1
Noncommunicable
Disease
2

Rawaa Azhari
Definition
3
non-communicable disease, or
NCDs, is a medical condition or
disease which by definition is
non-infectious and nontransmi...
Includes:

5

Heart disease
Chronic respiratory disease
Cancer
Chronic kidney disease
Inherited disease
Diabetes mel...
Auto immune disease
Stroke.
Road traffic accident and injuries

Osteoporosis
Blindness

obesity
6
Risk factors
7
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 lev...
Who is at risk of such
diseases?
All age groups and all regions are
affected by NCDs. Often associated
with older age grou...
diseases (NCDs) occur before the age
of 60. Of these “premature" deaths,
90% occurred in low- and middleincome countries…....
Children, adults and the
elderly are all vulnerable to
the risk factors that contribute
to non communicable
diseases,
13
Epidemiology
14
NCDs and global health

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

80% of dea...
by 2020, NCDs will attribute
to 7 out of every 10 deaths
in developing countries.
killing 52 million people
annually wor...
Impact on development
The NCD epidemic strikes
disproportionately among people of
lower social positions. NCDs and
poverty...
to behavioral risk factors
for NCDs and in turn ,
the resulting NCDs may
become an important driver
to the downward spiral...
The burden of disease
attributed to NCDs has been
estimated at 85% in industrialized
nations, 70% in middle income
nations...
Prevention
and control
20
Comprehensive approach requires
multisectrol coordination, including
health, finance, foreign affairs,
education, agricult...
Essential NCD interventions that
can be delivered through a primary
health-care

raising taxes on tobacco, banning
tobacco...
Reducing levels of salt in foods.
Stopping the inappropriate
marketing of unhealthy food
Non-alcoholic beverages to
childr...
Burden
in Sudan
24
NCD are emerging as one
of the major health problem
in Sudan.
Data on the disease burden
of NCDs in Sudan is scarce
and de...
The commonest non
communicable disease in
Sudan :
Hypertension,diabetes and heart
disease represent the most common
form.
...
Khartoum stepwise survey
2006 :
Smoking was 29.1% in male.
BMI showed 29.8% of male and
31.8% of female were over weight
,...
Hypertension was 23.6%
DM was 19.2%

High serum lipids was 19.8%
28
Thanks
29
30
Ibrahim Yagoup
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
Epidemiology
IHD is considered as “modern “
epidemic
The highest coronary mortality is
seen in north Europe and English
spoken countrie...
.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...
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 IH...
Risk factors
.Not modified risk factors :
1. Age
2. Sex
3. Family history
4. Genetic factors
1.Smocking
2.Hypertension
3.Elevated
serum
cholesterol
4.Diabetes
5.Dicrease
Physical
activity
6.Obesity
Organic Nitrates
Beta Blockers
Calcium Channel Blockers
Statins
Aspirin
1.Health
balance
diet
2. physical
activity
3. Smoking
cessation
4. alcohol cessation
5.Keep
diabetes
under control
6. The person must
take any medication
describe for him .
Hypertension
Nmariq
Abdulazeem

59
Definition
60
:
High blood pressure called
hypertension is the force of blood
applied against the wall of arteries
as heart pumps blood ...
Epidemiology
62
• As of 2000, nearly one billion people or ~26%
of the adult population of the world had
hypertension.] It was common in b...
• However rates vary markedly in different
regions with rates as low as 3.4% (men)
and 6.8% (women) in rural India and as
...
–

In 1995 it was estimated that 43 million
people in the United States had
hypertension or were taking
antihypertensive m...
• The prevalence of hypertension in the United
States is increasing and reached 29% in
2004.As of 2006 hypertension affect...
– It is more common in blacks and native
Americans and less in whites and Mexican
Americans, rates increase with age, and ...
68
69
70
Classification
71
Blood pressure is usually classified based on
systolic & diastolic blood pressure .
Systolic blood pressure is blood press...
• Primary hypertension or essential means
high blood pressure with no obvious
underlying medical cause about 90-95 at
case...
• Malignant hypertension is severe elevated
blood pressure greater than 180systolic or
diastolic 110 referred to hypertens...
Risk factor
75
• These may be classified as;
• 1-non modifiable risk factors ;• Age ;blood pressure rises in both sex and rising Is
great...
• Modifiable risk factors:•
•
•
•
•
•
•
•

Obesity
Salt in take
Saturated fat
Alcohol
smoking
Physical activity
Environmen...
Complications
78
Heart attack or stork .
Brain aneurysm .
Heart failure .
Metabolic syndrome .
Hypertensive nephropathy .
Hypertensive reti...
80
Diagnoses &investigations
• General diagnosed three separate
sphygmomanometer measurement at
least one week.
• Initial ass...
Management :
The essential HTN requires pt life style
management &therapeutic intervention
Benefits of pharmacologic treat...
Prevention of hypertension
WHO has recommended the following
approaches in the prevention of HTN:1-primaryprevention;-to r...
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
Exercise :

87
2- secondary prevention:
# early case detection .
# treatment .
# patient compliance :

88
Thanks
89
Stroke
OSMAN A. NOUR
ELHUDA
Definition
• A stroke occurs when blood
flow to the brain is interrupted by
a blocked or a burst blood vessel.
Epidemiology
Stroke is leading cause of death
in the sudan
• On average, someone suffers a
stroke every 40 seconds
• About 30.000 sudan...
•

Stroke is a leading cause of
serious, long-term disability .
• About 6.4 million sudanese are
stroke survivors .
Classification
Ischemic Stroke (Blockage)
• Caused by a blockage in blood
vessels in brain
Hemorrhagic Stroke (Bleeding)
• Caused by burs...
Causes of Ischemic Stroke
Begins with the development of fatty deposits
lining the blood vessel wall
• Thrombus: Developme...
Causes of Hemorrhagic
Stroke
Occurs when a weakened blood
vessel ruptures
• Aneurysms: Ballooning of a
weakened region of ...
Risk factors
Non-modifiable :
•
•
•
•
•

Age
Sex
Race
Prior stroke
Family history
Modifiable
•
•
•
•
•
•
•

Hypertension/High Blood Pressure
Heart Disease
Cigarette Smoking
Transient Ischemic Attacks
Diab...
Less Well-Documented
•
•
•
•

Geographical Location
Socioeconomic Factors
Excessive Alcohol Intake
Certain Kinds of Drug A...
Clinical
Manifistation
• Sudden weakness or numbness
of the face, arm or leg, especially
on one side of the body
• Sudden confusion, trouble
spea...
• Sudden trouble walking,
dizziness, loss of balance or
coordination
• Sudden, severe headaches with
no known cause (for h...
Transient Ischemic Attacks
• Warning strokes” that can happen before a
major stroke
• Occur when blood flow through a brai...
StrokeEffects
Right brain
Left Brain
Treatment
Ischemic Stroke : :
• Clot-busters
• Anticoagulants – warfarin. aspirin
• Carotid Endarterectomy
• Angioplasty/Stents
Hemo...
Prevention
•
•
•
•

Control high blood pressure
Prevent heart disease
Stop cigarette smoking
Recognize signs of TIA and tell
physicia...
Rehabitilation
After suffering a stroke, it’s
important to begin a
rehabilitation program as soon as
possible
Types
of rehabilitation
•
•
•
•

Hospital programs
Nursing facilities
Outpatient programs
Home-based programs
Thanks
Hadeil
Fakhereldin
Definition
121
Rheumatic heart disease is the
most serious complications of
rheumatic fever..

Acute rheumatic fever follows
cases of gro...
123
Worldwide rheumatic heart disease is
a major health problem..
Chronic Rheumatic disease is estimated
to occur in 5_30 mill...
125
Acute Rheumatic fever &
rheumatic heart disease both
are autoimmune inflammatory
response ..
Inflammation of heart (cardit...
127
128
Endocarditis lead to a set of valve
damage .. When it begins it tend to
continuously worsen over time..
Once mitral valve ...
Aortic valve also may be involved
&develop stenosis, regurgetation or
both..

130
131
132
It is diagnosed by Modified Jones
criteria which require the presence of 2
major or 1 major & 2 minor…
 Major criteria in...
previous group A streptococcal
pharyngitis is required to diagnose
rheumatic fever with :
+ve throat culture of streptococ...
135
Medical therapy critically attempts to
prevent rheumatic fever..
Oral Penicillin is used for pharyngitis
Allergic patients...
patients with rheumatic heart
disease complication , fluids& sodium
intake should be restricted.
Potassium supplementation...
138
Chronic Obstructive
Pulmonary
Disease
shattir saeed
Definition
Chronic obstructive pulmonary disease •
(COPD) is a preventable and treatable
disease state characterized by air flow
limi...
Epidemiology
According to WHO estimates, 65 million
people have moderate to severe chronic
obstructive pulmonary disease (COPD).
More t...
accurate epidemiologic data on COPD are
difficult and expensive to collect. It is known
that almost 90% of COPD deaths occ...
among women in high-income countries
and the higher risk of exposure to indoor
air pollution (such as biomass fuel used
fo...
In 2002 COPD was the fifth leading
cause of death. Total deaths from
COPD are projected to increase by
more than 30% in th...
mortility
Risk factors for COPD include both
environmental exposure and genetic
factors
.Tabacco smoke is the major cause of COPD (8...
Causes of COPD in
Non-smokers
.Alpha 1 AT Deficiency
.Primary Ciliary Dysknesia
.Beta receptor heterogeneity
.Dietary defi...
Clinical
manifestation
.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
Macrophag...
Diagnosis of COPD
EXPOSURE TO
RISK
FACTORS

SYMPTOMS
cough
sputum
dyspnea

tobacco
indoor/outdoor pollution
occupation

SP...
Complications
.Chronic respiratory faliure

.Pneumothorax
.Chronic pulmonary heart
disease
Management
. An effective COPD management plan
includes four components:
(1)assess and monitor disease;
(2) reduce risk factor
(3) ma...
. The goals of effective COPD
management are to:
.Prevent disease progression
.Relieve symptoms
.Improve exercise toleranc...
Treatment
Based on the principles of
prevention of further progress of •
disease
preservation and enhancement of •
pulmonary functio...
Stop smoking
Avoid environment pollution
Antibiotic therapy
Bronchodilators
Glucocorticoids
Expectorant
Respiratory stimul...
Thanks
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
an...
THE PROBLEM
• Every 23 Seconds Someone is Diagnosed with Cancer
• Cancer is a leading cause of death worldwide and
account...
• 70%
• Approximately 70% of cancer deaths occur in
low- and middle-income countries
Estimated age-standardised incidence
and mortality rates WORLD
Estimated age-standardised incidence
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
...
Cancer in sudan
• Cancer diseases in sudan are significantly
increasing to become one of the major ten kill
er diseases in...
Estimated age-standardised incidence
and mortality rates SUDAN
Estimated age-standardised incidence
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 ...
B- Alcohol : excessive intake of
alcoholic beverages is
associated with esophageal
and liver cancer.
Some recent studies h...
D- Occupational Exposures .
E- Viruses.
F-Parasites.
(2)-Genetic factors:
How can the burden of cancer be
reduced?
• Knowledge about the causes of cancer, and
interventions to prevent and manage t...
CANCER CONTROL • The who estimate that cancer acount for 7.6
million around 13% of all deaths more than 40%
of cancer case...
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...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Primary prevention
• A-control of tobacoo and
alcohol consumption
• B-personal hygiene
• C- reduce the amount of
radiation...
Secondary prevention
• 1-cancer registraion
• 2-early detection of cases
• 3-treatment
Secondary prevention
• 1-cancer registraion
• 2-early detection of cases
• 3-treatment
Secondary prevention
• 1-cancer registraion
• 2-early detection of cases
• 3-treatment
Diabetes
Mellitus
Amal hassan
204
Definition
205
Diabetes is a group of
metabolic diseases in which a
person has high blood sugar,
either because the body
does not produce...
Epidemiology
207
•

The crude prevalence was 3.4%
DM . The highest crude prevalevce
northern Sudan (5.5%) lowest in
western Sudan (0.9%). N...
Classification
209
Type 1:
Results from the body failure to
produce insulin.
It is also known by insulin-dependent
diabetes mellitus (IDDM).....
•
•

Also known as non insulindependent diabetes mellitus..

Type 3:
It is the gestational
diabetes ..
Presented by high
b...
Clinical
Presentation
212
• Loss of weight..
• Polyuria (frequent urination)..
• Polydepsia (increased
thirst)..
• Polyphagia (increased hunger)..

...
214
Diagnosis
215
dDiabetes

is charaterised by
acte
recurrent or persistent
hyperglycemia, and is diagnosed by
:
• Fasting plasma
glucose l...
• Two hours after 75g oral
glucose load tolerance Test..

217
Management
218
DM is a chronic disease which can
not be cured except in very specific
situation..
• It concentrate on keeping blood
sugar...
• controlling diet
• exercise
• medication & patient education
reduce complications ..

220
Medication
221
• Metformin is the firt line treatment
for type 2 DM
• Routine use of Aspirin to improve
uncomplicated DM..
• Insulin ther...
223
Complications
224
• Macrovascular disease related to
atherosclerosis is the major
complication …
•

•

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

226
227
228
Thanks
229
Obesity
MOHAMMED AL-BADRI
Definition
Abnormal or excessive fat accumulation
that may impair health.
.Of all countries,the United States has
the highst rate of ...
.The treating of obesity- related
diseases cost United states about 190
billion dollar.
.Africa is associated with infecti...
.In South Africa 64% of black
population are overweight or
obese.
.Black population think being
obese women is beautiful a...
Classification
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. Hypertrophi...
2. According to fat accumulation
and distribution
Two forms:
1. Android obesity:
It is the male pattern of obesity in whic...
• 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...
Waist_hip ratio
3. According to weight
Defined by :
the Percentage overweight
Causes of obesity
•Overeating ( habit , pleasure,
psychological )
Physical inactivity
Inheritance
Endocrinal e.g hypothyrodism ,
cushing syndrom.
Management
To establish an optimal body
weight
.Weight determination
.Comparison of body
circumferences or diameter.
.Measuring Skin ...
Skin fold thickness
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 f...
complications
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...
Exercise and health
Benefits of doing exercise
I- Reduces Risk of:
.CHD
.Stroke
.Bowel cancer
.Osteoporosis
.Obesity
.Stress & anxiety
.Mild D...
2-Increases sense of Well being

3- Increases HDL cholesterol.
4-Weight Control.
Thanks
Chronic
KidneyDisease
• Ahmed M. Alamin
Definition
 also known as chronic renal disease, is
a progressive loss in renal function over a
period of months or years Often,
 i...
Creatinine levels may be normal in the early
stages of CKD, and the condition is discovered if
urinalysis (testing of a ur...
Clinical
Manifestation
• . The symptoms of worsening kidney function
are unspecific, and might include feeling
generally unwell and experiencing ...
•

Blood pressure is increased due to fluid
overload and production of vasoactive
hormones created by the kidney via the r...
• Urea accumulates, leading to azotemia and
uremia (symptoms ranging from lethargy to
pericarditis and encephalopathy). Ur...
• Fluid volume overload — symptoms may range
from mild edema to life-threatening pulmonary
edema
• Hyperphosphatemia — due...
• Hypocalcemia — due to 1,25 dihydroxyvitamin D3
deficiency.
• Metabolic acidosis, due to accumulation of
sulfates, phosph...
Causes


The most common causes of CKD are
diabetes mellitus, hypertension, and
glomerulonephritis. Together, these cause
approx...
Vascular,
includes large vessel disease such as bilateral renal
artery stenosis and small vessel disease such as
ischemic ...
2/Glomerular,
comprising group and subclassified into:
oPrimary Glomerular disease:
such as focal segmental glomeruloscler...
• the kidney can also cause nephropathy
• 3/Tubulointerstitial including :
• polycystic kidney disease, drug and toxinindu...
Diagnosis
Abdominal ultrasound, in which the size of the kidneys is
measured . Kidneys with CKD are usually smaller (< 9 cm)
than n...
 . If these levels are unavailable (because
the patient has been well and has had no
blood tests)


.Additional tests ma...
Treatment
Control of blood pressure and treatment of the
original disease, whenever feasible, are the broad
principles of management...
Thanks
Alzheimer
Maysa Yaseen
296
Definition
297
Alzheimer's is a type of dementia
that causes problems with memory,
thinking and behavior. Symptoms
usually develop slowly...
Epidemiology
299
World wide dementia is
assuming greater social and puplic
health importance because of the
rising population of the eldery...
• The role of diet and culture factors
warrant further study as ways of
prevention a potential epidemic as
the African pop...
Clinical
Manifistation
302
• Early :
• difficulty remembering newly learned
information.
• Late:
• disorientation, mood and behavior changes;
deepeni...
Lab
Diagnosis
304
• Detailed pictures of the brain,
such as a CT scan (computed
tomography), an MRI (magnetic
resonance imaging), or a PET s...
306
• changes in brain structure or size
indicative of Alzheimer's, or to
look for brain tumors, blood
clots, strokes, normal ...
Prevention
and control
308
• Intellectual activities such as playing chess or
regular social interaction have been linked to a
reduced risk of AD in ...
Treatment
310
• pharmaceutical :
acetylcholinesterase inhibitors
NMDA receptor antagonist.
• Psychosocial intervention
• Caregiving
311
Thanks
312
Road Traffic
Accident


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



An
unexpected,
unplanned
occurrence wh...


A 1985 study by K. Rumar, using British and
American crash reports as data, found that
57% of crashes were due solely t...
More than 1.2 million
people are killed
in Road Accidents,
worldwide , every year.
1 to 2 % of Gross National Product
Is l...
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 ...
 According

to the latest WHO data
published in April 2011 Road Traffic
Accidents Deaths in Sudan reached
14,977 or 4.06%...
1990 Disease or Injury
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Lower Respiratory
infection
Diarrhoeal disease
Perinatal conditions...
The road traffic death rate by WHO
region and income level: Low- and middleincome countries have higher road traffic
fatal...
While road traffic death rates in
many high-income countries have
stabilized or declined in recent
decades, data suggest t...






In 2011 WHO began work on the second such
report. The objectives of this new Global status report
are:
to indicat...




to serve as a baseline for monitoring activities
relating to the Decade of Action for Road Safety at
the national an...
1.

2.
3.
4.

The exposure – the amount of
movement or travel within the
system by different users or a given
population d...







Inappropriate and excessive speed
Presence of alcohol and other drugs
Fatigue
Being young and male
Being vulne...






Traveling in darkness
Poor vehicle maintenance
Road design, layout and maintenance defects
Inadequate visibilit...
Drinking
&Driving


Drinking and driving is one of the
main causes of road crashes
worldwide. In high-income countries
about 20% of fatally...
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 ...


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



Safety awareness should begin fro...




Refreshment parlors should be made available
at (say) every 50 / 100 k.m. on all national
highways and truck / heavy...




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

Roads should be properly maintained.
Per...


Road Safety Day / Road Safety Week
should be observed in all Schools, every
year. Competitions on Road Safety Tips,
Slo...





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
Non c d communti
Non c d communti
Non c d communti
Non c d communti
Non c d communti
Non c d communti
Non c d communti
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Non c d communti

  1. 1. 1
  2. 2. Noncommunicable Disease 2 Rawaa Azhari
  3. 3. Definition 3
  4. 4. 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.
  5. 5. Includes: 5 Heart disease Chronic respiratory disease Cancer Chronic kidney disease Inherited disease Diabetes mellitus Alzheimer disease
  6. 6. Auto immune disease Stroke. Road traffic accident and injuries Osteoporosis Blindness obesity 6
  7. 7. Risk factors 7
  8. 8. Modifiable behavioral risk factors: Tobacco use  physical inactivity  unhealthy diet Alcohol intakes. 8
  9. 9. Non modifiable risk factor age. Sex Hereditary factor. 9
  10. 10. Metabolic/physiologic al risk factors raised blood pressure  overweight/obesity.  hyperglycemia (high blood glucose levels. 10 hyperlipidemia (high levels of fat in the blood.
  11. 11. 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
  12. 12. diseases (NCDs) occur before the age of 60. Of these “premature" deaths, 90% occurred in low- and middleincome countries…. 12
  13. 13. Children, adults and the elderly are all vulnerable to the risk factors that contribute to non communicable diseases, 13
  14. 14. Epidemiology 14
  15. 15. 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
  16. 16. 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.
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. Prevention and control 20
  21. 21. Comprehensive approach requires multisectrol coordination, including health, finance, foreign affairs, education, agriculture, planning and others Reduce the common modifiable risk factors 21
  22. 22. 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
  23. 23. 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
  24. 24. Burden in Sudan 24
  25. 25. 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)
  26. 26. 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
  27. 27. 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
  28. 28. Hypertension was 23.6% DM was 19.2% High serum lipids was 19.8% 28
  29. 29. Thanks 29
  30. 30. 30
  31. 31. Ibrahim Yagoup
  32. 32. Impaired heart function due to inadequate blood flow to the heart compared to its need
  33. 33. . Angina pectoris at effort .MI .Irregularity of the heart .Cardiac failure .Sudden death
  34. 34. Epidemiology
  35. 35. 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
  36. 36. .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
  37. 37. 25 % – 30 % of death due to IHD IHD is the leading cause of the death IHD is the leading cause of the morbidity
  38. 38. IHD is the leading cause in decreasing quality of the live Approximately one million working years wear lost because of IHD
  39. 39. Risk factors
  40. 40. .Not modified risk factors : 1. Age 2. Sex 3. Family history 4. Genetic factors
  41. 41. 1.Smocking
  42. 42. 2.Hypertension
  43. 43. 3.Elevated serum cholesterol
  44. 44. 4.Diabetes
  45. 45. 5.Dicrease Physical activity
  46. 46. 6.Obesity
  47. 47. Organic Nitrates Beta Blockers Calcium Channel Blockers Statins Aspirin
  48. 48. 1.Health balance diet
  49. 49. 2. physical activity
  50. 50. 3. Smoking cessation
  51. 51. 4. alcohol cessation
  52. 52. 5.Keep diabetes under control
  53. 53. 6. The person must take any medication describe for him .
  54. 54. Hypertension Nmariq Abdulazeem 59
  55. 55. Definition 60
  56. 56. : High blood pressure called hypertension is the force of blood applied against the wall of arteries as heart pumps blood through body . 61
  57. 57. Epidemiology 62
  58. 58. • 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
  59. 59. • 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
  60. 60. – 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
  61. 61. • 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
  62. 62. – 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
  63. 63. 68
  64. 64. 69
  65. 65. 70
  66. 66. Classification 71
  67. 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
  68. 68. • 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
  69. 69. • 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
  70. 70. Risk factor 75
  71. 71. • 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
  72. 72. • Modifiable risk factors:• • • • • • • • Obesity Salt in take Saturated fat Alcohol smoking Physical activity Environmental stress Others factors such as oral contraception ,noise, temperature 77
  73. 73. Complications 78
  74. 74. Heart attack or stork . Brain aneurysm . Heart failure . Metabolic syndrome . Hypertensive nephropathy . Hypertensive retinopathy . 79
  75. 75. 80
  76. 76. 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
  77. 77. 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
  78. 78. 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
  79. 79. consume the a diet rich in fruit and vegetables & reduce saturated fat 84
  80. 80. Reduce the up take of caffeine (coffee & tea) reduce salt 85
  81. 81. stop Smoking avoid alcohol 86
  82. 82. Exercise : 87
  83. 83. 2- secondary prevention: # early case detection . # treatment . # patient compliance : 88
  84. 84. Thanks 89
  85. 85. Stroke OSMAN A. NOUR ELHUDA
  86. 86. Definition
  87. 87. • A stroke occurs when blood flow to the brain is interrupted by a blocked or a burst blood vessel.
  88. 88. Epidemiology
  89. 89. 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
  90. 90. • Stroke is a leading cause of serious, long-term disability . • About 6.4 million sudanese are stroke survivors .
  91. 91. Classification
  92. 92. Ischemic Stroke (Blockage) • Caused by a blockage in blood vessels in brain Hemorrhagic Stroke (Bleeding) • Caused by burst or leaking blood vessels in brain
  93. 93. 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
  94. 94. 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
  95. 95. Risk factors
  96. 96. Non-modifiable : • • • • • Age Sex Race Prior stroke Family history
  97. 97. Modifiable • • • • • • • Hypertension/High Blood Pressure Heart Disease Cigarette Smoking Transient Ischemic Attacks Diabetes Elevated Blood Cholesterol/Lipids Asymptomatic Carotid Bruits
  98. 98. Less Well-Documented • • • • Geographical Location Socioeconomic Factors Excessive Alcohol Intake Certain Kinds of Drug Abuse
  99. 99. Clinical Manifistation
  100. 100. • 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
  101. 101. • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden, severe headaches with no known cause (for hemorrhagic stroke)
  102. 102. 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
  103. 103. StrokeEffects
  104. 104. Right brain
  105. 105. Left Brain
  106. 106. Treatment
  107. 107. Ischemic Stroke : : • Clot-busters • Anticoagulants – warfarin. aspirin • Carotid Endarterectomy • Angioplasty/Stents Hemorrhagic Stroke : • Surgical Intervention • Endovascular Procedures, e.g., “coils”
  108. 108. Prevention
  109. 109. • • • • Control high blood pressure Prevent heart disease Stop cigarette smoking Recognize signs of TIA and tell physician • Reduce blood cholesterol levels
  110. 110. Rehabitilation
  111. 111. After suffering a stroke, it’s important to begin a rehabilitation program as soon as possible
  112. 112. Types of rehabilitation
  113. 113. • • • • Hospital programs Nursing facilities Outpatient programs Home-based programs
  114. 114. Thanks
  115. 115. Hadeil Fakhereldin
  116. 116. Definition 121
  117. 117. Rheumatic heart disease is the most serious complications of rheumatic fever.. Acute rheumatic fever follows cases of group A beta_hemolytic streptococcal pharyngitis .. 122
  118. 118. 123
  119. 119. 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
  120. 120. 125
  121. 121. 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
  122. 122. 127
  123. 123. 128
  124. 124. 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
  125. 125. Aortic valve also may be involved &develop stenosis, regurgetation or both.. 130
  126. 126. 131
  127. 127. 132
  128. 128. 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
  129. 129. previous group A streptococcal pharyngitis is required to diagnose rheumatic fever with : +ve throat culture of streptococcal antigen. Elevated streptococcal antibody titer .. 134
  130. 130. 135
  131. 131. 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
  132. 132. patients with rheumatic heart disease complication , fluids& sodium intake should be restricted. Potassium supplementation is also necessary.. 137
  133. 133. 138
  134. 134. Chronic Obstructive Pulmonary Disease shattir saeed
  135. 135. Definition
  136. 136. 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.
  137. 137. Epidemiology
  138. 138. 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.,
  139. 139. 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
  140. 140. 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.
  141. 141. 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.
  142. 142. mortility
  143. 143. 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
  144. 144. Causes of COPD in Non-smokers .Alpha 1 AT Deficiency .Primary Ciliary Dysknesia .Beta receptor heterogeneity .Dietary deficiency: Retinoic acid, Betacarotene .Strong family history
  145. 145. Clinical manifestation
  146. 146. .Chronic cough, .Sputum production, .Dyspnea .History of exposure to risk factors for the disease.
  147. 147. 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
  148. 148. Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS cough sputum dyspnea tobacco indoor/outdoor pollution occupation SPIROMETRY
  149. 149. Complications
  150. 150. .Chronic respiratory faliure .Pneumothorax .Chronic pulmonary heart disease
  151. 151. Management
  152. 152. . An effective COPD management plan includes four components: (1)assess and monitor disease; (2) reduce risk factor (3) manage stable COPD; (4) manage exacerbations
  153. 153. . 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
  154. 154. Treatment
  155. 155. 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.
  156. 156. Stop smoking Avoid environment pollution Antibiotic therapy Bronchodilators Glucocorticoids Expectorant Respiratory stimulant Oxygen therapy Rehabilitation care Lung volume reduction surgery
  157. 157. Thanks
  158. 158. By NOOR ELKHAIR ALI KHALF ALLAH
  159. 159. WHAT IS CANCER • Cancer regard as a group of disease characterized by
  160. 160. • 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
  161. 161. 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.
  162. 162. • 70% • Approximately 70% of cancer deaths occur in low- and middle-income countries
  163. 163. Estimated age-standardised incidence and mortality rates WORLD
  164. 164. Estimated age-standardised incidence and mortality rates
  165. 165. 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
  166. 166. 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
  167. 167. Estimated age-standardised incidence and mortality rates SUDAN
  168. 168. Estimated age-standardised incidence and mortality rates SUDAN
  169. 169. Cases of cancer (1)- environmental factor (2)-Genetic factors
  170. 170. 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 .
  171. 171. 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 .
  172. 172. D- Occupational Exposures . E- Viruses. F-Parasites.
  173. 173. (2)-Genetic factors:
  174. 174. 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.
  175. 175. 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
  176. 176. PREVENTION 30% of cancers could be prevented (i)-Primary Prevention: (ii)- Secondary prevention:
  177. 177. 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
  178. 178. 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
  179. 179. 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
  180. 180. 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
  181. 181. 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
  182. 182. 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
  183. 183. 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
  184. 184. 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
  185. 185. 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
  186. 186. Secondary prevention • 1-cancer registraion • 2-early detection of cases • 3-treatment
  187. 187. Secondary prevention • 1-cancer registraion • 2-early detection of cases • 3-treatment
  188. 188. Secondary prevention • 1-cancer registraion • 2-early detection of cases • 3-treatment
  189. 189. Diabetes Mellitus Amal hassan 204
  190. 190. Definition 205
  191. 191. 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
  192. 192. Epidemiology 207
  193. 193. • 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
  194. 194. Classification 209
  195. 195. 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
  196. 196. • • Also known as non insulindependent diabetes mellitus.. Type 3: It is the gestational diabetes .. Presented by high blood glucose levels during pregnancy .. 211
  197. 197. Clinical Presentation 212
  198. 198. • Loss of weight.. • Polyuria (frequent urination).. • Polydepsia (increased thirst).. • Polyphagia (increased hunger).. 213
  199. 199. 214
  200. 200. Diagnosis 215
  201. 201. 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
  202. 202. • Two hours after 75g oral glucose load tolerance Test.. 217
  203. 203. Management 218
  204. 204. 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
  205. 205. • controlling diet • exercise • medication & patient education reduce complications .. 220
  206. 206. Medication 221
  207. 207. • 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
  208. 208. 223
  209. 209. Complications 224
  210. 210. • Macrovascular disease related to atherosclerosis is the major complication … • • Diabetic retinopathy Diabetic nephropathy 225
  211. 211. • Diabetic neuropathy..which contribute the risk of diabetes foot problem that may require amputation… 226
  212. 212. 227
  213. 213. 228
  214. 214. Thanks 229
  215. 215. Obesity MOHAMMED AL-BADRI
  216. 216. Definition
  217. 217. 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.
  218. 218. .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.
  219. 219. .In South Africa 64% of black population are overweight or obese. .Black population think being obese women is beautiful and attractive.
  220. 220. Classification
  221. 221. 1. According to number or size of fat cells, 2. According to fat accumulation and distribution, 3. According to weight.
  222. 222. 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.
  223. 223. 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)
  224. 224. • 2. Gyenoid obesity (Pear Shaped People) • In those people, fat accumulates around the hips (usually females).
  225. 225. A WHR > 0,8 in women is considered a degree of android obesity.
  226. 226. 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.
  227. 227. Waist_hip ratio
  228. 228. 3. According to weight Defined by : the Percentage overweight
  229. 229. Causes of obesity
  230. 230. •Overeating ( habit , pleasure, psychological )
  231. 231. Physical inactivity
  232. 232. Inheritance
  233. 233. Endocrinal e.g hypothyrodism , cushing syndrom.
  234. 234. Management
  235. 235. To establish an optimal body weight .Weight determination .Comparison of body circumferences or diameter. .Measuring Skin fold thickness. .Comparison of body mass index (BMI)
  236. 236. Skin fold thickness
  237. 237. Body Mass Index (BMI) • Is calculated by the following equation: [Weight in Kilograms (KG)/Height in meter2 ]
  238. 238. • • • • • Grades of BMI < 18 Underweight Grade I 18 -<25 Normal Grade II 25 -<30 Overweight Grade III >30 Obese
  239. 239. 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)
  240. 240. complications
  241. 241. 1- Psychological: emotional problems particularly among adolescents.
  242. 242. 2- Mechanical disability: Flat feet, osteo-arthritis, lower back pain and abdominal hernias.
  243. 243. 3- Metabolic complication: .Diabetes mellitus, .High cholesterol, .Gall stones .Fatty Liver
  244. 244. 4- Skin complications : infections particularly in skin flexures. 5- Accidents: In street, can’t quickly escape traffic
  245. 245. 6- Respiratory complications: The increased difficulty in breathing may lead to Co2 retention and subsequent drowsiness.
  246. 246. 7-Complications attributed to gynecology and obstetrics: • Amenorrhea could be a risk factor in genital tract tumors.
  247. 247. 8- Obesity increases risk of : Hypertension. coronary heart disease. High blood cholesterol level.
  248. 248. 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
  249. 249. Exercise and health
  250. 250. Benefits of doing exercise I- Reduces Risk of: .CHD .Stroke .Bowel cancer .Osteoporosis .Obesity .Stress & anxiety .Mild Depression
  251. 251. 2-Increases sense of Well being 3- Increases HDL cholesterol. 4-Weight Control.
  252. 252. Thanks
  253. 253. Chronic KidneyDisease • Ahmed M. Alamin
  254. 254. Definition
  255. 255.  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.
  256. 256. 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.
  257. 257. Clinical Manifestation
  258. 258. • . 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
  259. 259. • 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
  260. 260. • 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"). •
  261. 261. • Fluid volume overload — symptoms may range from mild edema to life-threatening pulmonary edema • Hyperphosphatemia — due to reduced phosphate excretion
  262. 262. • Hypocalcemia — due to 1,25 dihydroxyvitamin D3 deficiency. • Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc.
  263. 263. Causes
  264. 264.  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.
  265. 265. Vascular, includes large vessel disease such as bilateral renal artery stenosis and small vessel disease such as ischemic nephropathy, hemolytic-uremic syndrome and vasculitis
  266. 266. 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
  267. 267. • 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
  268. 268. Diagnosis
  269. 269. 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
  270. 270.  . 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
  271. 271. Treatment
  272. 272. 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.
  273. 273. Thanks
  274. 274. Alzheimer Maysa Yaseen 296
  275. 275. Definition 297
  276. 276. 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
  277. 277. Epidemiology 299
  278. 278. 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
  279. 279. • 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
  280. 280. Clinical Manifistation 302
  281. 281. • 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
  282. 282. Lab Diagnosis 304
  283. 283. • 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
  284. 284. 306
  285. 285. • 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
  286. 286. Prevention and control 308
  287. 287. • 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
  288. 288. Treatment 310
  289. 289. • pharmaceutical : acetylcholinesterase inhibitors NMDA receptor antagonist. • Psychosocial intervention • Caregiving 311
  290. 290. Thanks 312
  291. 291. Road Traffic Accident
  292. 292.  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.
  293. 293.  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
  294. 294. 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.
  295. 295. One child is killed in Road Accidents, every three minutes in the World.
  296. 296. 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.
  297. 297.  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
  298. 298. 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
  299. 299. 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)..
  300. 300. 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
  301. 301.    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.
  302. 302.   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.
  303. 303. 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
  304. 304.      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
  305. 305.      Traveling in darkness Poor vehicle maintenance Road design, layout and maintenance defects Inadequate visibility due to weather conditions Poor eyesight
  306. 306. Drinking &Driving
  307. 307.  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
  308. 308. Prevention of RTA / RTI What Can We Do?
  309. 309.  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.
  310. 310.  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.
  311. 311.   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.
  312. 312.   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 !!!
  313. 313.  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.
  314. 314.     You can fight road accidents by simply spreading the awareness on Road Safety
  315. 315. Driving without drinking Reduce driving speed Driving without using mobile phone or text message
  316. 316. 5 Tsunamis are wiping out lives from the world every year, in the form of Road Accidents. Nobody is noticing it !!!

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