Non c d communti

Noncommunicable
Disease
2

Rawaa Azhari

non-communicable disease, or
NCDs, is a medical condition or
disease which by definition is
non-infectious and nontransmissible between persons
. NCDs may be chronic diseases
of long duration and slow
progression, or they may result
in more rapid death such as
4
some types of sudden stroke.

Includes:

5

Heart disease
Chronic respiratory disease
Cancer
Chronic kidney disease
Inherited disease
Diabetes mellitus
Alzheimer disease

Auto immune disease
Stroke.
Road traffic accident and injuries

Osteoporosis
Blindness

obesity
6

Modifiable behavioral
risk factors:
Tobacco use

 physical inactivity
 unhealthy diet

Alcohol intakes.
8

Non modifiable risk
factor
age.
Sex

Hereditary factor.
9

Metabolic/physiologic
al risk factors
raised blood pressure
 overweight/obesity.
 hyperglycemia (high blood
glucose levels.
10

hyperlipidemia (high levels of fat
in the blood.

Who is at risk of such
diseases?
All age groups and all regions are
affected by NCDs. Often associated
with older age groups, but evidence
shows that more than 9 million of all
deaths attributed to non
communicable
11

diseases (NCDs) occur before the age
of 60. Of these “premature" deaths,
90% occurred in low- and middleincome countries….
12

Children, adults and the
elderly are all vulnerable to
the risk factors that contribute
to non communicable
diseases,
13

NCDs and global health

NCDs by far is the leading cause of
death in the world account for 63% of
all death.

80% of death occur in low and middl
income country

Nine million of all death occur before
15
the age of 60

by 2020, NCDs will attribute
to 7 out of every 10 deaths
in developing countries.
killing 52 million people
annually worldwide by 2030.
NCDs are not only health
problem but developmental
16
challenge as well.

Impact on development
The NCD epidemic strikes
disproportionately among people of
lower social positions. NCDs and
poverty create a vicious cycle whereby
poverty exposes people
17

to behavioral risk factors
for NCDs and in turn ,
the resulting NCDs may
become an important driver
to the downward spiral that
leads families towards
poverty.
18

The burden of disease
attributed to NCDs has been
estimated at 85% in industrialized
nations, 70% in middle income
nations, and nearly 50% in
countries with the lowest national
incomes.
19

Comprehensive approach requires
multisectrol coordination, including
health, finance, foreign affairs,
education, agriculture, planning and
others
Reduce the common modifiable
risk factors
21

Essential NCD interventions that
can be delivered through a primary
health-care

raising taxes on tobacco, banning
tobacco advertising and
legislating to curb smoking in
public places
22

Reducing levels of salt in foods.
Stopping the inappropriate
marketing of unhealthy food
Non-alcoholic beverages to
children, and controls on harmful
alcohol use.

Promoting physical activity
23

NCD are emerging as one
of the major health problem
in Sudan.
Data on the disease burden
of NCDs in Sudan is scarce
and deficient .

It account for 41% of all
25
death (2005)

The commonest non
communicable disease in
Sudan :
Hypertension,diabetes and heart
disease represent the most common
form.
Fallow by cancer ,asthma,
glaucoma, cataract , mental health
26
renal disease, RTAs and injury

Khartoum stepwise survey
2006 :
Smoking was 29.1% in male.
BMI showed 29.8% of male and
31.8% of female were over weight
,11.7% and 30.7% were obese
27

Hypertension was 23.6%
DM was 19.2%

High serum lipids was 19.8%
28

Impaired heart function due to
inadequate blood flow to the
heart compared to its need

. Angina pectoris at effort
.MI
.Irregularity of the heart
.Cardiac failure
.Sudden death

IHD is considered as “modern “
epidemic
The highest coronary mortality is
seen in north Europe and English
spoken countries ( Finland ,Scotland ,
northern Ireland )
In Africa IHD is Less than other
Continent but its still the main cause
of death

.Also the main cause of death is IHD
.A study done by the WHO over
100.000 Sudanese people in 2008
showed that
. 559 males and 545 of females die due
to IHD
23% die due IHD

25 % – 30 % of death due to IHD
IHD is the leading cause of the death
IHD is the leading cause of the
morbidity

IHD is the leading cause in
decreasing quality of the live
Approximately one million
working years wear lost because
of IHD

.Not modified risk factors :
1. Age
2. Sex
3. Family history
4. Genetic factors

Organic Nitrates
Beta Blockers
Calcium Channel Blockers
Statins
Aspirin

6. The person must
take any medication
describe for him .

Hypertension
Nmariq
Abdulazeem

59

:
High blood pressure called
hypertension is the force of blood
applied against the wall of arteries
as heart pumps blood through
body .

61

• As of 2000, nearly one billion people or ~26%
of the adult population of the world had
hypertension.] It was common in both
developed (333 million) and undeveloped
(639 million) countries.

63

• However rates vary markedly in different
regions with rates as low as 3.4% (men)
and 6.8% (women) in rural India and as
high as 68.9% (men) and 72.5% (women)
in Poland.

64

–

In 1995 it was estimated that 43 million
people in the United States had
hypertension or were taking
antihypertensive medication, almost 24% of
the adult United States population.

65

• The prevalence of hypertension in the United
States is increasing and reached 29% in
2004.As of 2006 hypertension affects
76 million US adults (34% of the population)
and African American adults have among the
highest rates of hypertension in the world at
44%.
66

– It is more common in blacks and native
Americans and less in whites and Mexican
Americans, rates increase with age, and is
greater in the southeastern United States.
Hypertension is more prevalent in men
(though menopause tends to decrease this
difference) and in those of low
socioeconomic status.
67

Blood pressure is usually classified based on
systolic & diastolic blood pressure .
Systolic blood pressure is blood pressure in vessels
during in heart beat
Diastolic blood pressure between heart beat
Classification are made after average a pts resting
blood pressure reading taken on two or more
office visits .
72

• Primary hypertension or essential means
high blood pressure with no obvious
underlying medical cause about 90-95 at
cases.
• Secondary hypertension or chronic caused
by endocrine, heart, renal diseases such
as Cushing syndrome ,acromegaly ,hyper
or hypothyroidism , hyperaldosteronism
,pherochromocytoma, aortic coarctation .
73

• Malignant hypertension is severe elevated
blood pressure greater than 180systolic or
diastolic 110 referred to hypertension
crises .
• Hypertension emergency previously
malignant hypertension is diagnosed when
evidence due to one or more multi organ
damage.
74

• These may be classified as;
• 1-non modifiable risk factors ;• Age ;blood pressure rises in both sex and rising Is
greater in those with higher initial blood pressure.
• Genetic factors ;family studies have shown that
children of 2 normotensive parents have 3%
possibility of developing. Possibility 45% in children
of two hypertensive parents.
76

• Modifiable risk factors:•
•
•
•
•
•
•
•

Obesity
Salt in take
Saturated fat
Alcohol
smoking
Physical activity
Environmental stress
Others factors such as oral contraception ,noise,
temperature
77

Heart attack or stork .
Brain aneurysm .
Heart failure .
Metabolic syndrome .
Hypertensive nephropathy .
Hypertensive retinopathy .

79

Diagnoses &investigations
• General diagnosed three separate
sphygmomanometer measurement at
least one week.
• Initial assessment of HTN pt complete
history & physical examination .
• Laboratory investigations
• ECG
• URINE ANALYSIS &BLOOD TEST
&LIPID PROFILES
81

Management :
The essential HTN requires pt life style
management &therapeutic intervention
Benefits of pharmacologic treatment in
people with mild & moderate hypertension
The treatment uncomplication HTN consider
mono therapy .
If BP is not control use combination
drugs:Diuretic ,ACE,ARB,CCB,BB .
82

Prevention of hypertension
WHO has recommended the following
approaches in the prevention of HTN:1-primaryprevention;-to reduce the
incidence of disease in a population
A- high risk strategy .
b- population strategy involve multi factorial
as nutritional .
83

consume the a diet rich in fruit and
vegetables & reduce saturated fat

84

Reduce the up take of caffeine
(coffee & tea)
reduce salt

85

stop Smoking

avoid alcohol

86

2- secondary prevention:
# early case detection .
# treatment .
# patient compliance :

88

• A stroke occurs when blood
flow to the brain is interrupted by
a blocked or a burst blood vessel.

Stroke is leading cause of death
in the sudan
• On average, someone suffers a
stroke every 40 seconds
• About 30.000 sudanese suffer a
stroke each year
• About every 4 minutes, someone
dies of a stroke

•

Stroke is a leading cause of
serious, long-term disability .
• About 6.4 million sudanese are
stroke survivors .

Ischemic Stroke (Blockage)
• Caused by a blockage in blood
vessels in brain
Hemorrhagic Stroke (Bleeding)
• Caused by burst or leaking blood
vessels in brain

Causes of Ischemic Stroke
Begins with the development of fatty deposits
lining the blood vessel wall
• Thrombus: Development of blood clot at the
fatty deposit
• Embolus: Traveling particle too large to pass
through a small vessel

Causes of Hemorrhagic
Stroke
Occurs when a weakened blood
vessel ruptures
• Aneurysms: Ballooning of a
weakened region of a blood vessel
• Arteriovenous Malformations
(AVMs): Cluster of abnormal blood
vessels

Non-modifiable :
•
•
•
•
•

Age
Sex
Race
Prior stroke
Family history

Modifiable
•
•
•
•
•
•
•

Hypertension/High Blood Pressure
Heart Disease
Cigarette Smoking
Transient Ischemic Attacks
Diabetes
Elevated Blood Cholesterol/Lipids
Asymptomatic Carotid Bruits

Less Well-Documented
•
•
•
•

Geographical Location
Socioeconomic Factors
Excessive Alcohol Intake
Certain Kinds of Drug Abuse

• Sudden weakness or numbness
of the face, arm or leg, especially
on one side of the body
• Sudden confusion, trouble
speaking or understanding
• Sudden trouble seeing in one or
both eyes

• Sudden trouble walking,
dizziness, loss of balance or
coordination
• Sudden, severe headaches with
no known cause (for hemorrhagic
stroke)

Transient Ischemic Attacks
• Warning strokes” that can happen before a
major stroke
• Occur when blood flow through a brain artery
is blocked or reduced for a short time
• Symptoms are temporary but similar to those
of a full fledged stroke
• A person who has a TIA is 9.5 times more
likely to have a stroke

Ischemic Stroke : :
• Clot-busters
• Anticoagulants – warfarin. aspirin
• Carotid Endarterectomy
• Angioplasty/Stents
Hemorrhagic Stroke :
• Surgical Intervention
• Endovascular Procedures, e.g.,
“coils”

•
•
•
•

Control high blood pressure
Prevent heart disease
Stop cigarette smoking
Recognize signs of TIA and tell
physician
• Reduce blood cholesterol levels

After suffering a stroke, it’s
important to begin a
rehabilitation program as soon as
possible

•
•
•
•

Hospital programs
Nursing facilities
Outpatient programs
Home-based programs

Rheumatic heart disease is the
most serious complications of
rheumatic fever..

Acute rheumatic fever follows
cases of group A beta_hemolytic
streptococcal pharyngitis ..
122

Worldwide rheumatic heart disease is
a major health problem..
Chronic Rheumatic disease is estimated
to occur in 5_30 million children &
adult..
Mortality rate from this disease
remain 1_10% …
Sudan House Hold Survey reported
that the incidence has
dropped from 3/1000 in
1980 to 0.3% in 2010 ..

124

Acute Rheumatic fever &
rheumatic heart disease both
are autoimmune inflammatory
response ..
Inflammation of heart (carditis),
pericardium (pericarditis), heart
muscle(myocarditis),endocardium
(endocarditis) ..
All are R.H.D.
presentation..
126

Endocarditis lead to a set of valve
damage .. When it begins it tend to
continuously worsen over time..
Once mitral valve is involved it
become laden with heavy deposits of
calcium which may cause stenosis
“failure to open completely”
,regurgetation “ failure to close
completely” or prolaps “stenosis &
regurgetation”..
129

Aortic valve also may be involved
&develop stenosis, regurgetation or
both..

130

It is diagnosed by Modified Jones
criteria which require the presence of 2
major or 1 major & 2 minor…
 Major criteria includes:
Carditis ,Polyarthritis,
Chorea,Subcutaneous nodules &
Erythema marginatum ..
 Minor criteria includes:
Fever, Arthralgia, prolonged PR interval,
increased Erythrocyte Sedimentation
rate (ESR)..
133

previous group A streptococcal
pharyngitis is required to diagnose
rheumatic fever with :
+ve throat culture of streptococcal
antigen.
Elevated streptococcal antibody
titer ..
134

Medical therapy critically attempts to
prevent rheumatic fever..
Oral Penicillin is used for pharyngitis
Allergic patients Erythromycin,
Clarithromycin & Azithromycin are
used..
When heart failure worsens after
medical therapy ,surgery to decrease
valve insufficiency may be lifesaving by
replacement..
136

patients with rheumatic heart
disease complication , fluids& sodium
intake should be restricted.
Potassium supplementation is
also necessary..
137

Chronic Obstructive
Pulmonary
Disease
shattir saeed

Chronic obstructive pulmonary disease •
(COPD) is a preventable and treatable
disease state characterized by air flow
limitation that is not fully reversible.

Air flow limitation is usually progressive •
and is associated with an abnormal
inflammatory response of lungs to
noxious particles or gases,primarily
caused by cigarette smoking.

According to WHO estimates, 65 million
people have moderate to severe chronic
obstructive pulmonary disease (COPD).
More than 3 million people died of COPD in
2005, which corresponds to 5% of all deaths
globally. Most of the information available
on COPD prevalence, morbidity and
mortality comes from highincome
countries.,

accurate epidemiologic data on COPD are
difficult and expensive to collect. It is known
that almost 90% of COPD deaths occur in lowand middle-income countries.
At one time, COPD was more common in
men, but because of increased tobacco use

among women in high-income countries
and the higher risk of exposure to indoor
air pollution (such as biomass fuel used
for cooking and heating) in low-income
countries, the disease now affects men
and women almost equally.

In 2002 COPD was the fifth leading
cause of death. Total deaths from
COPD are projected to increase by
more than 30% in the next 10 years
unless urgent action is taken to reduce
the underlying risk factors, especially
tobacco use. Estimates show that
COPD becomes in 2030 the third
leading cause of death worldwide.

Risk factors for COPD include both
environmental exposure and genetic
factors
.Tabacco smoke is the major cause of COPD (80%
to 90%)
.Other environmental factors include
occupational dusts and chemical and air pollution
.The best characterized genetic factor is alpha –
antitrypsin deficiency

Causes of COPD in
Non-smokers
.Alpha 1 AT Deficiency
.Primary Ciliary Dysknesia
.Beta receptor heterogeneity
.Dietary deficiency: Retinoic acid, Betacarotene
.Strong family history

.Chronic cough,
.Sputum production,
.Dyspnea
.History of exposure to risk factors for
the disease.

Pathophysiology
Smoking induces airway inflammation… •
TNF alpha is central to smoke induced
airway inflammation
Macrophages and PMNs recruited to •
respiratory bronchioles amplify
inflammation, burp elastase
Elastolytic damage causes loss of lung •
recoil and supporting structures

Diagnosis of COPD
EXPOSURE TO
RISK
FACTORS

SYMPTOMS
cough
sputum
dyspnea

tobacco
indoor/outdoor pollution
occupation

SPIROMETRY

.Chronic respiratory faliure

.Pneumothorax
.Chronic pulmonary heart
disease

. An effective COPD management plan
includes four components:
(1)assess and monitor disease;
(2) reduce risk factor
(3) manage stable COPD;
(4) manage exacerbations

. The goals of effective COPD
management are to:
.Prevent disease progression
.Relieve symptoms
.Improve exercise tolerance
.Improve health status
.Prevent and treat complications
.Prevent and treat exacerbations
.Reduce mortality

Based on the principles of
prevention of further progress of •
disease
preservation and enhancement of •
pulmonary functional capacity
avoidance of exacerbations in order •
to improve the quality of life.

Stop smoking
Avoid environment pollution
Antibiotic therapy
Bronchodilators
Glucocorticoids
Expectorant
Respiratory stimulant
Oxygen therapy
Rehabilitation care
Lung volume reduction surgery

By

NOOR ELKHAIR ALI KHALF
ALLAH

WHAT IS CANCER
• Cancer regard as a group of disease
characterized by

• The major categories of cancer are
which arise from epithelial cells
lining the internal surface of the various organ
and from the skin epithelium
,which arise from meseodermal cell
constituting the various connective tissue
, myeloma and leukemia's arising
from the cell of bone marrow and immune
systems

THE PROBLEM
• Every 23 Seconds Someone is Diagnosed with Cancer
• Cancer is a leading cause of death worldwide and
accounted for 7.6 million deaths (around 13% of all
deaths) in 2008.
• About 70% of all cancer deaths occurred in low- and
middle-income countries. Deaths from cancer
worldwide are projected to continue to rise to over
13.1 million in 2030.
• Along with cardiovascular diseases diabetes and
chronic respiratory disease acount for 60% of all deaths
globally.

• 70%
• Approximately 70% of cancer deaths occur in
low- and middle-income countries

Estimated age-standardised incidence
and mortality rates WORLD

and mortality rates

Current Situation of Cancer in Sudan
The worldwide view of cancer is bleak but in
Sudan it is worse and more complicated
Because of late presentation, misdiagnosis,
lack of awareness & poor socioeconomic
status.
Cancer is the 3rd killer disease of the hospital
admitted patients in Sudan (2003 Report).
Cancer cases in Sudan increased by more than
ten folds from 1967 to 2005..
175

Dr Abdelgadir Eltahir Ahmed NCDs Director
KSMOH

1/27/2014

Cancer in sudan
• Cancer diseases in sudan are significantly
increasing to become one of the major ten kill
er diseases in 2002.
• The case load from radi isotope center
khartoum(RICK) increased to twenty fold in
the last 30 year

and mortality rates SUDAN

Cases of cancer
(1)- environmental factor

(2)-Genetic factors

Cases of cancer
(1)- environmental factor:
•

environment factors the factors are
generally held responsible for 80 to
90 per cent of all human cancer.
• The major environmental factors
identified so far include:
• A- TOBACCO: tobacco in various forms
of its usage e.g (smoking, chewing) is
the major environmental cause of
cancer of the lung, larynx, mouth,
pharynx, esophagus, bladder, pancreas
and probably kidney .

B- Alcohol : excessive intake of
alcoholic beverages is
associated with esophageal
and liver cancer.
Some recent studies have
suggested
That beer consumption may be
associated with rectal cancer ,
is estimated that alcohol
contribute about 3% of all
cancer diatheses .
C- Dietary factor : smoked fish is
related to stomach cancer,
dilatory fibers to intestinal
cancer .

D- Occupational Exposures .
E- Viruses.
F-Parasites.

How can the burden of cancer be
reduced?
• Knowledge about the causes of cancer, and
interventions to prevent and manage the disease
is extensive. Cancer can be reduced and
controlled by implementing evidence-based
strategies for cancer prevention, early detection
of cancer and management of patients with
cancer. Many cancers have a high chance of cure
if detected early and treated adequately.

CANCER CONTROL • The who estimate that cancer acount for 7.6
million around 13% of all deaths more than 40%
of cancer cases can be prevented .
• 1/3 of cancer cases are curable if early detected.
Or
• 30% of cancers could be prevented

PREVENTION 30%
of cancers could be prevented
(i)-Primary Prevention:
(ii)- Secondary prevention:

Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation
• D-occupational exposure
• E-immunization
• F- food;drug and cosmotic
• H-treatment of
precancerous lesion
• i-cancer education

Secondary prevention
• 1-cancer registraion
• 2-early detection of cases
• 3-treatment

Diabetes
Mellitus
Amal hassan
204

Diabetes is a group of
metabolic diseases in which a
person has high blood sugar,
either because the body
does not produce enough
insulin or because cells
do not respond to
insulin that produced..
206

•

The crude prevalence was 3.4%
DM . The highest crude prevalevce
northern Sudan (5.5%) lowest in
western Sudan (0.9%). New
cases (2.2%) appear
with family history
of diabetes, obesity &
advanced age ..
208

Type 1:
Results from the body failure to
produce insulin.
It is also known by insulin-dependent
diabetes mellitus (IDDM)..
•

Type 2:
Result from insulin resistance, a
condition in which cells fail to use
insulin properly, some times combined
with an absolute insulin deficiency..
210

•
•

Also known as non insulindependent diabetes mellitus..

Type 3:
It is the gestational
diabetes ..
Presented by high
blood glucose levels during
pregnancy ..
211

• Loss of weight..
• Polyuria (frequent urination)..
• Polydepsia (increased
thirst)..
• Polyphagia (increased hunger)..

213

dDiabetes

is charaterised by
acte
recurrent or persistent
hyperglycemia, and is diagnosed by
:
• Fasting plasma
glucose level more than
126mg/dl..
• plasma glucose
more than 2oo mg/dl
•

216

• Two hours after 75g oral
glucose load tolerance Test..

217

DM is a chronic disease which can
not be cured except in very specific
situation..
• It concentrate on keeping blood
sugar level close to normal with out
causing hypoglycemia..
•

219

• controlling diet
• exercise
• medication & patient education
reduce complications ..

220

• Metformin is the firt line treatment
for type 2 DM
• Routine use of Aspirin to improve
uncomplicated DM..
• Insulin therapy for type 1 DM..
222

• Macrovascular disease related to
atherosclerosis is the major
complication …
•

•

Diabetic retinopathy
Diabetic nephropathy
225

• Diabetic neuropathy..which
contribute the risk of diabetes
foot problem that may require
amputation…

226

Abnormal or excessive fat accumulation
that may impair health.
.Of all countries,the United States has
the highst rate of obesity.
.About 35.7% of American adult are
obese and 17% of American children.

.The treating of obesity- related
diseases cost United states about 190
billion dollar.
.Africa is associated with infectious
diseases but in the past two decade
have been increase in obesity.

.In South Africa 64% of black
population are overweight or
obese.
.Black population think being
obese women is beautiful and
attractive.

1. According to number or size of fat
cells,
2. According to fat accumulation and
distribution,
3. According to weight.

1. According to number or size
of fat cells
There are three main types of obesity:
1. Hyperplastic obesity.
2. Hypertrophic obesity .
3. Hyperplastic - hypertrophic obesity.

2. According to fat accumulation
and distribution
Two forms:
1. Android obesity:
It is the male pattern of obesity in which
fat deposition primarily is in the
abdomen and trunk. (Apple shape)

• 2. Gyenoid obesity (Pear Shaped
People)
• In those people, fat accumulates
around the hips (usually females).

A WHR > 0,8 in women is
considered a degree of android
obesity.

Fat distribution
It is the ratio of waist circumference
to hip circumference
“Waist-hip ratio” (WHR) is a simple
objective method for estimating the
pattern of regional fat distribution.

3. According to weight
Defined by :
the Percentage overweight

•Overeating ( habit , pleasure,
psychological )

Endocrinal e.g hypothyrodism ,
cushing syndrom.

To establish an optimal body
weight
.Weight determination
.Comparison of body
circumferences or diameter.
.Measuring Skin fold thickness.
.Comparison of body mass index
(BMI)

Body Mass Index (BMI)
• Is calculated by the following
equation:
[Weight in Kilograms (KG)/Height in
meter2 ]

•
•
•
•
•

Grades of BMI
< 18
Underweight
Grade I
18 -<25
Normal
Grade II
25 -<30
Overweight
Grade III >30
Obese

Learn Program for weight control
The word “LEARN” are the Initials of:
L= Life style (regular meals, eat slowly,
chewing food well, avoid junk food)
E= Exercises (regular exercise)
A= Attitude (negative attitude towards
obesity)
R= Relationship (social support to lose weight)
N= Nutrition (lowering caloric intake to less
than 800 cal/day)

1- Psychological:
emotional problems particularly
among adolescents.

2- Mechanical disability:
Flat feet, osteo-arthritis, lower
back pain and abdominal hernias.

3- Metabolic complication:

.Diabetes mellitus,
.High cholesterol,
.Gall stones
.Fatty Liver

4- Skin complications :
infections particularly in
skin flexures.

5- Accidents:
In street, can’t quickly
escape traffic

6- Respiratory complications:
The increased difficulty in breathing
may lead to Co2 retention and
subsequent drowsiness.

7-Complications attributed to
gynecology and obstetrics:
• Amenorrhea could be a risk factor
in genital tract tumors.

8- Obesity increases risk of :
Hypertension.
coronary heart disease.
High blood cholesterol level.

Obesity is a Modifiable
Risk Factors
Stress
Physical Inactivity
Vascular Changes

Obesity

Lipid Profile

High Cholesterol > 200mg/dl
HighLDL > 160 mg/dl
Low HDL < 40 mg/dl
Triglycerides > 200mg/dl

Cerebrovascular
Disease

Hypertension
Coronary Heart Disease

Myocardial infarction/ Sudden Death

Benefits of doing exercise
I- Reduces Risk of:
.CHD
.Stroke
.Bowel cancer
.Osteoporosis
.Obesity
.Stress & anxiety
.Mild Depression

2-Increases sense of Well being

3- Increases HDL cholesterol.
4-Weight Control.

Chronic
KidneyDisease
• Ahmed M. Alamin

 also known as chronic renal disease, is
a progressive loss in renal function over a
period of months or years Often,
 identified by a blood test for
creatinine. Higher levels of creatinine
indicate a lower glomerular filtration rate
and as a result a decreased capability of
the kidneys to excrete waste products.

Creatinine levels may be normal in the early
stages of CKD, and the condition is discovered if
urinalysis (testing of a urine sample) shows that the
kidney is allowing the loss of protein or red blood
cells into the urine.

• . The symptoms of worsening kidney function
are unspecific, and might include feeling
generally unwell and experiencing a reduced
appetite.
• CKD is initially without specific symptoms
and can only be detected as an increase in
serum creatinine or protein in the urine. As
the kidney function decreases

•

Blood pressure is increased due to fluid
overload and production of vasoactive
hormones created by the kidney via the reninangiotensin system (RAS ), increasing one's
risk of developing hypertension and/or
suffering from congestive heart failure

• Urea accumulates, leading to azotemia and
uremia (symptoms ranging from lethargy to
pericarditis and encephalopathy). Urea is excreted by
sweating and crystallizes on skin ("uremic frost").
•

• Fluid volume overload — symptoms may range
from mild edema to life-threatening pulmonary
edema
• Hyperphosphatemia — due to reduced phosphate
excretion

• Hypocalcemia — due to 1,25 dihydroxyvitamin D3
deficiency.
• Metabolic acidosis, due to accumulation of
sulfates, phosphates, uric acid etc.



The most common causes of CKD are
diabetes mellitus, hypertension, and
glomerulonephritis. Together, these cause
approximately 75% of all adult cases.
some geographic areas have a high incidence of HIV
Historically, kidney disease has been classified
according to the part of the renal anatomy that is
involved.

Vascular,
includes large vessel disease such as bilateral renal
artery stenosis and small vessel disease such as
ischemic nephropathy, hemolytic-uremic syndrome
and vasculitis

2/Glomerular,
comprising group and subclassified into:
oPrimary Glomerular disease:
such as focal segmental glomerulosclerosis and
IgA nephritis
oSecondary Glomerular disease:
such as diabetic nephropathy and lupus nephritis

• the kidney can also cause nephropathy
• 3/Tubulointerstitial including :
• polycystic kidney disease, drug and toxininduced chronic tubulointerstitial nephritis
and reflux nephropathy
• 4 /Obstructive such as: with bilateral kidney
stones and diseases of the prostate
• On rare cases, pin worms infecting

Abdominal ultrasound, in which the size of the kidneys is
measured . Kidneys with CKD are usually smaller (< 9 cm)
than normal kidneys, with notable exceptions such as in
diabetic nephropathy and polycystic kidney disease.

Serum creatinine (over several months or years) as
opposed to a sudden increase in the serum creatinine
(several days to weeks

 . If these levels are unavailable (because
the patient has been well and has had no
blood tests)


.Additional tests may include nuclear medicine MAG3
scan to confirm blood flows and establish the differential
function between the two kidneys. DMSA scans are also
used in renal imaging

Control of blood pressure and treatment of the
original disease, whenever feasible, are the broad
principles of management. Generally, angiotensin
converting enzyme inhibitors (ACEIs) or angiotensin
II receptor antagonists (ARBs) are used

Currently, several compounds are in
development for CKD. These include, but are
not limited to, bardoxolone methyl,[11]
olmesartan medoxomil, sulodexide, and
avosentan.

Alzheimer's is a type of dementia
that causes problems with memory,
thinking and behavior. Symptoms
usually develop slowly and get worse
over time, becoming severe enough
to interfere with daily tasks.
298

World wide dementia is
assuming greater social and puplic
health importance because of the
rising population of the eldery who
are most effected . AD is the
commenst type of dementia
accuoning for 50-75 %of cases .
300

• The role of diet and culture factors
warrant further study as ways of
prevention a potential epidemic as
the African population is also
undergoing demographic transition
.
301

• Early :
• difficulty remembering newly learned
information.
• Late:
• disorientation, mood and behavior changes;
deepening confusion more serious memory
loss and behavior changes; and difficulty
speaking, swallowing and walking.
303

• Detailed pictures of the brain,
such as a CT scan (computed
tomography), an MRI (magnetic
resonance imaging), or a PET scan
(positron emission tomography)
to identify
305

• changes in brain structure or size
indicative of Alzheimer's, or to
look for brain tumors, blood
clots, strokes, normal pressure
hydrocephalus (NPH), or other
abnormalities that might account
for Alzheimer's-like symptoms.
307

• Intellectual activities such as playing chess or
regular social interaction have been linked to a
reduced risk of AD in epidemiological studies,

• diet
• exercise
309

• pharmaceutical :
acetylcholinesterase inhibitors
NMDA receptor antagonist.
• Psychosocial intervention
• Caregiving
311



The WHO Definition:
- unpremeditated event resulting in
recognizable damage.



An
unexpected,
unplanned
occurrence which may involve injury.



Occurrence in a sequence of events
which usually produces unintended
injury, death or property damage.



A 1985 study by K. Rumar, using British and
American crash reports as data, found that
57% of crashes were due solely to driver
factors, 27% to combined roadway and driver
factors, 6% to combined vehicle and driver
factors, 3% solely to roadway factors, 3% to
combined roadway, driver, and vehicle
factors, 2% solely to vehicle factors and 1%
to combined roadway and vehicle factors

More than 1.2 million
people are killed
in Road Accidents,
worldwide , every year.
1 to 2 % of Gross National Product
Is lost in Road Accidents.

One child is killed in
Road Accidents,
every three minutes
in the World.

Total worldwide death toll of
Tsunami of 2004 was about 230,000.
But the annual worldwide death toll of
Road Accidents is 1,200,000 !!!
i.e. more than
five times the Tsunami toll.

 According

to the latest WHO data
published in April 2011 Road Traffic
Accidents Deaths in Sudan reached
14,977 or 4.06% of total deaths. The
age adjusted Death Rate is 39.25 per
100,000 of population ranks Sudan
#9 in the world

1990 Disease or Injury
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Lower Respiratory
infection
Diarrhoeal disease
Perinatal conditions
Unipolar major depression
Ischaemic heart disease
Cerebrovascular disease
Tuberculosis
Measles
Road Traffic Injuries
Congenital Abnormalities

2020 Disease or Injury
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Ischaemic heart disease
Unipolar major depression
Road Traffic Injuries
Cerebrovascular disease
Chronic obstructive
pulmonary disease
Lower Respiratory infection
Tuberculosis
War
Diarrrhoeal disease
HIV

The road traffic death rate by WHO
region and income level: Low- and middleincome countries have higher road traffic
fatality rates (21.5 and 19.5 per 100 000
population, respectively) than high-income
countries (10.3 per 100 000 population)..

While road traffic death rates in
many high-income countries have
stabilized or declined in recent
decades, data suggest that in most
other regions of the world the global
epidemic of traffic injuries is still
increasing







In 2011 WHO began work on the second such
report. The objectives of this new Global status report
are:
to indicate the gaps in road safety nationally and
thereby stimulate road safety activities
to describe the road safety situation in all Member
States and assess changes that have occurred since
the publication of the first Global status report.





to serve as a baseline for monitoring activities
relating to the Decade of Action for Road Safety at
the national and international levels.
Data collection will begin in early 2011 and will be
carried out in all WHO Member States that agree to
participate, working through WHO Regional and
Country offices. The Report will be published in
2012.

1.

2.
3.
4.

The exposure – the amount of
movement or travel within the
system by different users or a given
population density.
The underlying probability of a
crash, given a particular exposure.
The probability of injury
The outcome of injury








Inappropriate and excessive speed
Presence of alcohol and other drugs
Fatigue
Being young and male
Being vulnerable road user in an urban or
residential area







Traveling in darkness
Poor vehicle maintenance
Road design, layout and maintenance defects
Inadequate visibility due to weather conditions
Poor eyesight



Drinking and driving is one of the
main causes of road crashes
worldwide. In high-income countries
about 20% of fatally injured drivers
have excess alcohol in their blood,
while in some low- and middleincome countries these figures may
be up to 69

Prevention of RTA /
RTI

What Can We Do?



Heavy Penalty should be imposed on all
those who cross speed limits. If this is
strictly implemented, nobody will dare to
go at high speed.



Heavy penalty should be imposed for
those who cause accidents.



All those who do not maintain the safe
distance for the speed should be punished.



Safety awareness should begin from
childhood, as it is difficult to impart
awareness to a grown up a human. If safety
awareness is imparted at childhood, safety
will be a habit.





Refreshment parlors should be made available
at (say) every 50 / 100 k.m. on all national
highways and truck / heavy vehicle drivers
should be forced to refresh by having a face
wash or by having a cup of tea or coffee.

Advertisement boards and other items that
may obstruct visibility at junctions, curvatures
and other parts of the roads should be removed
immediately.





TV and other media should be
effectively used for Public safety
awareness.

Roads should be properly maintained.
Permanent contracts / arrangements
should be in place for maintaining all
roads in good condition 24 hours a day,
365 days an year. If a gutter is repaired
in time it can save a life !!!



Road Safety Day / Road Safety Week
should be observed in all Schools, every
year. Competitions on Road Safety Tips,
Slogans, Essay, Painting etc should be
conducted for various categories of
students.






You can fight
road accidents
by simply
spreading the awareness on Road Safety

Driving without drinking

Reduce driving speed

Driving without using
mobile phone or text
message

5 Tsunamis are wiping out
lives from the world every year,
in the form of Road Accidents.
Nobody is noticing it !!!

Non c d communti

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