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Passive surveillance data from health facilities are generally the most comprehensive source available for estimating country-level disease burden; however, the extent of underreporting in most leishmaniasis-endemic countries is known to be substantial, ranging from twoto 40-fold in targeted studies. These findings imply that different, largely undetermined correction factors should be applied for each setting. The results of a village-based study in India suggested that as many as 20% of visceral leishmaniasis patients, disproportionately poor and female, died before their disease was recognized. The leishmaniases are widely dispersed, with transmission to humans on five continents, but the human disease burden is concentrated mainly in a few major foci. It has been estimated that more than 90% of the burden of visceral leishmaniasis is concentrated in Bangladesh, Brazil, Ethiopia, India, Nepal and the Sudan. Cutaneous leishmaniasis is even more widely dispersed, with major foci of anthroponotic L. Up to 90% of cases of cutaneous leishmaniasis occur in Afghanistan, Algeria, the Islamic Republic of Iran, Saudi Arabia and the Syrian Arab Republic and in Bolivia, Brazil, Colombia, Nicaragua and Peru. The distribution of leishmaniasis is dynamic: Colombia, Nicaragua and Pakistan recently reported large increases in the incidence of cutaneous leishmaniasis, while Ethiopia and the Sudan have experienced epidemics of the visceral form in previously unaffected areas. Many endemic areas show large fluctuations in incidence over time, which are sometimes attributable to specific events, such as population displacement or climate factors. Climatic, socioeconomic and other environmental changes could expand the geographical range of the vectors and leishmaniasis transmission in the future (see section 2. Epidemiological features Serological testing of populations has revealed large numbers of cryptic and oligosymptomatic infections. All the available evidence indicates that the disease is transmitted from human to human by an anthropophilic and zoophilic sandfly, P. It is usually endemic (in India, in 2008, 33 233 cases were officially reported, of which 28 125 were in Bihar State, 3690 in Jharkhand and 1256 in West Bengal). When account is taken of underreporting, the actual number of cases is estimated to be five to eight times higher. In 2005, the ministers of health of Bangladesh, India and Nepal signed a memorandum of understanding to eliminate kala-azar by 2015, with a target annual incidence of less than 1/10 000 at district level. Minimal operations Passive case detection and complete treatment will reduce the public health problem, while effective case reporting is essential for monitoring progress. The mainstay in the diagnosis of kala-azar is serological testing based on the rapid dipstick rK39 antigen test to confirm clinically suspected cases (fever for more than 2 weeks and splenomegaly in the absence of malaria). Geographical distribution of visceral leishmaniasis in the Old and New world be performed in any setting by a trained health worker, there is no need for parasitological confirmatory tests in all cases. Suspected cases with negative serological results should be referred to facilities where appropriate laboratory diagnostic testing is available.

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Fortunately, Hong Kong, unlike Guangzhou and other provincial towns and cities in Guangdong, benefts from world-class medical facilities and teaching hospitals equipped with the latest diagnostic technologies. Rather, Hong Kong health ofcials, many of whom were trained overseas in American and European universities, seek to apply the same clinical and public health standards as they would anywhere else in the world. In short, when a new epidemic or pandemic virus emerges somewhere in China, it is in Hong Kong that the alarm is likely to sound frst. For the soft-spoken microbiologist with a passion for epidemiology and viruses that cross the species barrier, it is the perfect situation. In the winter, geese, teal and other wild migratory birds swoop past his window en route to the Mai Po Nature Reserve, a protected wetland on the edge of the Inner Deep Bay that is an important waystation for birds migrating south from Siberia to New Zealand during the northern winter. A viral disease spread by mosquitoes that breed in rice paddies, Japanese encephalitis had broken out in Anuradhapura, an historic city in northern Sri Lanka famous for its architectural ruins. This was puzzling; although the virus can be transmitted to humans, it usually cycles between birds, mosquitoes and pigs. Moreover, although outbreaks of Japanese encephalitis in humans had previously been documented in Japan and other parts of Asia, large human outbreaks had not occurred in Sri Lanka before. At frst, Peiris and his colleagues thought that the outbreak might be due to a sudden change in the virulence of the virus, but when they looked at the virus in the lab they could see it had not mutated. In so doing, Peiris discovered, the pigs not only provided mosquitoes with a ready blood meal, but greatly increased the chances of transmission of Japanese encephalitis to humans. With the best intentions, somebody puts this in and, boom, you have this huge explosion. His appointment coincided with the frst documented transmission of avian infuenza from birds to humans. An infuenza virus, known as H5N1, had been isolated from the throat washings of a three-year-old boy.

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Atrophy is one of the first signs of the fibers run diagonally to a tendon running through immobilization of a limb, showing as much as a 20% to the muscle. In penniform muscle, the anatomical cross 30% decrease in cross-sectional area after eight weeks section, situated at right angles to the direction of the of cast immobilization (52). Disuse or inactivity leads fibers, is less than the physiologic cross section, the sum to atrophy because of muscle remodeling, resulting in of all of the cross sections in the fiber. The level of atrophy appears to be muscle specific where Muscle volume and physiologic cross section are larger lower extremity muscles lose more cross section than in the penniform muscle. The greatest niform muscle is influenced by the pennation angle, change occurs in the initial weeks of disuse, and this where a smaller force is applied to the tendon at greater should be a focus of attention in rehabilitation and pennation angles. Intermediateand aging muscle, and the regrowth process varies between fast-twitch fiber types are better suited for higher force fast and slow muscles. Muscle contraction occurs as When a muscle is injured, the force-producing capathe action potential traveling along the axon reaches the bilities usually decrease. Compensation occurs where muscle fiber and stimulates a chemical transmission across other muscles change in function to make up for the the synapse. It is 94 Section i Foundations of Human Movement at the sarcomere level that cross-bridging occurs between or through specific functional training. Another important the actin and myosin filaments, resulting in shortening or exercise consideration should be the decision on the use of lengthening of the muscle fiber. A muscle attaches to the bone via an aponeurosis, or Muscle injury is common and occurs most frequently in tendon. Tendons can withstand high tensile forces and two-joint muscles and during eccentric muscle action. To respond stiffly to high rates of loading and less stiffly prevent muscle injury, proper training and conditioning at lower loading rates. The passive or elastic components are in the tendon and the cross-bridges and in the sarcolemma and the connec2. Their effectiveness at one joint depends on the positioning of the other joint, the moment arms 11. As a person sits from a standing position, what is the to be located in the. The knee is flexing as the knee flexor muscle group is respiratory and muscular fitness in healthy adults. None of these describe an eccentric contraction Acta Physiologica Scandinavica, 28:364-382. The order of maximum potential force output by conand storage of elastic energy in human muscles during exertraction type is. Impairment of neuromuscular propagation during human fatiguing contractions at submaximal forces.

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This enzyme is produced by leukaemia cells, and causes them to multiply uncontrollably. By blocking Bcr-Abl kinase, as well as other kinases, dasatinib helps to control the spread of leukaemia cells. Drug metabolism Process in which a drug is broken down by enzymes present in the body so it can be used by the body and expelled afterwards. Efficacy In medicine, the ability of an intervention, for example, a drug or surgery, to produce the desired beneficial effect. This includes keeping track of the health of people who participate in a clinical study* or clinical trial for a period of time, both during the study and after the study ends. Graft Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. Granulocyte A type of immune cell that has granules (small particles) with enzymes that are released during infections, allergic reactions, and asthma. Hemoglobin level Quantitative measure of the protein called hemoglobin contained in red blood cells, it is expressed in weight (grams) by volume of blood (deciliters). Histocompatibility antigens Proteins existing on the surface of nearly every cell in the body. They help our immune system to differenciate our own cells from foreign substances. Hydroxyurea An anticancer drug that belongs to the family of drugs called antimetabolites. These enzymes can be found in some receptors on the surface of cancer cells, including the receptors that are involved in stimulating the cells to divide uncontrollably. Interferon A protein made by lymphocytes and involved in the communication between immune cells. There are several types of interferons, including interferon-alpha, -beta, and gamma. Lymph node A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymphocyte infusion Type of therapy in which lymphocytes from the blood of a donor are given to a patient who has already received a stem cell transplant from the same donor. A lymphocyte is a type of white blood cell that is essential in the immune system. Metaphase the phase of cell division in which the already duplicated chromosomes align along the center of the cell. Afterwards the cell will divide into two cells with the same number of chromosomes each. A tumor formed by cells that have spread is called a metastatic tumor or a metastasis.