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Studies on the epidemiology of Bordetella bronchiseptica infection in catsBinns, Sarah Helen January 1997 (has links)
No description available.
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The respiratory distress syndrome of the newborn : studies of blood gases and acid/base balance with the object of formulating principles of treatmentWarley, Mogamat Arashat 15 April 2020 (has links)
Respiratory failure accounts for a large, if not the largest, percentage of deaths during the first 48 hours of life. During the last ten years a great deal of research has been devoted to this early respiratory failure. The syndrome has been known by different names at different times; hyaline membrane disease (because pulmonary hyaline membrane is a frequent autopsy finding), congestive pulmonary failure, vernix membrane disease, pulmonary syndrome, and more recently the respiratory distress syndrome. A vast literature on the subject has accumulated. Many new and interesting facts have come to light and although many new theories have been put forth to explain the syndrome, the cause is still unknown.
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MYCOPLASMA AGASSIZII IN THE SONORAN POPULATION OF THE DESERT TORTOISE IN ARIZONAJones, Cristina Ann January 2008 (has links)
Upper Respiratory Tract Disease (URTD), caused by the pathogens Mycoplasma agassizii and M. testudineum, has been documented in the desert tortoise (Gopherus agassizii). Although URTD was identified as a putative agent that led to federal listing of the Mojave population of the desert tortoise, little is known about this disease in the Sonoran population of the desert tortoise. The purpose of this study was to determine: 1) the prevalence of URTD across an urban gradient in Greater Tucson, Arizona, 2) the relationship between URTD and captive and free-ranging tortoises in Mohave, Maricopa, and Pima counties in Arizona, and 3) the effects of URTD on desert tortoise home range size and winter temperature selection.
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Use of overground endoscopy for detection of upper airway abnormalities in Thoroughbred racehorses in South AfricaMirazo Michelena, Javier E. January 2013 (has links)
Upper airway endoscopy at rest has been the diagnostic method of choice for diagnosing equine upper respiratory tract (URT) disease since its development in the 1970´s. The development of high-speed treadmill endoscopy (HSTE) improved the sensitivity of URT endoscopy by allowing the examiner to observe the horse’s nasopharynx and larynx during exercise. However, the level of exertion achieved during HSTE may not always represent that achieved during normal exercise as surface, rider, tack, and environmental variables are altered. Recently, the development of dynamic overground endoscopy (DOE) has addressed some of those shortcomings.
A retrospective study was undertaken to describe the upper airway abnormalities detected during DOE in horses presenting with poor performance and/or abnormal respiratory noise in South Africa. Patient records of Thoroughbred racehorses undergoing DOE from November 2011 to August 2012 by the Onderstepoort Veterinary Academic Hospital were reviewed. Data collected included signalment, primary complaint, distance exercised, maximum speed attained, and dynamic airway abnormalities detected. XIII
A second study was carried out to evaluate agreement within and among examiners of three grading systems for laryngeal function at exercise. The grading systems assessed were an existing system for grading axial deviation of aryepiglottic folds (ADAF), a modified system for grading recurrent laryngeal neuropathy (RLN) at exercise, and a proposed system for grading vocal cord collapse (VCC). For investigation of intra-observer variability, recordings were watched by two of the investigators at the same time, on two different occasions, in real time, slow motion, and at frame-by-frame speed. To evaluate inter-observer variability, recordings were watched by four investigators on one occasion, as described for investigation of intra-observer variability, and scoring sheets completed. Kappa agreement was calculated for both intra- and inter-observer sessions.
Fifty-two horses that underwent DOE for investigation of poor performance and/or abnormal respiratory noise were identified. The main abnormalities detected included dorsal displacement of the soft palate (DDSP) (13/52 horses, 25%); recurrent laryngeal neuropathy (RLN) (17/52 horses, 33%); axial deviation of the aryepiglottic folds (ADAF) (21/52 horses, 40%) and vocal cord collapse (VCC) (18/52 horses, 35%). A total of 40 horses presented one or more abnormalities of the URT (77%). Fifteen horses (29%) had a single abnormality, and 25 horses (48%) had multiple abnormalities. Results at frame-by-frame speed from the intra-observer evaluations for all the conditions showed substantial agreement for RLN by both observers (K = 74 - 80). Intra-observer evaluations for VCC were moderate to substantial (K 53 – 63). ADAF was the most difficult URT abnormality to assess for both observers, and agreement within observers was only fair to moderate (K = 36 - 52). Inter-observer evaluations for RLN showed substantial to moderate agreement (K = 62). Inter-observer evaluations for VCC showed moderate agreement (K = 47 – 54), and inter-observer evaluations for ADAF showed only slight to fair agreement and were the lowest for all the conditions (K = 14 – 22).
This study showed that DOE is a useful technique for providing valuable information about disease of the URT. Finding multiple abnormalities in 48% of horses examined using DOE suggests that DOE may be indicated even for those horses with an obvious abnormality found during resting endoscopy.
The intra-observer evaluations showed that RLN had higher agreement values than those for ADAF and VCC at all speeds, and that ADAF had lower agreement values than those for VCC and RLN at all speeds. Inter-observer agreement was less than intra-observer agreement, presumably because more observers were involved in the inter-observer assessment. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Companion Animal Clinical Studies / unrestricted
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Estudo das condições de saúde das crianças de 5 a 9 anos de idade residentes no Distrito Butantã, cidade de São Paulo, com e sem doença respiratória, declarada pelos pais ou responsáveis / Study of the health of children from 5 to 9 years of age in the District Butantã, city of Sao Paulo, with and without respiratory tract disease, reported by parents or guardiansAranha, Maria Aparecida Figueiredo 06 February 2009 (has links)
INTRODUÇÃO: A saúde passou a ser avaliada sob a óptica de qualidade de vida, a partir de 1948, com a definição da Organização Mundial da Saúde, como bem estar físico, mental e social e não mais ausência de doença. A saúde em crianças tem sido definida como um conceito subjetivo e multidimensional que deve incluir a avaliação física, o impacto psicossocial da doença sobre a criança e sua família. Em sociedades desenvolvidas ou em desenvolvimento é grande a importância epidemiológica da doença respiratória. Tal fato decorre do importante impacto exercido sobre seus expressivos índices de morbidade e de mortalidade na população infantil. Fazse necessário então, pela importância epidemiológica da doença respiratória, a incorporação de novas técnicas e processos para o estudo das condições de saúde da população com e sem problemas respiratórios sob a óptica da percepção dos pais ou responsáveis. Com o objetivo de estudar o impacto das doenças respiratórias nas condições de saúde das crianças de 5 a 9 anos de idade residentes no Distrito de Saúde Escola do Butantã foi utilizado, no presente estudo, o instrumento Child Health Questionnaire versão destinada aos pais(CHQ-PF-50), validado no mundo e no Brasil. Avaliou-se também a relação da declaração de doença respiratória segundo a instituição de ensino, instrução dos pais, faixa de renda e etnia MÉTODOS: Avaliaram-se as condições de saúde de 959 crianças na faixa etária de 5 a 9 anos de idade residentes no Distrito do Butantã, na Cidade de São Paulo, com e sem doença respiratória declarada pelos pais ou responsáveis. No período de março a julho de 2004. A pesquisa foi do tipo descritivo, com enfoque retrospectivo através da análise de dados disponibilizado junto a um banco de dados. Para tanto foi utilizado o método de levantamento de informações junto aos elementos amostrais, por meio de instrumento de coleta de dados estruturado e não disfarçado, utilizando o CHQ-PF50. As doenças respiratórias perguntadas e declaradas foram: rinite, sinusite, otite, laringite, faringoamigdalite, pneumonia, asma ou quadro asmatiforme. Os dados apresentados nesse trabalho foram analisados a partir de um conjunto de procedimentos aplicados aos dados originais coletados, conforme orientação metodológica encontrada em Landgraf et al.RESULTADOS:O estudo indicou que as crianças cujos pais referiram doença respiratória apresentaram condições de saúde insatisfatórias, quando comparadas às crianças sem doença respiratória. Pais de crianças que estudam em escolas privadas e com maior grau de escolaridade referiram mais doença respiratória em seus filhos. A renda mensal ou etnia não interferiu na declaração de doença respiratória. CONCLUSÕES: Para melhorar as condições de saúde das crianças com doença respiratória é necessário o entendimento dessas patologias no âmbito global, biopsico e social, além do aprimoramento educacional da população. / BACKGROUND: The health has been evaluated in terms of quality of life, from 1948, with the definition of the World Health Organization, as well the physical, mental and social rather than absence of disease. The health of children has been defined as a subjective and multidimensional concept that includes a physical evaluation, the psychosocial impact of disease on the child and his family. In societies developed or developing is great epidemiological importance of respiratory disease. This fact stems from the important impact on their expressive rates of morbidity and mortality in children. It becomes necessary then, the epidemiological importance of respirator tract disease, the incorporation of new techniques and processes for the study of the health of the population with and without respiratory problems in terms of the perception of parents or guardians. In order to study the impact of respiratory tract diseases in the health conditions of children from 5 to 9 years of age in the District Health School of Butantã was used in this study, the instrument Child Health Questionnaire version aimed at parents (CHQ - PF-50), validated in the world and Brazil. Was also evaluated the relationship of the declaration of respiratory tract disease according to the university, education of parents, track income and ethnicity METHODS: We evaluated the health of 959 children aged from 5 to 9 years of age residing in District of Butantã in the city of Sao Paulo, with and without respiratory tract disease declared by the parents or guardians. From March to July 2004. The research was a descriptive, with a focus through the retrospective analysis of data provided with a database. To that end we used the method of lifting elements of information from the sample by means of data collection instrument structured and not undercover, using the CHQ-PF50. Respiratory tract diseases were asked and declared: rhinitis, sinusitis, ear infections, laryngitis, pharyngitis, pneumonia, asthma or asthma framework. The data presented in this study were analyzed from a set of procedures applied to the original data collected as methodological guidance found in Landgraf et al.RESULTS: The study indicated that children whose parents had reported respiratory tract disease conditions of poor health, compared to children without respiratory tract disease. Parents of children who study in private schools and with a higher degree of education reported more respiratory disease to their children. The monthly income or ethnicity did not interfere in the declaration of respiratory tract disease. CONCLUSIONS: To improve the health conditions of children with respiratory tract disease is necessary to understand such conditions in the global context, and social biopsico, in addition to improving education of the population.
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Estudo das condições de saúde das crianças de 5 a 9 anos de idade residentes no Distrito Butantã, cidade de São Paulo, com e sem doença respiratória, declarada pelos pais ou responsáveis / Study of the health of children from 5 to 9 years of age in the District Butantã, city of Sao Paulo, with and without respiratory tract disease, reported by parents or guardiansMaria Aparecida Figueiredo Aranha 06 February 2009 (has links)
INTRODUÇÃO: A saúde passou a ser avaliada sob a óptica de qualidade de vida, a partir de 1948, com a definição da Organização Mundial da Saúde, como bem estar físico, mental e social e não mais ausência de doença. A saúde em crianças tem sido definida como um conceito subjetivo e multidimensional que deve incluir a avaliação física, o impacto psicossocial da doença sobre a criança e sua família. Em sociedades desenvolvidas ou em desenvolvimento é grande a importância epidemiológica da doença respiratória. Tal fato decorre do importante impacto exercido sobre seus expressivos índices de morbidade e de mortalidade na população infantil. Fazse necessário então, pela importância epidemiológica da doença respiratória, a incorporação de novas técnicas e processos para o estudo das condições de saúde da população com e sem problemas respiratórios sob a óptica da percepção dos pais ou responsáveis. Com o objetivo de estudar o impacto das doenças respiratórias nas condições de saúde das crianças de 5 a 9 anos de idade residentes no Distrito de Saúde Escola do Butantã foi utilizado, no presente estudo, o instrumento Child Health Questionnaire versão destinada aos pais(CHQ-PF-50), validado no mundo e no Brasil. Avaliou-se também a relação da declaração de doença respiratória segundo a instituição de ensino, instrução dos pais, faixa de renda e etnia MÉTODOS: Avaliaram-se as condições de saúde de 959 crianças na faixa etária de 5 a 9 anos de idade residentes no Distrito do Butantã, na Cidade de São Paulo, com e sem doença respiratória declarada pelos pais ou responsáveis. No período de março a julho de 2004. A pesquisa foi do tipo descritivo, com enfoque retrospectivo através da análise de dados disponibilizado junto a um banco de dados. Para tanto foi utilizado o método de levantamento de informações junto aos elementos amostrais, por meio de instrumento de coleta de dados estruturado e não disfarçado, utilizando o CHQ-PF50. As doenças respiratórias perguntadas e declaradas foram: rinite, sinusite, otite, laringite, faringoamigdalite, pneumonia, asma ou quadro asmatiforme. Os dados apresentados nesse trabalho foram analisados a partir de um conjunto de procedimentos aplicados aos dados originais coletados, conforme orientação metodológica encontrada em Landgraf et al.RESULTADOS:O estudo indicou que as crianças cujos pais referiram doença respiratória apresentaram condições de saúde insatisfatórias, quando comparadas às crianças sem doença respiratória. Pais de crianças que estudam em escolas privadas e com maior grau de escolaridade referiram mais doença respiratória em seus filhos. A renda mensal ou etnia não interferiu na declaração de doença respiratória. CONCLUSÕES: Para melhorar as condições de saúde das crianças com doença respiratória é necessário o entendimento dessas patologias no âmbito global, biopsico e social, além do aprimoramento educacional da população. / BACKGROUND: The health has been evaluated in terms of quality of life, from 1948, with the definition of the World Health Organization, as well the physical, mental and social rather than absence of disease. The health of children has been defined as a subjective and multidimensional concept that includes a physical evaluation, the psychosocial impact of disease on the child and his family. In societies developed or developing is great epidemiological importance of respiratory disease. This fact stems from the important impact on their expressive rates of morbidity and mortality in children. It becomes necessary then, the epidemiological importance of respirator tract disease, the incorporation of new techniques and processes for the study of the health of the population with and without respiratory problems in terms of the perception of parents or guardians. In order to study the impact of respiratory tract diseases in the health conditions of children from 5 to 9 years of age in the District Health School of Butantã was used in this study, the instrument Child Health Questionnaire version aimed at parents (CHQ - PF-50), validated in the world and Brazil. Was also evaluated the relationship of the declaration of respiratory tract disease according to the university, education of parents, track income and ethnicity METHODS: We evaluated the health of 959 children aged from 5 to 9 years of age residing in District of Butantã in the city of Sao Paulo, with and without respiratory tract disease declared by the parents or guardians. From March to July 2004. The research was a descriptive, with a focus through the retrospective analysis of data provided with a database. To that end we used the method of lifting elements of information from the sample by means of data collection instrument structured and not undercover, using the CHQ-PF50. Respiratory tract diseases were asked and declared: rhinitis, sinusitis, ear infections, laryngitis, pharyngitis, pneumonia, asthma or asthma framework. The data presented in this study were analyzed from a set of procedures applied to the original data collected as methodological guidance found in Landgraf et al.RESULTS: The study indicated that children whose parents had reported respiratory tract disease conditions of poor health, compared to children without respiratory tract disease. Parents of children who study in private schools and with a higher degree of education reported more respiratory disease to their children. The monthly income or ethnicity did not interfere in the declaration of respiratory tract disease. CONCLUSIONS: To improve the health conditions of children with respiratory tract disease is necessary to understand such conditions in the global context, and social biopsico, in addition to improving education of the population.
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Towards good pharmacy practice in Hanoi : a multi-intervention study in private sector /Chuc, Nguyen Thi Kim, January 2002 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.
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Chlamydophila felis em gatos (Felis catus) : detecção de antígeno e pesquisa de anticorpos /Seki, Meire Christina. January 2008 (has links)
Orientador: Aramis Augusto Pinto / Banca: Mitika Kuribayashi Hagiwara / Banca: Tânia de freitas Raso / Resumo: O presente trabalho, primeiro estudo sobre clamidiose felina no Brasil, teve o objetivo de pesquisar a presença direta e indireta de Chlamydophila (elis em gatos domésticos provenientes de cinco municípios da região nordeste do estado de São Paulo. Adicionalmente, correlacionar os dados de ficha clínica com os resultados positivos obtidos nos três testes laboratoriais utilizados, ou seja, reação em cadeia pela polimerase (PCR), reação de imunotluorescência indireta (RI FI) e reação de fixação do complemento (RFC). O grupo experimental final foi constituído de 151 animais, dos quais 73 eram provenientes de gatis, 18 de clínica/hospitais veterinários e 60 de abrigos públicos para animais. Das 151 amostras de suabes de conjuntiva submetidas à PCR, em 6,0% (9/151) foi encontrado DNA de C. (elis. Anticorpos anti-Chlamydiaceae foram detectados em 72,1% (106/147) das amostras de soros submetidas à RIFI. Em somente 9,4% (10/106) dos soros positivos à RIFI, foram detectados anticorpos fixadores do complemento, revelando que a RFC, embora específica, apresenta baixa sensibilidade quando utilizada na pesquisa de anticorpos anti-Chlamydiaceae em gatos domésticos. Foi também observado que gatos provenientes de gatis, animais com idade maior que um ano e inferior a seis anos, bem como as fêmeas, estão mais predispostos a soroprevalência para C.felis pela RIFI. Entretanto, tais resultados não foram observados nos animais PCR positivo. Ademais, pode-se verificar uma estreita relação entre as presenças de DNA clamidial e de anticorpos anti-Chlamydiaceae em gatos domésticos brasileiros aos dados das fichas clínica relacionados à doença do trato respiratório superior, a secreção ocular e a conjuntivite. / Abstract: This work, first study about feline chlamydiosis in Brazil, had the objective to evaluate the direct and indirect presence to Chlamydophila felis in domestic cats coming trom tive cities of northeast of São Paulo state. Additionally, relate informations of clinical records with positives results get in the three laboratories tests used, whatever, complement fixation test (CFT), immunofluorescende assay (IFI) and Polymerase Chain Reaction (PCR). Experimental group had 151 animais, witch 73 coming from catteries, 18 coming trom veterinary clinicallhospital and 60 coming from public animal shelters. From 151 samples of conjunctival swabs submitled to PCR, in 6% (9/151) were detect DNA of C.felis. Anti-Chlamydophila antibodies were detect in 72,1%(106/147) of samples of serum submitted to IFI. In just 9,4% (10/106) of the positive serums in IFI, had complement fixation antibodies, detected by CFT. The CFT, although specific, presented low sensibility when to use to research of anti-Chlamydiaceae antibodies in domestic cats. In cats from catteries, animais between one and six year, and female were more predispose to a presence of antibodies anti-Chlamydophila by IFI. However, these results were not observed in animais PCR positive. Thus, was observed a relationship between the presence of chlamydial DNA and antibodies anti-Chlamydiaceae in Brazilian domestic cats, added with informations of clinical records, like with upper respiratory tract disease, ocular discharge and conjunctivitis. / Mestre
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Prevalence of Diabetes Mellitus and Its Associated Unfavorable Outcomes in Patients With Acute Respiratory Syndromes Due to Coronaviruses Infection: A Systematic Review and Meta-AnalysisPinedo-Torres, Isabel, Flores-Fernández, Magaly, Yovera-Aldana, Marlon, Gutierrez-Ortiz, Claudia, Zegarra-Lizana, Paolo, Intimayta-Escalante, Claudio, Moran-Mariños, Cristian, Alva-Diaz, Carlos, Pacheco-Barrios, Kevin 01 January 2020 (has links)
Introduction: Only 3 types of coronavirus cause aggressive respiratory disease in humans (MERS-Cov, SARS-Cov-1, and SARS-Cov-2). It has been reported higher infection rates and severe manifestations (ICU admission, need for mechanical ventilation, and death) in patients with comorbidities such as diabetes mellitus (DM). For this reason, this study aimed to determine the prevalence of diabetes comorbidity and its associated unfavorable health outcomes in patients with acute respiratory syndromes for coronavirus disease according to virus types. Methods: Systematic review of literature in Pubmed/Medline, Scopus, Web of Science, Cochrane, and Scielo until April of 2020. We included cohort and cross-sectional studies with no restriction by language or geographical zone. The selection and extraction were undertaken by 2 reviewers, independently. The study quality was evaluated with Loney’s instrument and data were synthesized by random effects model meta-analysis. The heterogeneity was quantified using an I2 statistic. Funnel plot, Egger, and Begg tests were used to evaluate publication biases, and subgroups and sensitivity analyses were performed. Finally, we used the GRADE approach to assess the evidence certainty (PROSPERO: CRD42020178049). Results: We conducted the pooled analysis of 28 studies (n = 5960). The prevalence analysis according to virus type were 451.9 diabetes cases per 1000 infected patients (95% CI: 356.74-548.78; I2 = 89.71%) in MERS-Cov; 90.38 per 1000 (95% CI: 67.17-118.38) in SARS-Cov-1; and 100.42 per 1000 (95% CI: 77.85, 125.26 I2 = 67.94%) in SARS-Cov-2. The mortality rate were 36%, 6%, 10% and for MERS-Cov, SARS-Cov-1, and SARS-Cov-2, respectively. Due to the high risk of bias (75% of studies had very low quality), high heterogeneity (I2 higher than 60%), and publication bias (for MERS-Cov studies), we down rate the certainty to very low. Conclusion: The prevalence of DM in patients with acute respiratory syndrome due to coronaviruses is high, predominantly with MERS-Cov infection. The unfavorable health outcomes are frequent in this subset of patients. Well-powered and population-based studies are needed, including detailed DM clinical profile (such as glycemic control, DM complications, and treatment regimens), comorbidities, and SARS-Cov-2 evolution to reevaluate the worldwide prevalence of this comorbidity and to typify clinical phenotypes with differential risk within the subpopulation of DM patients. / Revisión por pares
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Respiratory pathogens in thoroughbred foals up to one year of age on a stud farm in South AfricaPicard, J.A. 27 February 2006 (has links)
The project was undertaken to monitor a group of 30 foals on a farm both clinically and microbiologically from birth until one year of age, to determine the aetiology of upper respiratory tract infections and to establish immune profiles of some of the known respiratory viral pathogens. One to two months prior to the birth of their foals, blood for serology was collected from the mares. The same specimens were collected from the foals just after birth, prior to suckling and a day after suckling. Thereafter the foals were examined monthly for the presence of respiratory disease and specimens taken. The following specimens were collected from each foal: three nasopharyngeal swabs, (one for virus isolation, one for bacteria and fungus isolation, and one for mycoplasma isolation) and blood that was allowed to clot. Blood was collected in heparin from sick foals with elevated rectal temperatures. Virus isolation was done on roller tube cultures of equine embryonic lung (EEL), Vero cells and rabbit kidney 13 (RK13) cells. The bacteria (including mycoplasmas) and fungi were cultured from the swabs and identified using a variety of traditional methods. The serum neutralization test (SNT) was used to detect antibodies to equid herpesvirus 1 (EHV-1), equid herpesvirus 4 (EHV-4), equine rhinovirus 1 (ERV-1), equine rhinovirus 2 (ERV-2) and equine adenovirus 1 (EAdV-1). The complement fixation test (CFT) was used to detect antibodies to EHV-1 and EHV-4 and the haemagglutination inhibition test (HIT) antibodies to equine influenzavirus (EIV). Only EHV-4 was cultured from the nasopharyngeal swabs of nine foals when they were 5 to 6 months of age and from one foal two months later. A wide variety of bacteria and fungi were cultured and it was established that coagulase-negative staphylococci, viridans streptococci, Moraxella spp. and Flavobacterium spp. predominated in most of the samples. Several potential bacterial pathogens were isolated but the most common were Streptococcus equi subsp. zooepidemicus, Actinobacillus equuland Staphylococcus aureus. Colostrum-derived antibodies were detected for all the viruses in all but two of the foals. It was found that the foals had similar or slightly higher titres than their mothers. The levels declined in direct proportion to what they initially were and were depleted by the time the foals were 2 to 7 months of age. Antibodies to natural infection was detected to EHV-4, ERV-2 and EAdV-1. A rise in antibody titres occurred when the foals were 5 to 6 months of age, two months later and when they were one year of age. Antibodies resulting from immunization was detected to EHV-1, EHV-4 and EIV. It was established that the most important virus causing upper respiratory tract disease of the foals from 5 to 12 months of age was EHV-1 with EAdV-1 playing a minor role. These viruses caused repeated bouts of infection with a two to five months interval. Streptococcus equi subsp. zooepidemicus was considered to be the most important secondary pathogen. Prior to this period most of the foals were healthy with only a few suffering from upper respiratory disease. The aetiology was not determined in these cases, but based on the bacteriology results, it was suspected that some of them were suffering from bacterial infections. / Dissertation (MSc (Veterinary Science))--University of Pretoria, 2005. / Veterinary Tropical Diseases / unrestricted
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