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About Cholera

1. Cholera is caused by a bacterium called Vibrio Cholerae. 2. It is an infection of the small intestine that causes a large amount of watery diarrhoea. 3. It occurs in places with poor sanitation, crowding, war, and famine. Common locations for cholera include: Africa Asia India Mexico South and Central America

Bacteria cells and Prokaryotic cells


1. The picture is showing the structure of a bacterial cell, and therefore prokaryotic cell: 2. The cell wall is made of peptidoglycan, this is a mixture of polysaccharides, and peptides 3. It has a flagellum or flagella, allowing it to swim through fluids 4. There is a cell surface inside the cell wall, and this contains the cytoplasm that contains 70s type Ribosomes, the smaller ones. 5. Genetic material is in the form of circular strands of DNA. And there are smaller pieces too called plasmids which can reproduce independently and can give the cell resistance to harmful chemicals such as antibodies.

How it causes disease


1. The majority of the Vibrio Cholerae bacteria will be killed by the stomach, but some may survive, particularly if the PH is above 4.5. The surviving bacteria reach the small intestine, and then they use their flagella to propel themselves in a corkscrew like fashion through the mucus lining of the wall of the intestine. 2. Then they produce toxins, and these are proteins. One part of the protein is complimentary to certain carbohydrate receptors on the cell surface membrane of the epithelial cells. This part of the process is what causes cholera to only affect the small intestine. 3. The bacterium binds to the epithelial cell. The toxic part (its called the A1 subunit) of the protein enters the epithelial cell and this causes the channel proteins to open up, allowing chloride ions through into the lumen of the small intestine.

4. This then increases the water potential of the epithelial cells and decreases the water potential of the lumen of the small intestine and so water moves by osmosis into the lumen down the concentration gradient. 5. Ions begin to move from the blood and other tissues into the epithelial cells due to the newly acquired concentration gradient, which causes the tissues water potential to increase. This moves even more water into the lumen of the small intestine, by osmosis. Thereby resulting in very watery diarrhoea and dehydration.

Oral Rehydration Therapy


1. A solution of several substances is given to the cholera infected patient, to rehydrate them. Their intestines are now not absorbing water, water is in fact being lost, so other substances are required to decrease the water potential surrounding the small intestine.

ORS as a treatment
1. The rehydration solution has to use alternative pathways to get the water out of the lumen of the small intestine, by reducing the water potential of the surrounding cells. 2. As ions are absorbed, the water potential decreases and so water enters by osmosis. 3. The solution contains: -Water, to rehydrate the tissues -Sodium, to replace sodium ions lost, and to make optimum use of the sodium-glucose carrier proteins -Glucose, to stimulate the absorption of sodium ions and to provide energy for any active transport needed. -Potassium, to replace any lost potassium ions from the process -Other electrolytes, to help prevent the ion imbalance that Cholera causes

Developing better ORSs


1. Starch was found to be better than just using glucose, because it is broken steadily down into glucose, and this glucose can be taken up when it is produced. This means that the water potential inside the cell can decrease. 2. Rice Starch is often chosen, because it is in great supply in many areas of the world, particularly those which are worst affected by Cholera. It also provides other nutrients, such as amino acids which help the uptake of sodium ions in the small intestine.

Ethical Issues involved with trialling ORSs on humans


1. The solution may have side-effects which can cause serious illness, unrelated to Cholera.

2. The solution is unknown to the patients and the possible dangers they face are unknown too, so they are blindly participating without understanding what is being tested on them. 3. If the patient becomes ill or if their condition worsens, there is an argument that they should be compensated for that. However, because the patients do it voluntarily in the first place, there is also an argument that they had a choice, and did not have to participate in the first place.

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