MDSC1001 Environment and Health
13 September to 29 October 2010
(7 weeks)
Contents Introduction ..................................................................................................................................... 2 General Objectives .......................................................................................................................... 3 Course Assessment ......................................................................................................................... 4 Course Development Committee & Resource Personnel ............................................................... 5 Learning Topics .............................................................................................................................. 6 Practical Sessions ............................................................................................................................ 8 Specific Objectives ......................................................................................................................... 9 Problem 1: Cellular Worlds .......................................................................................................... 15 Problem 2: Is Street Food Safe?.................................................................................................... 16 Problem 3: Poison Arrows ............................................................................................................ 17 Problem 4: Professor Too-Bright .................................................................................................. 18 Problem 5: Happy, Grumpy…… and DROOPY .......................................................................... 19 Problem 6: Their Legs Went Weak… .......................................................................................... 20 Problem 7: Animal Farm, H1N1, HIV and Pregnancy ................................................................. 21 Textbooks...................................................................................................................................... 22 Multimedia Resources .................................................................................................................. 23 Websites ........................................................................................................................................ 24 1
Introduction The eukaryotic cells that form multicellular animals and plants are complex, interdependent
entities which live in communities and exhibit varying degrees of specialisation. The elaboration
of multicellular organisms has selective advantages by affording an increase in size and the range
of specialisation for movement, sensory detection, homeostatic control, communication and
social organisation. These innovations enabled eukaryotic organisms to compete, propagate and
survive in more complex ways in diverse environments.
The first course, to which the students will be exposed, is intended to introduce pre-clinical
students to the Basic Health Sciences and to provide basic knowledge of the structure and
function of the prokaryotic and eukaryotic cells. First year students are required to obtain from
this course, fundamental knowledge of the protein, lipid, carbohydrate and nucleic acid
constituents of prokaryotic and eukaryotic cells and the structure-function relationships between
these macromolecules in health and disease. A basic knowledge is also required of the
microscopic anatomy of various cell types, tissues, and organs as well as embryology. An
important objective of this course is that students should appreciate the ways in which organisms
cope with changes in the external environment and preserve homeostasis, i.e. the constancy of
the internal environment. Students will also be introduced to the basics of Public Health and
Epidemiology.
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General Objectives The general objective of this course is to enable the student to achieve the following:
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To understand the basic structure and functions of eukaryotic cells, and to understand the
methods used in the study of these.
To know the differences that exist in the structures and functions of the cells that make up
different tissues (bones, cartilages, muscles, nerves etc.).
To be familiar with the processes involved in cell division and general embryology.
To understand the structures and types of proteins, lipids, carbohydrates, and nucleic
acids found in animal cells.
To understand the relationship between the structure and function of these compounds as
it relates to metabolism of eukaryotic cells.
To know how major components of the cell are synthesized and to have a basic
understanding of biochemical and molecular biological approaches to studying
macromolecules.
To understand homeostatic control in the body, the functions of the cell membrane and
mechanisms of membrane transport.
To understand the mechanisms by which membrane potentials are maintained and action
potentials generated in excitable cells and tissues.
To understand the autonomic nervous system (ANS) and the mechanism of excitationcontraction coupling in muscle.
To understand the determinants of health, the basic mechanisms of disease and the basics
of epidemiology.
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Course Assessment Continuous Course Assessment (25%)
PBL – 5%:
13 September – 29 October 2010
Anatomy Spotter 10%: 29 October 2010*
Biochemistry practical assessment 5%
Physiology practical assessment or Spotter 5%**:
*Time and venue to be confirmed; check notice boards
**The nature and timing of the Physiology component will be advised.
Final Course Examination (75%)
Phase 1 examination:
13 December 2010
0900 to 1130 hours***
***Venue to be confirmed by the University Examinations Section
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Course Development Committee & Resource Personnel Dr T A Alleyne – Convenor
Biochemistry, ext 4636
Dr G Kurhade – Assistant Convenor
Physiology, ext 4617
Dr C Carrington
Biochemistry, ext 4634
Dr F Youssef
Physiology, ext 4618
Dr A Odekunle
Anatomy, ext 4626
Dr R Naidu
Dentistry, ext 4141
Professor A Adogwa
Veterinary Anatomy, ext 4205
Dr A Kumaresan
Veterinary Physiology, ext 4313
Dr K Mungrue
Public Health & Primary Care, ext 2883
Mrs J Wilson
CMSE, ext 5229
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Learning Topics ANATOMY
General Histology and Embryology
1.
Structure of the eukaryotic cell. Structure and functions of organelles.
2.
Microscopy. Histological, Histochemical and Electron Microscopy techniques.
3.
Epithelium: type, distribution functions and modifications.
4.
Cell division: Mitosis and Meiosis.
5.
Gametogenesis.
6.
Muscular tissues: skeletal, cardiac and smooth muscles.
7.
Connective tissues: bones, cartilages, adipose tissues.
8.
Nervous tissue: structure of a neuron, types and distribution.
9.
Fertilisation: capacitation of spermatozoa, site of fertilisation and the processes
involved up to morula stage.
10.
Embryogenesis.
11.
Foetogenesis with particular emphasis on organogenesis.
12.
Congenital malformations and teratogenesis.
13.
Skin and its appendages.
BIOCHEMISTRY
1.
Course Orientation – details of course, practicals, contact details, exams, exemptions,
etc.
2.
Cellular Organelles and Proteins
3.
Molecules of functional significance: Lipids
4.
Molecules of functional significance: Carbohydrates
5.
Aminoacids (1)
6.
Aminoacids (2)
7.
Protein structure (1)
8.
Protein structure (2)
9.
Immunoglobulin structure and function
10.
Protein separation techniques (1)
11.
Protein separation techniques (2)
12.
Enzymes: Properties
13.
Enzymes: Kinetics
14.
Enzymes: Inhibition
15.
Structure and organisation of nucleic acids
16.
DNA replication and transcription
17.
Genetic code and translation
18.
Gene mutations
19.
Regulation of gene expression
20.
Chromosome theory of inheritance and the genetic basis of disease
21.
Molecular Biology: DNA electrophoresis and RFLP analysis Southern Blotting and
nucleic acid probes
22.
Molecular Biology: DNA sequencing and PCR
23.
Molecular Biology: Molecular cloning and recombinant DNA
24.
Introduction to Nutrition
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PHYSIOLOGY
1.
Introduction to Physiology – 1 hour
2.
Body Water and Body Fluid Compartments – 3 hours
3.
The Cell Membrane and Transport Systems – 2 hours
4.
Electrical Properties of Cells – Resting Membrane Potentials – 3 hours
5.
Tutorial – 2 hours
6.
Electrical Properties of Cells – Action Potentials – 2 hours
7.
Synaptic Transmission – 4 hours
8.
The Autonomic Nervous System – 3 hours
9.
Contraction of Skeletal muscle tissue – 2 hours
10.
Contraction of Cardiac muscle tissue – 1 hour
11.
Contraction of Smooth muscle tissue – 1 hour
12.
Biophysical Properties of muscle – 2 hours
13.
Review – 2 hours
PUBLIC HEALTH AND PRIMARY CARE
1.
Introduction to Community Health
2.
Concept of Health, Illness, Disease
3.
Natural History of Disease and Levels of Prevention
4.
Basic Epidemiology
5.
Measurement of Health and Disease
6.
Causation of Disease
7.
Natural History of Disease and Levels of Prevention
8.
Biological Determinants of Health
9.
Environmental Determinants of Health - the biological environment and disease
10.
Social Determinants of Health - population dynamics, cultural, socio-economic status,
poverty and psychosocial perspective
11.
Environmental Determinants of Health
12.
Lifestyle Determinants of Health - smoking, alcohol, exercise, nutrition
13.
Introduction to Ethics
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Practical Sessions Laboratory Practicals
ANATOMY
General Histology and Embryology
1.
Microscopy, histological, histochemical and electron microscopic technique
2.
Epithelium: type, distribution, functions and modifications
3.
Cell division: Mitosis and Meiosis
4.
Gametogenesis
5.
Muscular tissues: skeletal, cardiac and smooth muscles
6.
Connective tissues: bones, cartilages, adipose tissues
7.
Nervous tissue: structure of a neuron, types and distribution
8.
Skin and its appendages
BIOCHEMISTRY
1.
Introduction to laboratory techniques
2.
Reactions of aminoacids and proteins
SKILLS TRAINING SESSIONS
1.
Basic general history taking
2.
Basic life support
3.
Basic suturing techniques
VET SKILLS TRAINING SESSIONS
Check Vet School for Details
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Specific Objectives By the end of the block students should be able to:
ANATOMY
1. Discuss the different methods used in the study of cells and the preparation of tissue for
microscopy.
2. Describe the ultrastructure of an animal cell.
3. Discuss the morphology of different organelles and their functions.
4. Relate the morphology and relative abundance of various cellular organelles to the
functions of the cell.
5. Discuss the histology of muscle cells (skeletal, cardiac and smooth).
6. Discuss the structure of neurons, the different types and their distribution.
7. Describe the organization, microscopic anatomy and ultrastructure of skeletal muscle and
its regenerative properties.
8. Describe the functional histology of the neuromuscular junction.
9. Describe the different types of connective tissue.
10. Describe the microscopic anatomy of the various types of bones, joints, cartilages,
tendons and ligaments.
11. Discuss the microscopic structure of the epiphyseal plates, the periosteum, endosteum
and their involvement in growth and ossification of bones and bone healing.
12. Describe the microscopic structure and regenerative properties of the skin and skin
appendages and aging changes of the integumentary system.
13. Identify various histological elements of the integumentary system (skin & skin
appendages), different types of bones, joints and muscles under the microscope.
14. Explain “the rule of nines”, a quick method for estimating the percentage of surface area
of the skin.
15. Describe the processes involved in embryogenesis (from fertilisation to embryo
formation).
16. Describe fetogenesis.
17. Discuss the causes of congenital malformations.
18. Discuss the need for intracellular compartmentalisation and the basic principles of
intracellular metabolism.
BIOCHEMISTRY
1. Describe the structure and classification of lipids.
2. Describe the structure and classification of carbohydrate.
3. Describe the carbohydrates of major significance to man and other animals.
4. Discuss the structure and function of amino acids and proteins.
5. Explain what is meant by the terms primary, secondary, tertiary and quaternary structure
of a protein.
6. Explain why the primary structure of a protein is said to determine its three dimensional
structure and its function.
7. Explain why the substitution of a single amino acid alters the shape and biochemical
function of the haemoglobin molecule.
8. Discuss the basic structure of enzymes and explain how they catalyse reactions.
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9. Discuss the effects of temperature, pH, substrate concentration and enzyme concentration
on the rates of enzyme-catalysed reactions.
10. Discuss the characteristics of the different classes of enzyme inhibitors.
11. Describe the structure of nucleic acids (DNA and RNA).
12. Describe DNA replication.
13. Compare the structures of eukaryotic and prokaryotic genes.
14. Discuss the basis of the genetic code.
15. Distinguish between chromosomal and point mutations.
16. Describe the different types of point mutations and their possible effects on protein
structure and function.
17. Describe and compare gene expression (transcription, translation) in prokaryotes and
eukaryotes.
18. Discuss the regulation of gene expression.
19. Define the terms allele, dominant, recessive, genotype and phenotype.
20. Discuss the chromosome theory of inheritance, the effect of recombination and the
genetic basis of disease.
21. Describe molecular biology techniques used in diagnosis and characterisation of genetic
and infectious diseases (e.g. DNA electrophoresis, RFLP analysis, Southern blotting and
the use of nucleic acid probes, PCR, DNA sequencing, molecular cloning and genetic
engineering) and give examples of their application.
22. Define the terms nutrient and essential nutrient and understand the classification of macro
and micronutrients.
23. Discuss the role of nutrition in health.
PHYSIOLOGY
1. Explain what is meant by the study of physiology.
2. Understand the relationship between physiology and anatomy.
3. Define the term homeostasis.
4. Explain why homeostasis is vital for normal body function.
5. List the parameters under homeostatic control in the human body.
6. Explain the terms auto-regulation and extrinsic control as they apply to homeostatic
control.
7. Define and explain the terms negative and positive feedback as they apply to homeostatic
control and give examples of each.
8. Identify the divisions of the body fluid compartments.
9. State the percentage of the total body weight and body water found in each compartment.
10. Understand the principle used in the measurement of the fluid compartments.
11. List the materials used to measure fluid compartments.
12. List the major anions and cations (identifying the predominant ones) found in each
compartment.
13. Explain the forces governing movement of ions & fluid between the compartments.
14. Describe Starling’s Hypothesis of fluid exchange.
15. Define oedema.
16. Explain how changes in Starling’s forces cause oedema.
17. Describe the causes & consequences of overhydration & dehydration of the fluid
compartments.
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18. Describe the functions of the cell membrane in organisms.
19. List the components that make up the cell membrane.
20. Describe the structure of the cell membrane, including the ‘fluid mosaic model’.
21. Classify and explain the functions of the proteins, lipids and carbohydrates within the cell
membrane.
22. List the mechanisms by which molecules are transported across the cell membrane with
examples or each.
23. Define and explain the process of simple diffusion.
24. List and explain the factors that alter the rate of diffusion.
25. Use Fick’s Law to calculate the rate of diffusion of a substance.
26. Utilize graphs to describe how the rate of transport process changes with substrate
concentration.
27. Describe facilitated diffusion and explain its physiological basis.
28. Define and explain osmosis.
29. Define and explain active transport.
30. Distinguish between primary and secondary active transport.
31. Define and explain vesicular transport.
32. Define the term resting membrane potential (rmp) and understand its significance to
living cells.
33. State the value of the normal resting membrane potential in different cells.
34. Explain the terms ionic equilibria and electrochemical potential difference and how these
phenomena are produced.
35. Define the Nernst Equilibrium.
36. Apply the Nernst equation to simple equilibrium calculations.
37. Discuss the factors that contribute to the establishment of the resting membrane potential.
38. Utilize the Chord Conductance equation and the Goldman-Hodgkin-Katz equation to
calculate the rmp of cells.
39. Define the term action potential.
40. Compare and contrast action potentials and local potentials.
41. Identify the phases of an action potential and the ionic shifts responsible for their
generation.
42. Define the terms absolute refractory period and relative refractory period and explain the
physiological mechanisms responsible for their generation.
43. Compare and contrast the action potentials in different excitable cells, e.g. cardiac muscle
cell vs an axon.
44. Explain how action potentials are conducted along myelinated and unmylinated axons.
45. Discuss the factors that affect the speed of conduction of action potentials.
46. Explain the physiological mechanisms underlying the action of local anesthetics.
47. Understand and explain the term synaptic transmission.
48. Describe the anatomy of a chemical synapse with specific reference to the neuromuscular
junction.
49. Compare and contrast electrical and chemical synapses.
50. Describe the process of synaptic transmission.
51. Explain how neurotransmitters are released from chemical synapses.
52. Describe the different means by which neurotransmitters are removed from the synaptic
cleft.
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53. Describe the synthesis, packaging, release and removal from the synaptic cleft of
acetylcholine and noradrenaline.
54. Discuss the events responsible for the postsynaptic response.
55. Explain the term synaptic integration.
56. Describe temporal and spatial summation.
57. Explain with examples what is meant by presynaptic inhibition and autoreceptors.
58. List the different classes of neurotransmitters and know examples of each.
59. Define the autonomic nervous (ANS) and describe the general functions of the ANS.
60. Identify the divisions of the ANS and their functional anatomy.
61. Compare and contrast the parasympathetic nervous system and the somatic nervous
system.
62. Compare and contrast the parasympathetic and sympathetic divisions of the ANS.
63. Explain the term dual innervations and its physiological relevance.
64. Describe the effect of parasympathetic and sympathetic activities on different organ
systems.
65. Describe and classify the different receptors within the ANS.
66. Identify common pharmacological agents that can block either division of the ANS and
their effects.
67. Explain what is meant by the ‘fight or flight’ response.
68. Describe the role of the adrenal medulla in the ANS.
69. Compare and contrast noradrenaline and adrenaline.
70. Briefly describe the histological features of skeletal, cardiac and smooth muscle tissue
and relate their functioning to their morphology.
71. Describe the arrangement of skeletal muscle tissues from its largest unit (whole muscle)
to its smallest unit (myofilament).
72. Describe the structure of the actin and myosin myofilaments and their relationship to
other proteins important for muscle contraction.
73. Draw and label a sarcomere and identify the different bands or regions.
74. Identify common agonist and antagonists at the neuromuscular junction.
75. Describe the sequence of events responsible for excitation-contraction coupling from the
motor end plate to the development of tension in skeletal muscles.
76. Explain the physiological mechanisms responsible for rigor mortis.
77. Describe the basic dysfunction in myasthenia gravis as it relates to the neuromuscular
junction, including diagnostic and treatment options.
78. Identify where smooth muscle tissue is found in the body and explain the different types
of arrangement.
79. Describe the ultrastructure of smooth muscle tissue.
80. Explain the mechanism of excitation-contraction coupling in smooth muscle.
81. Explain how strength of contraction is regulated in smooth muscle tissue.
82. Explain the ‘latch’ mechanism of smooth muscle contraction and how smooth muscle
tissue is able to undergo sustained contractions with minimal use of energy.
83. Describe the process of excitation contraction coupling is cardiac muscle.
84. Explain why cardiac muscle does not undergo tetany.
85. Explain how strength of contraction can be regulated in cardiac muscle tissue.
86. Compare and contrast excitation-contraction coupling in skeletal, cardiac and smooth
muscles.
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PUBLIC HEALTH AND PRIMARY CARE
1. Discuss the historical development of the concepts of health and illness in relation to the
prevailing philosophies of human civilizations over the ages.
2. Discuss the development of the biomedical model and the holistic model of health and
illness (including differentiating between “disease” and “illness”).
3. Critique the definitions of health presented in the constitution of the WHO and in the
WHO’s Ottawa Charter of health promotion.
4. Differentiate between ethics and morality; distinguish between professional ethics and
professional etiquette; and identify virtues and moral qualities significant for all health
care professionals.
5. Discuss and describe how population variables determine health and influence health care
needs.
6. Discuss the impact of social factors such as socio-economic status, age, gender, mental
status and education on health status and health practices.
7. Discuss the role of culture in disease causation and in health maintenance.
8. Define psychological health and its relationship to social support (e.g. Erikson, Spiegel,
1989); and describe four characteristics of a Rogerian therapist in a helping relationship.
9. Explain how the Health Belief Model can be used to design programmes to alter the
lifestyles of patients and members of the community at large.
10. Discuss how lifestyles relate to health and disease.
11. Explain the “health fields” concept of what determines health and the interplay between
biologic determinants, environmental factors (biological, physical, and social), lifestyle
factors, and elements of the health care system.
12. Discuss age, gender, heredity and ethnicity as major biologic determinants of health.
13. Describe major environmental hazards including drinking water, sewage, marine water
supplies, air pollution, solid waste, hazardous wastes, food safety and noise pollution and
their potential impact on the health community, including global warming.
14. Discuss three (3) topics addressed in the Declaration of Barbados that arose from the
Global conference on Sustainable Development of Small Island Developing States.
15. Discuss the concept of natural history of disease and describe its stages (prepathogenesis, pathogenesis, post-pathogenesis) and correlate the pathogenesis of disease
and clinical course and outcome.
16. Outline the concept of primary, secondary and tertiary prevention and the relationship
between the sage of the natural history of a disease and the methods of prevention.
17. Describe three (3) sources of measurement variation and discuss their effect on clinical
observations.
18. Describe three (3) different methods of distinguishing “normal”, “abnormal” findings on
diagnostic tests.
19. Discuss the impact and role of epidemiology on healthcare including its uses:
differentiating descriptive from analytical and population-based from clinical
epidemiology, the link with determinants of health and public health.
20. Discuss, and compare and contrast, the different types of epidemiological studies
(descriptive studies, ecological, natural experiments, case control, cohort, cross-sectional,
trials).
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21. Differentiate surveillance from monitoring and compare and contrast active and passive
surveillance of disease.
22. Define basic statistical terms and concepts used in epidemiological research.
23. Discuss the quantitative measures of health conditions (using ratios, proportions, rates)
and demonstrate their use (including incidence and prevalence, standardized rates/ratios).
24. Describe the usefulness and the limitations of mortality and morbidity data for estimating
the health of a population, (including derivatives such as life expectancy at birth,
potential years life lost, and quality adjusted life years) and discuss their use.
25. Using the epidemiological triangle as a model of disease causation, define agent factors,
host factors and environment factors; and contrast the epidemiological triangle to the
concept of a “web of causation”.
26. Apply Hill’s criteria to establish the plausibility of putative cause-and-effect
relationships.
27. Describe how risk factors can be causative or contributory, modifiable or non-modifiable.
28. Given incidence rates of disease for two populations with different levels of exposure to
putative causative factor, calculate and interpret the relative risk of disease for the
exposure in question.
29. List the criteria that should be considered in evaluating a proposed screening program.
30. Evaluate the ability of a screening test to accurately detect the presence or absence of
disease.
31. Describe how population variables determine health and influence health care needs.
32. Discuss the impact of social factors such as socio-economic status, age, gender, mental
status and education on health status and health practices.
33. Discuss the role of culture in disease causation and in health maintenance.
34. Explain how the Health Belief Model can be used to design programmes to alter the
lifestyles of patients and members of the community at large.
35. Discuss how lifestyles relate to health and disease.
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Problem 1: Cellular Worlds In viewing a specimen of animal cells through a light microscope, two first-year veterinary
medicine students, Shrinath and Peters, were intrigued by the various compartments within the
cells. Shrinath was interested in what could have been seen with a more powerful microscope
and also wondered why biochemists needed to “mash up” cells in order to study their behaviour.
“Doesn’t that kill them…wouldn’t they learn more if they studied the whole cell while it was
alive?” he said.
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Problem 2: Is Street Food Safe? An article in the local newspaper recently reported unusually high numbers of cases of diarrhoea
over the last three months. An expert medical source in the newspaper report suggested that it
could be an outbreak of cholera, an intestinal infection caused by bacteria and spread through the
consumption of contaminated water and food. The article indicated that about 10-20% of those
infected would develop severe watery diarrhoea with vomiting. This “secretory diarrhoea” is a
result of cholera toxin binding to the epithelial lining of the small intestine and triggering a series
of events culminating in the massive efflux of electrolytes and water into the intestinal cavity
that can lead to severe dehydration and death. Citizens were being advised to seek medical
treatment promptly, boil their drinking water and be mindful when buying food from street
vendors. Public Health Authorities were undertaking investigations and moves were being made
to clamp down on vendors who did not display valid food badges.
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Problem 3: Poison Arrows In his lectures, the professor of Pharmacology Dr. K. L. Sharma explained, that in the old days
South American hunters dipped the tips of their arrows in the extracts of certain plants in order to
quickly immobilize prey. He explained that several of these poisonous extracts contained curare
as the active compound. One of the students, John, decided to inject curare into the limbs of the
frog. He observed that this prevented muscle contraction in response to nerve stimulation but the
muscle continued to respond when stimulated directly. He decided he would investigate the
effect of curare on the behaviour of nerves and neurons. Among other things he wanted to
understand how curare affected the extra cellular and intra cellular distribution of ions in the cell
and its effects on the Resting membrane potential and on action potentials.
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Problem 4: Professor Too­Bright In 1970 Professor Too-Bright announced that he had uncovered the rules of protein folding. He
suggested that by making use of some unusual amino acids, he could synthesize a range of
protein substitutes. Prof Too-Bright predicted that the primary structure of these synthetic
proteins could be as little as one tenth that of the corresponding natural proteins. He also felt that
in almost all cases, his synthetic proteins would achieve full biological activity without having to
rely on quaternary structure. He pondered for a while about the potential food value of these
unusual proteins to man and other domestic animals.
It is now some 40 years later and PTB’s initial objective of producing synthetic haemoglobin has
not been achieved but that is the least of his problems. Recently epidemiologists discovered that
many sickle cell subjects who, over the years, took part in secret trials conducted by Prof TooBright had eventually become very ill. Now as he sits in jail with time on his hands, he has
started to read molecular genetics and histology and finds that for the first time he really
understands point mutations. He also discovered that there were significant histological
differences between the red blood cell of humans and chickens and wondered if these differences
could be exploited in the fight against sickle cell anaemia. He decided that he would look
carefully at how the human red blood cell compared to that of the rat, his initial research animal.
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Problem 5: Happy, Grumpy…… and DROOPY A 21-year-old salesgirl complained of weakness in the shoulders and drooping eyelids. These
symptoms appeared in the evenings but disappeared after a night’s rest. On and off she also had
difficulty swallowing, particularly at dinner time.
Her GP suspected a problem with either her nerves or muscles and referred her to a neurologist.
The latter performed an edrophonium test and EMG (electromyogram) to confirm the diagnosis.
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Problem 6: Their Legs Went Weak… Mr. & Mrs. Singh could hardly digest the news. They had just returned from the doctor’s office.
He had told them that it was very likely that their son Shiva had an inherited disorder called
Muscular Dystrophy. He spent a lot of time explaining all the tests that would have to be done to
confirm the diagnosis and to determine whether it was Duchenne’s Muscular Dystrophy (DMD).
All poor Mr and Mrs Singh remembered was what he had said about Shiva being unlikely to live
past the age of 25.
“But how did he get it?” Mr. Singh asked his wife, “I can’t remember anyone in our family
having anything like that?”
After getting over the initial shock, Mrs. Singh decided to call her niece Nalini who was a
medical student. Nalini explained that DMD was a genetic disorder that only occurred in boys
and that people with DMD did not produce a protein that was necessary for proper muscle
function. She said that Duchenne’s was only one of several types of muscular dystrophies and
that each type differed in the muscles affected, the age of onset, and its rate of progress but she
was not sure what caused them.
Nalini explained (as simply as she could) the different tests that were likely to be done like a
muscle biopsy, histological tests, immunohistochemistry, EMG and DNA analyses. She knew
that there had been research directed at developing techniques for replacing the defective gene.
She had read about attempts to repair the defective gene in a canine model of DMD in golden
retrievers (GRMD) but wasn’t sure whether these “gene therapies” were being used on humans
yet.
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Problem 7: Animal Farm, H1N1, HIV and Pregnancy John, an 8 year old boy from Siparia, was unable to go to school because he had flu-like
symptoms. Over the past few days he had been playing with his cousins who were visiting from
their pig farm in Miami. His mother, Angela, was worried because of Public Health Bulletins of
H1N1 viral infection in Miami and at some schools in Trinidad. She did not know if her son had
contracted the H1N1 viral infection or if he was suffering from the common cold. Charmaine,
John’s aunt, who lived with them, had her own worries. Unmarried and aged 25 she had just
found out that she was pregnant. Only 3 weeks before, she had learned that she was HIV
positive. She was worried about her baby as well as how others would now react to her. On
discussions with a counsellor she was referred to the Medical Research Foundation. At the centre
it was explained that if she was able to start taking the modern antiretroviral drugs at the correct
time, her baby might not be affected by the virus. She was informed that as long as she stayed
relatively healthy, her placenta would help to protect the foetus against infections during the
pregnancy.
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Resource Material
Textbooks ANATOMY
Recommended:
1.
Michael H. Ross, Gordon I. Kaye, Wokciech Pawlina. Histology, A Text and Atlas
(With Cell and Molecular Biology). Lippincott Williams and Wilkins. 4th Edition.
2.
Edward Uche-Nwachi. Multiple Choice Questions and Answer in Anatomy and Cell
Biology. Mbeyi Publishers.
3.
Bruce M. Carlson. Human Embryology and Development Biology. Mosby Publishers.
Reference:
1.
Junqueira, Basic Histology, Lange Publishers.
2.
CompuHistology (CD-ROM). Isitor, G.
BIOCHEMISTRY
Recommended:
1.
Granner, Mayes, Murray, Rodwell, Harper's Biochemistry, Prentice Hall Inter. (latest
Ed.)
Reference:
1.
T M Devlin (The Latest Edition Available), Textbook of Biochemistry with Clinical
Correlations, John Wiley & Sons Inc.
2.
E Morrison, Biochemistry by Diagrams, Canoe Press.
3.
Conway, Montgomery & Spector, Biochemistry: A Case Oriented Approach, (5th
Ed.) St. Louis, (1990), C V Mosby.
4.
L Stryer, Biochemistry, (Int. Student Ed.) (1998), W H Freeman.
5.
Watson, Gilman, Witkowski and Zoller. Recombinant DNA (latest edition). Scientific
American Books.
PHYSIOLOGY
Recommended:
1.
Ganong W F. Review of Medical Physiology. Stamford (Conn): Appleton and Lange.
Reference:
1.
Berne R M and Levy M N. Physiology. St. Louis: Mosby.
2.
Guyton A C. Textbook of Medical Physiology. Philadelphia: W B Saunders.
3.
Elaine Marieb. Human Anatomy and Physiology. Benjamin Cummings.
PUBLIC HEALTH AND PRIMARY CARE
Recommended:
1.
Torrence, Mary E. Understanding Epidemiology. Mosby (1997 or later), Latest
Edition.
2.
Last John M. A Dictionary of Epidemiology. Oxford University Press, 2001, 4th
Edition.
3.
Last John M. Public Health and Human Ecology. McGraw-Hill Professional, 1998
2nd Edition.
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Multimedia Resources Available at the Library
VIDEO TAPES
• Alcoholism: A Treatable Disease (24 Mins)
• Anatomy & Physiology (25 Mins)
• CPR for Healthcare Professionals (17 Mins)
• Disease Management and Outcome (21 Mins)
• History Taking for Medical Student (13 Mins)
• Occupational Health
• Prevention is better than Cure (1hr 13 Mins)
AUDIO TAPES
• Doctor – Patient Relationship
• Taking a History
SLIDE SHOW
• Human Blood Morphology
SLIDE TAPES
• Basic Genetics (56 Mins)
• External Parasites Transmitted from Dog/Cat to Man
• Neurological System
• Normal human chromosomes in Mitosis
CD-ROMs
• ADAM Comprehensive Anatomy
• ADAM Interactive Physiology: Muscular System
• Basic Human Anatomy Nomenclature
• Interactive Atlas of Clinical Anatomy
• Interactive Skeleton
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Websites Biology I Animations Movies & Interactive Tutorial Links on DNA replication, gene
expression and translation
http://science.nhmccd.edu/biol/bio1int.htm
Eukaryotic vs. Prokaryotic Cells
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?db=Books&rid=cell.table.48
Autonomic Nervous System
http://www.ndrf.org/ans.html
Medical History Taking Study Guide
http://www.templejc.edu/dept/ems/documents/Presentations/1stSemesterParamedic/PtAssessmen
t/HistoryTaking.ppt
Patient History Taking Outline
http://www.drbackman.com/History_Taking.htm
Epidemiology (Public Health, Biosciences and Medicine)
http://www.epibiostat.ucsf.edu/epidem/epidem.html
International Agencies (Public Health Information Links)
http://www.sph.emory.edu/PHIL/intl.html
The Determinants of Health
http://www.who.dk/document/e81384.pdf
Erasmus MC
http://www.eur.nl/fgg/mgz/clusters/cluster6.html
Medical Gross Anatomy
http://anatomy.med.umich.edu
Biology
http://www.accessexcellence.org/AB/GG
Population Health
http://www.hc-sc.gc.ca/hppb/phdd/determinants
Molecular genetics, bioinformatics and their applications
http://www.ncbi.nlm.nih.gov/About/primer/
http://www.genome.gov/25019879/
http://intro.bio.umb.edu/aipotu/
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