessive rapidity in the action of the heart; the term is usually applied to a heart rate above 100 per minute and may be qualified as atrial, junctional (nodal), or ventricular, and as paroxysmal. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence
Glossary 209
of a toxic microbe or of a poison. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Toxoids: Preparations of pathogenic organisms or their derivatives made nontoxic and intended for active immunologic prophylaxis. They include deactivated toxins. [NIH] Toxoplasmosis: An acute or chronic, widespread disease of animals and humans caused by the obligate intracellular protozoon Toxoplasma gondii, transmitted by oocysts containing the pathogen in the feces of cats (the definitive host), usually by contaminated soil, direct exposure to infected feces, tissue cysts in infected meat, or tachyzoites (proliferating forms) in blood. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Translating: Conversion from one language to another language. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Trichinosis: A disease due to infection with trichinella spiralis. It is caused by eating undercooked meat, usually pork. [NIH] Trichuriasis: Infection with nematodes of the genus trichuris, formerly called Trichocephalus. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU]
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Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Yaws: A systemic non-venereal infection of the tropics caused by Treponema pallidum subspecies pertenue. [NIH] Yellow Fever Vaccine: Vaccine used to prevent yellow fever. It consists of a live attenuated 17D strain of the yellow fever virus. [NIH] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
212 Cholera
INDEX A Abdominal................................40, 99, 200 Acidosis .................................................79 Adenosine........................48, 62, 148, 195 Adjuvant.............39, 47, 50, 143, 145, 164 Alimentary................................88, 96, 205 Amebiasis ............................................111 Analogous..............................................80 Antibacterial...........................88, 141, 208 Antibiotic ........17, 78, 84, 85, 88, 155, 208 Antibody.............................42, 54, 63, 196 Antiemetic..............................................91 Antigen .....43, 45, 48, 49, 54, 62, 64, 163, 195, 199 Antimicrobial ..................17, 111, 134, 198 Asymptomatic ..........15, 99, 120, 195, 200 B Bacteremia ......23, 63, 155, 196, 203, 207 Bacteriophages......................................45 Biosynthesis ..........................................79 Blastomycosis........................................97 C Campylobacter ....................................111 Carbohydrate.......54, 65, 82, 87, 160, 201 Cardiac ................................................110 Chemotaxis............................................46 Chlorine .................................................12 Cholesterol ....................66, 158, 160, 203 Chromosomal ............................38, 44, 81 Chronic ...84, 99, 101, 120, 176, 195, 196, 209 Clostridium.............................................78 Colitis .....................................................78 Conjugated ............................................80 Contamination .....11, 14, 16, 67, 163, 207 Cryptococcosis ......................................97 Cytoplasm..............................................41 Cytotoxic ................................................50 D Degenerative .......................................159 Dehydration ...........11, 22, 76, 83, 86, 197 Deprivation ............................................96 Diphenoxylate........................................91 Diving...................................110, 120, 198 Dysentery ..................36, 91, 94, 120, 195 E Echinococcosis......................................97 Electrolyte..........73, 80, 97, 100, 144, 206 Encephalitis .........................................110 Endemic...............22, 40, 42, 86, 104, 197 Endocytosis .............................41, 64, 199
Endogenous.......................................... 38 Endosomes ........................................... 39 Enteritis ................................................. 84 Enterotoxins ................ 41, 64, 80, 97, 199 Enzyme ....... 64, 67, 68, 86, 199, 206, 208 Epidemic .... 11, 12, 14, 16, 17, 45, 53, 56, 60, 61, 62, 77, 93, 94, 104, 142, 150 Epithelium ............................................. 80 Epitopes ................................................ 47 Exotoxins .............................................. 38 Extraction .............................................. 49 F Feces ........................ 11, 36, 96, 101, 209 Fibrosis ............................. 38, 97, 99, 200 Filariasis................................................ 97 Fleas ..................................................... 97 Fluorescence .......................... 80, 87, 200 Folklore ................................................. 60 G Gastroenteritis .......... 23, 67, 96, 106, 207 Gastrointestinal .... 24, 38, 51, 65, 79, 200, 210 Giardiasis .............................................. 91 Glucose................... 65, 66, 146, 201, 202 Glycoproteins .......................... 75, 87, 201 Granuloma ............................................ 97 H Helicobacter ........................................ 111 Hepatitis ................................ 90, 110, 111 Herpes .................................... 39, 65, 201 Hormonal .............................................. 84 Humoral ................................................ 47 Hydroxyquinolines ................................ 91 Hygienic ................................................ 76 Hypotension ........................................ 163 I Immunity .... 12, 24, 40, 42, 47, 50, 52, 55, 65, 73, 78, 82, 96, 202, 209 Immunization . 23, 47, 49, 65, 68, 78, 110, 202, 208 Immunotherapy..................................... 51 Induction ................................. 51, 65, 202 Ingestion ................... 23, 47, 86, 161, 205 Insulin........................ 52, 65, 66, 201, 202 Intoxication............................................ 81 Intramuscular .......................... 49, 88, 205 Iodine .................................................... 12 Isotonic.................................................. 79 J Jejunum ................................ 66, 145, 202
Index 213
L Labile ...38, 41, 73, 74, 75, 81, 85, 86, 122 Larva......................................................97 Lethal .....................................................73 Lipoprotein.....................................66, 203 Lymphoma.............................88, 163, 203 M Malaise ..................................................40 Malignant .....................66, 83, 84, 88, 203 Mammary...............................................84 Mannitol ...............................................145 Melanoma..............................66, 148, 203 Membrane ..38, 39, 41, 55, 64, 67, 73, 81, 83, 87, 88, 100, 142, 148, 163, 199, 202, 204, 205, 206 Microbiology ..................41, 155, 163, 203 Microorganism ...................22, 76, 86, 195 Molecular ....24, 38, 41, 44, 48, 50, 51, 67, 81, 108, 113, 114, 206, 209 Motility ...................................................44 Mucus ....................................22, 190, 198 Mutagenesis ....................................82, 86 Myiasis...................................................97 N Nausea ..............22, 98, 99, 196, 198, 200 Neomycin...............................................91 Neural ..............................41, 65, 159, 201 O Oliguria ..........................................66, 203 Operon...................................................73 Osmolality....................................100, 205 Osmolarity .....................................66, 203 Osmotic .......................................100, 205 Overdose .............................................159 P Panic......................................................59 Parasitic ...........................22, 97, 111, 198 Parenteral ........................................76, 82 Phosphorylation.............................44, 142 Plasmids ................................................83 Poisoning.........................23, 99, 200, 207 Polypeptide......................................56, 61 Porins ....................................................53 Potassium............................................160 Prophylaxis ......................68, 82, 111, 209 Protease ..........................................55, 62 Proteins ..... 38, 39, 41, 44, 46, 48, 61, 63, 68, 74, 77, 80, 81, 86, 144, 145, 158, 160, 196 Pulmonary .............................22, 110, 197 R Receptor ................38, 45, 55, 63, 82, 196
Recombinant................. 38, 76, 80, 82, 86 Regulon................................................. 46 Rehydration......... 13, 17, 36, 61, 142, 146 Retrograde .......................................... 144 Riboflavin ............................................ 158 Ribose..................................... 48, 62, 195 Rotavirus............................................... 36 S Saline .................................................... 79 Salmonella ............................................ 36 Sanitation .................................. 11, 14, 17 Secretion.... 38, 55, 60, 61, 68, 79, 80, 86, 97, 142, 145, 150, 187, 204, 207 Seizures ...................................... 187, 207 Selenium ............................................. 160 Serum ....................... 43, 68, 87, 202, 207 Solvent .................................. 49, 100, 205 Species .... 22, 24, 63, 64, 65, 67, 68, 83, 84, 85, 88, 99, 134, 196, 197, 198, 200, 201, 205, 208, 210 Spectrum............................... 74, 120, 210 Sporotrichosis ....................................... 97 Stomach.................................. 65, 99, 200 Substrate............................................... 41 Syphilis................................................ 104 Systemic ......................... 50, 97, 101, 210 T Tachycardia .................................. 63, 196 Testis .................................................. 149 Tetracycline................................. 134, 198 Thermoregulation................................ 158 Thyroxine ............................................ 160 Toxicity...................................... 39, 41, 82 Toxoids ................................................. 47 Toxoplasmosis...................................... 97 Trichinosis............................................. 97 Trichuriasis............................................ 97 V Vaccination ............. 12, 42, 43, 49, 50, 82 Vaccine .... 12, 19, 24, 39, 40, 41, 43, 44, 47, 50, 51, 52, 62, 72, 74, 76, 77, 82, 86, 104, 145, 195, 209 Vasoactive ............................................ 61 Vesicular ......................................... 39, 41 Vestibular ............................................ 148 Vibrio............................................. 72, 111 Viruses ..... 23, 24, 39, 68, 74, 88, 97, 155, 203, 204, 209, 210 Y Yaws ..................................................... 96 Yersinia ............................................... 111
214 Cholera
Index 215
216 Cholera
