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Human Disease – Autumn Term
Epidemiology – deals with causes, distribution and control of disease
Monitor does it, how does it and where does it change, control and prevent disease, treat individuals
but study whole pop
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and provides basis for health provision
Data Collection Issues – no data collection in certain areas – some countries due to primitive social
infrastructure, Data collection house based - no homeless people collected from, Pateint/public may
lie to census, some areas difficult to access – no post, some participants cannot read/write - need
help – time and money
Mortality measurements – Crude Mortality – no of deaths per 1000 per year, measurements – no of
people in pop died, total no of people in pop, time period that deaths occurred in
Specific Mortality – uses graph – difficult to compare several
Standardised Mortality – standardised mortality ratio (SMR) can compare pop of interest with larger
pop if both pops have same death rate, separate fem and mal, get no of deaths in interest pop
Obsereved deaths/expected deaths x 100 = SMR
Incidence – may increase due to better disease detection, Is it inc or dec? may be linked to certain
groups, between pops
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Historic Perspective – disease recognised by humans for millennia, Egypt/bible – disease =
punishment, middle ages – aware of diff diseases (mostly infection – leprosy, plague, syphilis, also
had cancer, rheumatism, gall stones)
19th Century – 1800’s disease recognised as pathology (body not working properly), knew infection
caused by microbes, understood transmission, control and treatment measures known, thought
diseases were gone…
Main causes of 1800’s deaths – Typhus, Typhoid, Diptheria, Scarlet Fever, TB, influenza, small pox
Diseases flourished – migration from rural to city for work, overcrowded city – dirty, refuse, sewage
contaiminated water, easy disease transmission in poor pops
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High infant Mortality e
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1850s 1-7, 1980s 1 in 77 – due to common childhood diseases – measles,
mumps, scarlet fever, whooping cough
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Association between disease and causative agent – Anthrax 1868, TB 1882
2
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Anaesthesia – Ether – 1846 – William Morton USA (tooth removal), Chloroform – 1847 –
James Simpson Scot (childbirth), Nitrous Oxide – 1880 – Humprey Davey England (teeth)
Anesthesia = more successful surgery – patient not thrashing about in pain
4
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Education  Better work  Reduced Poverty (educated people understand healthcare messages
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Drop in vaccines = rise in incidence
Antibiotics – Salversan -1909 – syphilis =  Arsenic, Penicillin 1929 – Syph + other but not TB ,
Sulphadrugs – Pre WW2 – good for injuries but not TB, Streptomycin – 1940s – TB!, tetracycline –
broad spec, Resistance to drugs understood 1930 (1 year after peni) – multi drugs needed to treat
resistant microbes  multi drug therapy
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Communicable Disease – hunter gatherers – 600K years ago – small groups 20-25, low pop density,
nomadic – environment couldn’t be reservoir of infection – may stay in soil but groups moved on
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Agriculture – 10k years ago, static pop – sow, water, wait, harvest, repeat, food supply for larger pop
and food source more reliable
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– cereals + dairy – but limited crops deficicency
diseases, disrupting ecology – chop trees – prevents microbes and envornment living in harmony,
close animal contact, other humans – more disease – parasitic worms, swine/bird flu/mad cow/TB,
microbes now adapt to human disease due to more humans and living closer to animals that can
develop disease
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Transmission of Disease – Low pathogenicity – low infectiousness – host survives – no need to infect
new quickly
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Common cold –
sneeze – inhaled virus droplets, TB – cough – inhaled bacteria droplets, Salmonellosis – diarrhoea
and vomiting into environment, syphilis – infected sore - contact
Indirect or direct transmission, common source or host to host, vertical or horizontal
Direct or indirect transmission – Direct – host to host, good for microbe, remains inside environment
for long time, minimal outside time – require high population density, low risk
Indirect – leave human host arthropods (mosquito), verts (cow TB), fromites (door cold), food and
water – risky may not be vector there, permits wider spread – more potential hosts
Cases per day – common source – spikes, host to host – fluctuates but fairly level
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Incidence – disease incidence increases with social infrastructure collapse, incidence higher in
poorer pops
1/3 of global deaths due to infection  most preventable but cost, delivery, compliance
Preventing Transmission
1
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Control/change human behaviour – sexual practices – give them condoms – may not use,
personal hygiene – cook food, washing hands after/before looking after kids/elderly, food
handling – visit factory and change practices
3
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Control alternative host – cull badgers/cattle with TB, vaccinate – chickens for salmonella,
easy to control domestic – poor access to wild animals
5
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Prevention - vaccination - effective for individual and pop if Herd immunity achieved – enough
vaccinated so disease has nowhere to go
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Antivirus – antiviral agents – viruses are intercellular and replication occurs before symptoms appear
– harder to kill
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Antibiotics should kill microbes, be
selective to microbes (not toxic to humans), be broad spec, target wide microbe range, be cheap and
available
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Route of admission, oral  + cheap, intravenous – unconscious/quick, suppository 
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If in contact vaccinated, there contacts vaccinated,
WHO declared smallpox eradicated 1980
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Microbe types – bacteria (shigella), fungi – moulds (aflatoxin) yeasts (candida albicans), algae – not
directly implicated in diseases, protozoans, viruses – rotavirus
Microbes – naming use fill name underlined
Characteristics – very small (bac -2microm), multiply quickly (MGT-mean generation time-20mins),
loads of them everywhere 109per g of soil, ubiquitous – everywhere- humans evolved to live with
microbes, everywhere plants+animals are + live in extreme conditions, adaptable – at pop level not
individual microbe level 15mutant
5 Kingdoms – animal (none), plants (none), fungi (yeasts+moulds), protoctists (protozoa+algae) – all
eukaryotes
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Viruses – have no kingdom
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Metabolism drives C,N, O cycle, most microbes – good for microbes/planet, few (100) associated
with disease
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1665 – Robert hooke
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1836-agostino Bassi – started off pest control – silk worm infection
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1876-Robert Koch – Kochs postulates
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1953 – Watson and Crick – discovery of DNA double helix
1970’s – recombinant DNA
Kochs Postulates – Microbe must be present in every disease case, microbe must be isolated from
diseased host and grown in pure culture, disease must be reproduced when pure microbe culture
inoculated into healthy host, microbe must be recoverable from experimentally infected host, links
microbe to disease – exception Leprosy cannot be grown in lab
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Structure –cell wall – protects from cell lysis, determines cell shape, involved in movement + cell
division, allows division into 2 groups – Gram +,-
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Gram + - thick layer of murein, Gram - - thin layer of murein
Gram Staining Procedure
1
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Add Gram stain 1 (carbolgentian violet) purple, wash away excess
3
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Decolourise with 95% alcohol for 30 secs – may/may not remove purple
5
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Characteristics of bacterial infection – caused by diff bacteria, reservoir of infection (where bacteria
grow when not in humans), infective dose to overwhelm varies (ecoli – 100 cells, bacillus-100M)
Onset of symptoms time varies –hoursweeks, symptoms + treatments vary, at risk groups vary,
several variations (flu more common in winter)
Classification – KPCOFGS, G + S in name – many ways of classifying – grouped by major body system
Pyogenic Infections – exception – pus forming – Strep pyogenes – tonsilitus, sore throat, rheumatic
heart disease
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Strep
pneumoniae/klebsiella pnuemoniae/ legionella pneumoniae – Pneymonia
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Campylobacter jejuni – commonest in UK
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Vibrio cholera – 50% mortality – need prompt rehydration or death
Urinary Tract infections – caused by variety of microbes
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Descending – urethra – bladder – kidneys at risk – suggest circulation infection
Nervous system infections – strep pneumonia, Neisseria mengitides – meningitis causing bacteria
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Haemophilus influenza – vaccinated against – rare to cause it
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Bloodbrain – highly protected junction
Sexually Transmitted Infections – reduced impact when antibiotics available
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Clostridium botulinum –
anaerobicgangrene
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Pseudomonas aeruginosa –
opportunistic, burns
Virus – poisoning substance, acellular – no cell – do not post characteristics of other microbes,
agents of disease, do not multiply in virtro - on normal culture media (can only be grown in vivo – in
embryonated eggs or tissue culture), are obligate, intracellular parasites (must be in a living cell),
dormant in environment (may remain viable but cant multiply), rely on host for replication
(plant,animal, microbe)

History – 1920’s – discovered bacteria can be filtered, something infectious remained – the virus
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1942 – 1st e micrograph of virus (x500k magnification)
Structure – core of nucleic Acid – DNA or RNA, protein coat – capsid – composed of capsomeres
(subunits), may have an outer layer of protein/lipid ‘envelope’
Classification – can be classified by Nucleic acid (DNAorRNA), chromosome structure
(linear/circular), capsid architecture – helical/spherical/complex, presence/absence of envelope
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Viruses can use plant, animal and microbial cells to replicate
Viral Diseases – classify by infection route, 400 diff viruses known to be pathogenic to humans,
treatment – supportive or prophylactic – not euk or prok – cannot target particular cell part
Airbourne Infections – may become systemic
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Dormancy may lead to
adult shingles
Measles - <5, pneumonia, diarrhoea, blindness – death rate 1 in 1000, increases if unvaccinated, in
poor health
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Common cold
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0x107 deaths in 1914-1918
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Food and water borne – viral gastro-enteritis – rotavirus – small round virus, peaks in colder months
(unlike bacteria) major cause of death <1 year, dangerous for children especially under weight/under
nourished
Polio – normally water, from swimming in water - Picrornavirus – small RNA virus, multiplies in GI
tract/throat – 1% become blood bourneparalytic polio
Oncogenic infections – cancer generating infections – Pampilloma – warts, verrucae, cervical cancer
Burkitts Lymphoma – caused by Epstein Barr Virus – causes infectious mononucleosis – kissing
dieases (not cancer generating) but Epstein + co carcinogen (malaria) cancer of lymph nodes and
jaw
Slow virus diseases - caused by prions – protinaceous infectious particles
Kuru – transmissible spongiform encephalopathy (cannibalism link – eat bit of dead to make dead
immortal)
Scrapie (sheep) – bovine spongiform encephalopathy (BSE) crueutzfeldt – Jacob disease –
neurodegenerative disease in cows, sheep, humans
Algae – diverse group – microscopic cellsmetres long kelp, rarely pathogenic to humans
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Need moisture – very
susceptible to dessication, eukaryotes, classified into 4 groups by cell structure
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Parasitic – sporozoa – Malaria – 108 infected, 107 new infections 106 deaths per year AFRICA,
plasmodium species (1880 discovery) transmitted by anopheles mosquito
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Candida albicans (thrush) reduced
immunity/microbial flora
Mycotoxicoses – primary via infected plant material, 2nday via infected food chain, fungal toxin
produced – fungi grows on food, produces toxins – hepatoxic – bad for liver
Host parasite relationship – microbes need host, humans have evolved protective mechanisms,
microbes evolved avoiding mechanisms
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Autocrine – works on cell that produced it, Paracrine – works on nearby cell to producer
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Target cells – target cell sends biological response, this tells producer cell that no
more hormone needed
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Increased estrogen associated with improved verbal memory, recent events memory, fine motor
skills
Oxytosin and milk letdown reflex – suckling stimulates oxytosin, milk released from mammary
glands, cues associated with baby (suckling, cries, smells, sights, thoughts of baby), milk let down
Stress – the recognition by the body of a stressor and a state of threatened homeostasis, adaptive
responses – bodys attempt to counteract stressor and re-establish homeostasis
Physiology of the stress response
Stress  activates HPA – Hypothalamic – pituitary – adrenal axis
epinephrine released from adrenal medulla, norepinephrine released from sympathetic nervous
system
hypothalamus releases corticotropin-releasing hormone (CRH)
stimulates release of Adrenocortic Hormone (ACTH), prolactin, Beta endorphins from anterior
pituitary gland, and vasopressin from posterior pituitary
ACTH stimulates cortisol release from adrenal cortex + more epinephrine from adrenal medulla
growth hormone + testosterone levels drop
Homeostasis – ideal physical + phychological state – allostasis – equilibrium
Stressors – physical – disease, temp, hunger
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Antidepressants directly decrease HPA axis activity
Neurobiology – glial cells – outnumber neurons x 10, function support the neurons – hold in place +
insulate, 5 types – overlapping functions
Astrocyte – physical + nutritional support for neurones – digests dead neuron, regulates extracellular
fluid
Microglia – digests dead neurons
Oligodendroglia – neuron insulation (myelin)

Satellate cell – physical support for neurones in PNS
Schwann cell – neuron insulation (myelin)
Information pathways – pathways made of neurons, dendrites + soma receive chemical info from
neighbour neuronal axons, chemical infoelectrical currents – travel down and converge on soma
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Opiate receptor activation decreases GABA release – GABA inhibits dopamine release leading to an
increase in dopamine release
Cannabis – THC – activates reward system, triggers cerebellum, hippocampus, nuceloses
Neurons  behaviour – nerve cells differ most at molecular level, modify specific
connectionsbehaviour adaptation, neural activity can produce long term changes by plasticity
hypothesis
Neuroplasticity – ability of CNS to change + adapt in response to environmental cues, experience,
behaviour, injury or disease
Neurogenesis – process by which neurons are created, mostly occurs in prenatal development, adult
neurogenesis – thought not to occur BUT Gould et al and Eriksson et al 1999 – occurs in mammals+
humans, thought to begin with neural stem cells (NSC’s) – they are multipotent + self renewing
Cardiovascular system – heart double pump-heart – arteries – arterioles – capillaries – venules – vein
Double pump – deoxygenated blood pumped to lungs via pulmonary arteries
Pulmonary circulation eliminates CO2 + oxygenates blood via lungs
Oxygenated blood returns to heart via pulmonary veins
Oxygenated blood pumped to all body tissues via aorta – systemic circulation delivers O to all body
cells and carries away waste

Deoxygenated blood returns to heart via vena cavae
Heart Structure – thick heart muscle – continuous with blood vessels, needed to pump hard
Endocardium (in contact with blood), myocardium (middle), epicardium (outer layer)
Chambers – 2 atria, 2 ventricles
Blood flow – vena cava RA RVlungsLALVaorta
Vena cava – biggest vessel carrying body blood to heart, Aorta – 1st vessel blood goes to leaving
heart – one of biggest vessels
Heart Blood Supply – coronary artery + vein system
Right and Left coronary arteries branch off aorta – branch into smaller vessels
Cardiac veins deliver blood to coronary sinus then return to right atrium
Heart disease – no 1 killer, coronary heart disease – major form, 12M USA die, Heart attack – 1
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4% of USA deaths in 2000
Signs and Symptoms – silent ischemia – may feel no effects, chest pain – coronary arteries cannot
supply enough blood to heart, shortness of breath, extreme fatigue with excertion, swelling in feet
and ankles, heart attack – artery to heart muscle blocked, part of heart dies
Atherosclerosis – can occur in most body arteries – crucial effect in heart, coronary arteries blocked
– cardiac muscle begins to fail, blood circulation decreases, including the hearts circulation
Coronary heart disease causes – high blood cholesterol, high blood pressure, smoking, obesity, lack
of physical activity
Risk factors – controllable – smoking, diabetes, high blood cholesterol/pressure, overweight/obesity,
physical inactivity
Non controllable – age, family history of early heart disease, previous heart attack/other heart
disease signs
Screening and Diagnosis – electrocardiogram – measures electrical impulsesgraphic outline of
heart movement, stress test – measures blood supply to heart, coronary ongiography – shows
specific sites of narrowing in coronaries, blood tests – evaluate kidney + thyroid function/check
cholesterol level/presence of anemia, chest xray – shows heart size/checks for fluid around heart
and lungs, ejection fraction (EE) – determines how well heart pumps with each beat
Treatment – medication, lifestyle changes, angioplasty (rotational burr, balloon, stent), surgery –
healthy blood vessel taken from leg/arm/chest, used to create new route for blood in heart
bypassing section of diseased artery
Prevention – regular checkups, control b
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p  decrease in brain blood flow  brain dysfunction, coma, death
Also too little insulin – increase in plasma ketones  increase in plasma [H+] acidosis
comadeath
IDDM – cure – pancreas transplant – islet cell transplants – 90% require insulin after 5 years,
exenatide may delay insulin need
Partial pancreas transplant – preferred when receiving relatives kidney, prevents kidney damage

Full pancreas transplant – limited by immunosuppressive medication, 50% rejected, indicated for
Type 1 DM requiring kidney transplant
NIDDM – progressive relentless deterioration of pancreatic beta cell function, insulin resistance +
declining insulin secretion, increases requirements for powerful medication to combat
hyperglycemia, most patients require insulin eventually
Monitoring glucose – blood glucose levels easily measured,
diabetes – controllable by adjusting therapy according to changes in glucose levels
Problems – excersise alters glucose levels (they vary), food intake varies, illness + stress use glucose,
alcohol causes hypoglycaemia
HbA1c – produced from non covalent haemoglobin modification, half life of 60 days in body,
measure – indicator of long term glucose levels (controlled by treatment)
Problems – daily variation not show, hyper and hypoglycaemia missed
Exenatide – GLP-1 analogue (FDA approved 2005), promotes glucose –dependant insulin secretion,
indications – therapy of type 2 when 1st line oral therapy fails, 2ndary benefit – weight loss
Amylin – stored in beta cells, co secreted with insulin, decreases gastric emptying, suppresses
glucagon secretion/glucose production, promotes saiety, decreases appetite, decreased levels in all
diabetics – some type 1 – no response to meals due to low Amylin
Too much Amylin  cell death
Insulin – increases glucose uptake in cells, convert glucose to glycogen (glycogenesis), promotes
lipogenesis, blood glucose level drops, increase AA uptake + protein synth, slows gluconeogenesis
and glycogenolysis, hypoglycaemia inhibits insulin release
Glucagon – acts on hepatocytes, converts glycogen to glucose (glycogenesis), forms glucose from
lactic acids + AA’s (gluconeogenesis), glucose released from liver to make blood glucose increase to
normal, hyperglycaemia inhibits glucagon release
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, prevents cell sapping nutrients from organism/spread of viral
infection
Necrosis -breaking down of cell, organelles spilled 
Tumour – uncontrolled growth of abnormal cellsabnormal cell keeps dividingabnormal cells
eventually to join to form tumouras tumour becomes larger, impedes function of nearby
organsunless growth stopped + tumour removedhealthy organs destroyed
Causes of uncontrolled growth – stimulation genes becomes hyperactive (dominant) altered gene =
oncogene
Inhibitory genes become inactive (recessive) – lost gene = tumor suppressor gene
Tumour development – Hyperplasia – proliferation of cells within organ/tissue – may cause benign
tumour
Dysplasia – abnormality in maturation of cells within a tissue – indicative of early neoplastic process
– pre cancerous
Neoplasia – genetically abnormal cells proliferate in a non physiological manner, may result in
formation of malignant tumour
Tumour – abnormal mass of tissue/cells (parenchyma) with supporting conncective tissue
framework and blood vessels (stroma)
Cancer – abnormal growth of cells, tend to proliferate uncontrollably sometimes metastasise

Tumour – 2 categories – benign – not cancer – remain localised to tissue they arise from, curable by
surgery – slow growth from centre (can be dangerous if restricts blood flow, impair digestion, cause
brain paralysis
Malignant tumours – are cancer – grow by expansion + infiltration – can detach + extend through
adjacent tissues – cells carry in lymph/blood to other organs, rapid or slow growth
Cancer – not one disease, group of 100 diff diseases, can be called malignancy, malignant tumour,
neoplasm
4 Stages – InitiationPromotionProgressionMetastasis
Initiation - molecular changes that start path to malignant tumour growth
Promotion – events that contribute to tumour growth - proliferation of tumour cells and their
growth into a microscopic tumour in situ
Progession – further growth + spreading into further tissues
Metastasis – spreading of tumour to other sites
Carcinogen – agent known to influence 1 or more stages of tumour growth in humans – e
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chemical, physical, viral
Co-carcinogen – chemical that promotes effect of carcinogen, not carcinogen alone, may be anti and
co-carcinogenic depending on carcinogens present e
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beta catotene
Benign – slow growing, self contained tumour, not seriously harmful
Malignant – usually fast growing, often fatal tumour, invades surrounding tissue, sheds cells which
circulate body and create new tumours
Classification of Tumours – describe type of tissue in which cancer cell develop to begin with e
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Adenocarcinoma – originates in glandular tissue
Determines appropriate treatment + prognosis – made according to origin site, histology – cell
analysis (grading), extent of disease (staging)
Grading – examining tumour cells from a biopsy under a microscope – cell abnormality determines
cancer grading - 1-4
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True congenital tumours (at birth) extremely rare – hormone balance may effect predisposition to
develop certain cancers e
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breast
Extrinsic – lifestyle + infectious agents , Lifestyle – smoking, obesity/diet, U
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Infectious agents – non infectious – toxins/chemicals/physical (U
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High fibre/low fat/plenty of fruit + veg – lowers cancer risk, 5
fruit/veg portions recommended
Physical activity – reduces risk, inactivity = increased colon + breast cancer risk

Suns U
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9M diagnosis, 6
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6M people surviving 10 years after diagnosis (worldwide)
Risk factors - Personal habits – smoking 19th century – lung cancer almost unknown
Lifestyle – sun exposureskin cancer, Diet – high salt, smoked food, high alcohol – many cancers
e
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oesophagus, occupation – dye industry bladder cancer, Geography – colon cancer – high in
western Europe, N USA, New Z, rare in Africa, Japan
Prevention – WCRF – world cancer research fund, AICR – American Institute for cancer research
Review evidence, explore extent of cancer risk – food, nutrition, physical activity, body comp,
Provides public health goals, personal recommendations
1997 and 2007 Published
Recommendations – be as lean as pos in norm body weight range, by physically active as part of
everyday life, limit consumption of energy dense foods + avoid sugary drink, eat lots of food of plant
origin – make up most of diet, limit red meat intake, avoid processed foods, limit alcohol, limit salt
consumption, avoid mouldy grain/cereals, aim to meet nutritional requirements through diet only,
breast feed children
Identification – used to be histopathology based, developments allow identification of proteins from
bodily fluids to diagnose, identification currently done by DNA profiling
Diagnosis – can be done non invasively – imaging – imaging techniques – X-ray – EM radiation,
photographs inside of body, X rays absorbed by light blood, cancer/abnormalities = shadow
CT scan – uses Xrays, 3D image of body, locates tumour + nearby organs, surgey/radiotheraphy then
decided
MRI scan – Magnetic resonance imaging, magnetic field not xrays, view slices of body/3D organ
images, can show brain/blood flow
PET scan – Positron emission tomography, tracer injected – releases subatomic particles – positrons
– positrons collision with body atoms releases energy
Ultrasound – use sound waves – tiny speaker emits – bounce off internal organs –sound + pc
image

Tissue samples – Biopsy, endoscopy – endoscope – long thin, flexible tube with light + camera – can
be used to take abnormal tissue samples – take cell/biopsy by surgical/endoscope means – sample
taken for diagnostic tests
Molecular diagnosis – identifies specific molecules e
...
PSA – prostate specific antigen – check for
prostate cancer, used with other techniques – imaging + samples
Screening – widespread use of tests to detect cancer in pop, inexpensive and non invasive, if
detected more follow up tests used to confirm diagnosis
Screening for cancer – earlier diagnosis  extended life
Tests – colon – colonscopy + faeces test, cervical – pap smear – identification of pre cancerous
legions, Breast – self examination, regular mammograms, testicular – self examination
Treatment – surgery – oldest treatment form, important rule in diagnosis and staging, more limited,
less invasive, procedures done to remove but preserve as much normal function as possible,
greatest chance of a cure – especially if not metastised,
several types – prophylactic (preventative), biopsy (diagnostic), endoscopy (staging), curative,
cytoreductive (debulking), palliative
Radiotherapy – energy carried by wave/particles that can change DNA used to kill cancer cells, works
best of actively/quickly dividing cells, Radiosensitivity – how vunerable a cell is to radiation damage,
attacks dividing cancer cells (can damage healthy tissue) uses xray/gamma rays to destroy/damage
cancer cells
External – machine directs rays from outside, internal – uses radioactive source/pellet/wire implant
near tumor
Side effects – early – during/just after treatment, late – months/years after- often permanent,
Common – fatigue, skin change, hair loss, appetite loss
Chemotherapy – medicenes/drugs to treat cancer, antineoplastic – anti cancer, cytotoxic – cell
killing, used as systemic treatment – chemo reaches all cells – gets metastised cells too
 - cures, controls – prevents further growth – extends and improve life quality, palliation – relieve
symptoms – improve quality of life
Side effects – can damage normal cells – especially fast dividers – bone marrow/blood cells, hair
follicle cells, cells lining repro and digest tract
Immunotherapy – causes certain parts of immune system to fight disease (including cancer),
stimulates own immune system to work harder/smarter, give immune system help – man made
immune system proteins – Monoclonal antibodies (passive immunotherapy) cancer vaccines, other
active immunotherapies (HPV) non specific immunotherapies,
Cancer vaccines – mostly experimental treatment, HPV targets cancer causing virus not cancer
Gene therapy – adding functional genes to cells with abnormal/missing genes e
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missing p53 –
tumour suppressor, stops oncogenes working – preventing growth + spread
Pharmacology – ancient historic displine  present use of herbs + plant extracts
Produces life saving drugs, genetic manipulation, molecular pharmacology, adult stem cell therapy,
limitless discovery potential
Study – botany, molecular chemistry (understand drugs), research, toxicology (understand impact on
human), legislation (government control as supplies public, protect public) patient education
(effects, why take, symptoms, prognosis)
Drugs – 3 medical uses – prevent, diagnose, treat – symptoms/signs/conditions/diseases
Preventative – prevent occurance of disease/conditions e
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vaccinations, contraception
Diagnostic – by themselves or in conjuction with procedures/tests e
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radiopaque contrast dye,
cardiac stress tst
Therapeutic – used to control, improve or cure symptoms, conditions or diseases e
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antibiotics,
insulin
History of drugs – ancient times – Egypt – treated diseases with frog bile, sour milk, pigs teeth, lizard
blood, sugar cakes, dirt, spider webs, mouldy bread (penicillin)

Recorded 800 diff herbal formulations + perscriptions and extracted plant oils
China – practised healing arts – use of herbs/minerals, herbal preparations, acupuncture, massage,
exercise, animal products, Chinese book of herbal medicine
Native americans – Aztec – grow herbs with medicinal properties
Greeks + romans – futhered medicine study – 1st steps
Ancient drugs – drying, crushing and combining plants, animal substances, minerals
Prescription – Rx – combining ingredients to form
Drugs – guesswork but some medical lore + superstition, some therapeutic, others worthless or
harmful (eating soap for bloody pee, mercury for intestinal worms) also herbs/powdered
gold/addictive opium
Major Pharmaceutical discoveries
1803 – morphine from crude opium
1827 –1st commercial morphine production - Merck + company
1843 – syringe + injectable morphine – Dr Alexander Wood
1899 – Aspirin
1908 – Sulfanilamide – 1st anti-infective
1912 – Phenobarbital – 1st anti-epileptic
1913 – Vitamins A + B discovered
1922 – Insulin introduced – 1st diabetes mellitus
1938 – Dilantin – Epilepsy
1941 – Penicillin – 1st antibiotic
1945 – Benadryl – 1st antihistamine
1948 – Cortisone – 1st corticosteroid – for chronic problems (steroid hormone – needs careful
management)
1952 – Thorazine – Psychosis – 1st antipsychotic – not profitable – don’t admit sick – taboo, don’t
know sick
1952 – Hydrocotisone – 1st topical corticosteroid (surface (skin))
1957 – Librium – neurosis – 1st anti anxiety
1958 – Haldol – Psychosis
1966 – clotting factors – Hemophilia
1967 – Inderal – hypertension – 1st beta blocker – lowers blood vessel tension to lower b
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Immunology – study of mechanisms that protect body from attack by foreign (non self) invading
organisms/macromolecules e
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viruses, bacteria, associated molecules (all antigens Ag)
Immune system also attacks self molecules/cells/tissues – autoimmunity (self), tumour
immunity(killing of aberrant cells in system), transplant tissue
Immune system – protects with layered defences with increasing security – most basic/primary
defence – barrier tissues - stop organism entry into bodies – Skin, Mucosa (thick sticky secretion –
lines all body cavities exposed to external environment e
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Nasal passage), normal gastrointestinal
flora – prevents colonisation of pathogenic bacteria – secrete toxic substances/compete for
nutrients/attachment sites
If barriers breached – Cellular and Humoral systems activated
Immune response – Innate or Acquired (both have cellular and humoral responses)
Innate – 1st defence, fast, non specific, no memory, “paramedics”

Acquired – 2nd defence, specific, memory – wants to know invader, “doctors”
Innate – cellular – phagocytes, granulocytes (PMN), Humoral -complement
Acquired – cellular – lympocyrtes, T+B cells, natural killer cells, Humoral – Antibodies (IgG, IgA, IgM,
IgD, IgE)
Antigen – any substance body regards as foreighn, against which immune system mounts response,
usually proteins or polysaccharides from micro organisms- can be whole structures/parts of bacteria
or viruses – coats, capsules, flagella, toxins
Non microbial – pollen, egg white, cells/proteins from transplant
Epitopes or Ag determinants - Specific Ag structures recognised as non self by immune system
Innate Immunity – non specific – recognise general structures on pathogens Phagocytosis
(engulfing)  disposal (digestion via enzymes)/sequestration of pathogens  signal to other cells to
destroy pathogen (acts as antigen presenting cell) OR activate + release potent factors  cause
inflammation, attack foreign mciro-organisms/allergens
Immediate - ready to respond to invasion/tissue damage release of preformed/newly synthed
inflammatory mediators interferon (IFN can block replication of viruses in cells), Lysozymes (can
break down bacterial cell wall)  activation of complement system  cause further inflammation,
trigger damage + lysis of microbes/infected cells
Inflammation – causes vascular permeability, allows antibodies + cells to enter tissues, too much
destroys body, chronic inflammation
Innate- Cellular – Phagocytes – engulf whole particles/pathogens, phagocytose = engulfing cells –
monocytes, macrophages, dendritic cells, neutrophils
Granulocytes – cells – spontaneously release potent chemicals on Ag contact e
...
O radicals, kill
pathogens , cause inflammation – eosinophils, basophils, mast cells
Humoral – complement system – series of 20 serum enzymes + molecules – when activated increase
phagocytosis, inflammation and lysis
...
g
...
g alcohol abuse – can be universal –campaign – poster,
indicated – liver damage patient
Different levels of Preventative Medicene – Primary – aims at complete disease avoidance –
immunisation, fluoridation – prevents tooth decay, meals on wheels – prevents malnourishment
Measure aimed at entire at risk group, directly linked to improved health
Secondary – aims at disease detection + cure, before symptoms arise/early disease stages – breast
cancer screening/regular dental check ups/blood pressure measurement
Problems – expensive, inconvienient, anexiety, patient discomfort, patient may not be suffering
from condition – undue stress/worry, use opportunistic screening instead
Oppurtunistic screening – >90% visit G
...
p, urine (glucose +
protein), weight, lifestyle (diet, smoking, alcohol)
So >90% screened for vascular disease –bp, renal disease – protein in urine, diabetes – glucose in
urine
Tertiary – aims at minimising consequences for patients with disease – effective treatment, illness
consequences – depression (if painful/chronic illness), health of carer, ongoing support/checks to
monitor illness + provide supplies – clean needles + colostomy bag

Problems of preventative medicine – problematic – patient not ill
 -early diagnosis, confirmation of no disease
...
5X higher in very poor than well off families, mortality from
accident 5x higher in poor than rich social class, traffic + domestic accidents more common in poor
Overcrowding, cross contamination, stress, poor nutrition
Childhood deaths – more likely in 1st month of 1st year, linked to maternal health, birth weight,
relates to marriage – more likely in single, relates to immigration – more likely in immigrants
Antenatal care + screening good opportunity for preventative – monitor maternal health – b
...
Drug abuse, drug overdose, suicide
Difficult to preach preventative medicine – think invincible, not intrested in future health benefits –
middle age/elder, challenge authority – not receptive to advice – health/teacher/parent, strong peer
pressure, limited illness experience - may have been nice – looked after
Prevention targets – good diet, no smoking, no drug abuse, no alcohol abuse, no unwanted
pregnancy - all don’ts 
Prevention in Adult Life – (25-65), people more staid – more serious, less adventurous
Accident risk declines, death most likely circulatory/malignant – disability caused by rheumatoid
arthritis, Ischaemic Heart disease, respiratory disease, stroke, accidents, anexiety, depression,
alcohol abuse
Risk factors – cigarette smoking, obesity (-9 years), inactivity, stress, alcohol, exposure to risk (under
individuals control)
Access to group difficult- via – work – occupational healthy schemes, GP – individual must make
more, Media – newspapers, TV
Easier to explain preventative medicine to educated people
Screen for – dental decay, high b
...
P + physcians – many women prefer to see female
Prevention in later life – 65+ - aging natural process, risk of disease + death increases with age, time
to enjoy benefits of preventative health or impact of smoking + inactivity
Adult life expectancy improved – improved health due to improved nutrition, sanitation and
housing, preventative medicine
...

Aged - >1 disease, chronic, difficult to diagnose, interactions
(diabetes, cardiovascular, deafness) - disease may be present for a long time, aging body has been
exposed to environmental factors – sun, alcohol, stress
Health Care – elderly need more care, hospital beds, prescriptions, 1 in 6 have difficulty with
activities of daily life (ADL), 1 in3 have a severe disability, ½ of all hospital beds occupied by elderly
Falls – Not an illness, potential problem, ½ of elderly persons suffer at least 1 fall per year, many are
not serious, some injury, complications, death – costs 1Bill £
Dementia – 7% >65’s dementia, 20% >80’s have dementia, gradual decline of interlectual function,
failure of brain to function normally, affects – memory, language, spatial awareness, judgement,
problem solving, also – mood, personality, behaviour
Alzheimers – 70% - multi infarct dementia, 20% others, 10% alcohol, uraemia, B12 deficiency
Aims of preventative medicine for elderly - preventing loss of functional ability – ADL’s, preventing
loss of quality of life, retaining independence
Problems – poverty, provision of health care needs, patient co-op, pop continues to increase –
important issue, medical, social, political, financial – estimated £25-£30,000 = 1 person in care
But – not all elderly have problems, some remain healthy + active and contribute, health linked
closely to wealth
Aim – improve health not extend lifespan
Preventative medicine – implemented throughout lifespan, mostly through normal GP/patient
meetings, increasing range of elderly detection tests (PSA,occult(hidden)blood), immunisation and
prophylactic drugs
+ statuatory changes – seat belts, food safety

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