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C. Gembak, M.A., M.D., M.P.H.

Vice Chair, University of Virginia School of Medicine

It occurs in two clinically and epidemiologically distinct forras; the classical severe form-variola major with an overall mortality of 15-30%, and tim milder form-variola minor or alastrim, w! Variola major is endemic in South East Asia and Africa, while variola rninor is predominant irt Brazil but occurs also in Africa and Indonesia. Cowpox is an infection of cattle, endemic i:,Lseveral countries of Europe and apparently is less common in tD: Americas; in man it is an occupational disease among those han, lling infected cows. In the t:ourse o[routine vaccination serious complications occasionally occur with extensive involvement of the skin,: uch as eczema vaccinatL m, generalized vaccinia and progressive vaccinia (vaccinia necrosum). Infection in man occurs in those handling infected animals and carcasses and usually takes the form of one or more lesions on the hands, forearm or face. Historical Note I Smallpox is believed to have been resent in Asia before the Christian era. Only in the present century has the disease ceased to be endemic in mosl countries of Europe and North America. Although a milder type of sm tllpox was recorded in England in the 18th century (11), it was only in the present L 284 century that variola minor was recognized as a clinically distinct disease. Cowpox was first clearly described by Jenner in 1798 (21) although it appears to have been an occupational hazard of milkers for many years before. Variola-Smallpox is usually spread by d:irect contact with a clinical case although it may occur indirectly h, handling of clothing, bedclothes or utendls soiled by the infe :tious discharges of patients. The incubation period is most commonly 12 or 13 days but occasionally it may be as short as 8 or as long as 17 days. The clinical illness begins with fever, headache, pains in the limbs and prostration. During this preertdptive-phase, lasting 2 to 4 days, transient erythematous or pete(hial rash over the groins, axillae and flanks is seen in about 10% of cases. The focal eruption appears usually on the 3rd or 4th lay and soon afterwards the temperature drops and the patient feels much better. The focal rash usually appears first on the oral and pharyngeal mucosa, on the face or forearms and hands and then spreads to the trunk and legs. In all except, the mildest cases the temperature usually rises again as the lesions become pustular. In the fully developed pustular eruption-about the 8th to 10th day of illness-the distribution is usually characteristic, the face: an:t extremities being more extensively invoh,ed than the trunk, tlke back more than the front of the trunk and the chest more than the abdomen. Flexures such as the gq:oins, axillae, the fronl of the elbow and popliteal skin tend to be spared. Although tile eruption on the face and arms may be a day in advance of th: se on the legs, the eruption on any part of the body is homol ieneous in that all elements are at the same stage of development. In patients who are to recover, the lesion,; begin to dry up about tLae lOth to 12th day of illness and after 3 weeks most of the scabs have been shed, with the exception of the deep brown seeds in the palms of the hands and soles of the feet. In the most severe cases, the fulminant or hemorrhagic, petechile appear in the skin on the 2nd or 8rd day; there may be bleeding into the conjunctiva, from the mouth, nose, bladder, rectum or vagina and the patient may die in 4 or 5 days before the focal erupti m can develop. Usually a leukopenia develops early in the disease followed by leukocytosis when the eruption becomes pustular. Except in the ac te fulminant cases most deaths occur towards the end of the 2m[week of illness. Patients are most infectious from:about the 3rd to the l(:th day of illness and infection is spread at this time chiefly from the leavily infected secretions from the mouth and upper respiratory tract. However, virus is present in the crusts and the patient cai not be regarded as free from infection until all crusts have separated. The commonest complications are abscesses in the skin or subcmaneous tissues, and variolous infection of bones. Encephalitis is a rare complication; since the introduction of antibiotics secondary bacterial bronchopneumonia, once coramon in severe cases, is now rarely seen. Variola minor or alastrim show ; a clinical picture similar to that of variola major with discrete eruptions. The incubation period is of the same duration, there is the same preeruptive illn.

Food consumption and nutrient intakes with a special focus on milk product consumption in early pubertal girls in Central Finland. The European respiratory journal: official journal of the European Society for Clinical Respiratory Physiology Vol 8; 1995: 1506-13. Carbohydrate malabsorption in infants with diarrhea: diagnostic and evolutive aspects. Lactose intolerance, detected by the hydrogen breath test, in infants and children with chronic diarrhoea. Intestinal nitrogen and electrolyte movements following fermented milk ingestion in man. Effect of pancreatic insufficiency and intestinal lactase deficiency on the gastric emptying of starch and lactose. Effect of animal and vegetable protein intake on oxalate excretion in idiopathic calcium stone disease. Comparison of the analgesic efficacy of flurbiprofen and aspirin for postsurgical dental pain. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons Vol 43; 1985: 106-9. Lactose digestion by yogurt beta-galactosidase: influence of pH and microbial cell integrity. Strains and species of lactic acid bacteria in fermented milks (yogurts): effect on in vivo lactose digestion. Comparative effects of an elemental and a complex enteral feeding formulation on the absorption of phenytoin suspension. Serum IgA anti-gliadin antibodies (monomeric versus dimeric) in childhood coeliac disease. Single nucleotide polymorphism C/T(13910), located upstream of the lactase gene, associated with adult-type hypolactasia: validation for clinical practice. Actions and interactions with alcohol of drugs on psychomotor skills: comparison of diazepam and gamma-hydroxybutyric acid. Comparison of a rice-based, mixed diet versus a lactose-free, soy-protein isolate formula for young children with acute diarrhea. Evaluation of the intraepithelial lymphocyte count in the jejunum in childhood enteropathies. Plasma insulin response to oral carbohydrate in patients with glucose and lactose malabsorption. The role of urinary indican as a predictor of bacterial colonization in the human jejunum. Postnatal development of disaccharidase activities in jejunal fluid of preterm neonates. Sub-optimal taurine status may promote platelet hyperaggregability in vegetarians. Comparison of three regimens in the management of acute gastroenteritis in infants. Randomized controlled study of digestive enzyme activity following trophic feeding. Origins and implications of the distribution of adult lactase deficiency in human populations. Lactose intolerance: a newly recognized cause of gastrointestinal symptoms seen in the practice of occupational medicine. Modification of sweet acidophilus milk to improve utilization by lactose-intolerant persons. Contribution of dairy products to dietary potassium intake in the United States population. Effect of ibuprofen on platelet function in normal subjects and hemophiliac patients. Controlled-release dosage forms and gastrointestinal blood loss: Four clinical studies. Abstinence from smoking and expired-air carbon monoxide levels: lactose intolerance as a possible source of error.

Selective reabsorption:Selective reabsorption is the process by which the composition and volume of the glomerular filtrate is altered during its passage through the convoluted tubules, Loop of Henle and the collecting tubule. The purpose of this process is to reabsorb those constituents of the filtrate which are essential to the body, maintain the fluid and electrolyte balance and the alkalinity of blood. Smooth muscles helps contraction & relaxation of blood vessels & controls blood flow & movement of the food in the alimentaryCardiac muscles help in the functioning ofd)Give the composition & function of gastric juice. B12 from smallMucus prevents mechanical injury to the stomache) Name hormones of adrenal cortex & mention their functions. The male reproductive system consists of the following organs:Testis 2Epididymis2Spermatic cords2Seminal vesicles2Ejaculatory ducts2Prostate gland1Urethra & Penis1Q3. Solve any four of the following: 12Give differences between striated and smooth muscles. The fibres (cell) are cylindrical and hasmany nucleiThe cells are spindle shapedwith only one central nucleus4. The fibrous tissue enclosingthe whole muscle extends beyond the fibres to become the tendon which attaches the muscle to the bone or skin. Present in tongue, arms or hands, legs,etcPresent in oesophagus, stomach,intestine, etcb) Define: (1 mark each)Gout: Inflammation of joints due to deposition of sodium urate crystals in the joints. Transfusion of any group into these individuals is safe since there are no antibodies to react with them. At the same time four pulmonary veins transport oxygenated blood into the left atrium. It acts as the barrier against the invasion of the microbes, chemicals &dehydration. To ensure constant body temp, a balance between heat production & heat loss is maintained by the skin. Solve any four of the following: 12Define and give normal values: (1 mark for each)Tidal volume: It is the volume of air moved in & out of lungs during normal breathing. Normal value is 500 14Inspiratory reserve volume: It is the amount of air that can be breathed in and above the tidal volume by the deepest possible inspiration. When the endplate potential increases, it stimulates the entire muscle fibre causing an action potential to travel in both directions along the fibre. When the action potential spread to inside of muscle fibre then Ca ions are released. Immediately after action potential is over, the previously released Ca ions recombine with reticulum and the muscle contraction stops. It is continuous with the oesophagus at cardiac sphincter and with duodenum at pyloric sphincter. There are three layers of smooth muscle fibres outer longitudinal, the middle circular layer & the inner oblique fibres. Exocrine gland: the glands that discharge their secretions through the duct are known as exocrine glands. Endocrine glands: Pituitary gland, thyroid gland, parathyroid glands, pancreas (islets of Langerhans). The cycle consists of menstrual phase for 4 days, proliferative phase for 10 days & secretary phase for 14 days. Oestrogen stimulates the proliferation of the endometrium in preparation of the fertilized ovum. The endometrium becomes thicker by rapid cell multiplication and this is accompanied by an increase in the number of mucus-secreting glands and blood capillaries. This phase lasts for 10 days and stops when ovulation occurs and oestrogen production is inhibited i. The blood from right atrium enters the right ventricle through a tricuspid valve, which prevent back flow of blood from ventricle into atrium. The deoxygenated/ impure blood from right ventricle is forced into pulmonary artery through pulmonary valve. The pulmonary arteries divide into two branches each enters the right and left lungs.

The shift of the sex ratio in favor of sons was observed in the offspring of subdominant Water vole males (Evsikov et al. Contrary, females mated to dominant males produced more sons in zebra finches (Poephila guttata) (Burley, 1986) and yellow-headed blackbirds (Xanthocephalus xanthocephalus) (Patterson, Emlen, 1980). In domestic chickens (Gallus gallus domesticus) no effect was observed (Leonard, Weatherhead, 1996). The contradictory results received by different authors, on the same object at different schemes of experiment, may be accounted for by their ignoring the role of population mechanisms (for example, it is possible to ignore the social range of individuals in Drosophila). In natural conditions disturbances of tertiary sex ratio from optimum always makes one sex "deficient" and the other-"abundant" with opposite changes of their states. Deviations from tertiary sex ratio optimum firstly reflect animals with low reproductive range. Such disturbances always lead to the increase of deficit sex birth-rate independently of organismic or population mechanism occurs and where it acts-inside male or female organism (Table 14. Artificial situations are also possible, when the state of both sexes is exposed to similar changes. The result of sex ratio regulation depends on which of the parent organism has a negative feedback mechanism. Analysis of natural secondary sex ratio deviations may show the type of negative feedback mechanism: organismic or populational. If m- is a group of individuals with minimal, m0 -with average and m+ -with the maximal value of an attribute for each distribution, then sexual dimorphism of parental pairs from identical classes: m- x m-, m0 x m0 and m+ x m+ will be close to an optimum. The maximal deviation will be obtained for the opposite combinations of parents: m- x m and m x m-. One of these reciprocal combinations has maximal sexual dimorphism, another-minimal one. Abscissa: value of an attribute X, Ordinate: probability of individuals with the given value of an attribute X. M E C H A N I S M S O F R E G U L A T I O N For the realization of the predicted feedback controlling the value of sexual dimorphism, it is necessary, that the posterity of parents with optimum sexual dimorphism had also optimum sexual dimorphism. Posterity of the parents with maximal sexual dimorphism (min max), should have minimal sexual dimorphism (max, min), and vise versa (Figure 14. For this purpose sons should inherit quantitative attributes more from mothers, and daughters-from fathers. The well-known genetic mechanism of sex-linking (X-coupling) can provide such connection. Hence, we come to a conclusion that X-chromosomes have greater regulatory modification role in determination of reaction norm and quantitative attributes compare to autosomes. Higher correlations "mother-son" and "father-daughter" on quantitative attributes in comparison with "mother- daughter" and "father-son" were repeatedly described (Beilharz, 1961,1963; Brumby, 1960; Morley, Smith, 1954). Some of them were already discussed in the book, in such case the reference is given to that chapter. Three main parameters of the dioecious population-sex ratio, dispersion and sexual dimorphism-should decrease in stable environment and increase when conditions change and in any natural or social cataclysms (earthquakes, war, starvation, migrations) (Chapter 8). In males the share of "genetic component" must be larger, and the "environmental" one-smaller than in females. If we compare variance between pair of identical (monozygotic) twins and variance between different pairs of twins, then intra-pair variance should be greater in female twins, while between pairs it should be higher for male twins (Chapter 7). Phenotypic variance in the pure lines should be relatively larger in females and in the polymorphic (wild) populations, larger in males (Chapter 7). Along with the sexual dimorphism, in the phylogeny there must exist also a "sexual dichronism", expressed in an earlier appearance of characters in males. In paleontology, it will manifest itself in the deeper layers of bedding, in which characters appear in males (Chapter 9). Large vertebrates whose evolution was accompanied by increased sizes as a rule should have males larger than females (Chapter 10).