Early identification and prevention

1. Non-Communicable Diseases-1

2. Non Communicable Diseases
• Non communicable diseases under
major focus:
– Cardiovascular Diseases (CVD)
such as heart attacks
– Diabetes
– Chronic Respiratory Diseases
(Chronic Obstructive Pulmonary
Diseases and Asthma)
– Cancer
• Key factors linked to the onset of NCDs
– Tobacco use and exposure
– Unhealthy diet
– Physical inactivity
– Harmful use of alcohol
– Indoor and ambient air pollution
– Stress
– Poverty (as a cause and consequence)
– Poor health seeking behaviors
– Low access to health-care services

3. NATIONAL PROGRAMME FOR THE
PREVENTION AND CONTROL OF CANCER, DIABETES,
CARDIOVASCULAR DISEASES AND STROKE
(NPCDCs)

4. Diabetes
• Usually occurs in younger people, children and adolescents
• The diagnosis of T1DM can be made throughout childhood
but it is more likely below 15 yrs of age
• The onset is usually acute and severe and insulin is required
for survival
Type 1 diabetes
(T1DM):
• It usually occurs after the age of forty years but occurs
frequently even at lower age among Indians
• T2DM is known as non-insulin dependent diabetes mellitus.
• The onset is usually insidious and may be mild to severe
Type 2 diabetes
(T2DM):

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6. When to suspect diabetes?
Symptoms of uncontrolled hyperglycemia:
• Excess thirst
• Excess urination
• Excess hunger with loss of weight
• Frequent infections
• Non-healing wounds
• Fatigue
• Tuberculosis

7. • When to Recommend Hospitalization
– Uncontrolled infection
– Severe cellulitis
– Infections including bad diabetic foot needing intravenous
antibiotics
– Recurrent UTI not responding to oral antibiotics
– Presence of ketones in urine

8. Diabetes Patient Education and Diet Counselling
Initial Visits Follow up visits
• What is Diabetes?
• Why does it occur?
• Lifestyle measures: Diet, Exercise
• Detailed lifestyle advice
• Use of Oral Drugs
• Advice on identifying signs and symptoms of hypoglycemia
and hyperglycemia and their management
• Patient should be informed about the importance of factors
other than glucose control: cholesterol, blood pressure,
stopping smoking,/ tobacco, etc
• Importance of glycemic control
• Prevention of complications
• Foot care
• Pre-conceptional counselling
regarding the importance of good
glucose control prior to pregnancy.

9. Complications of Diabetes mellitus
Microvascular complications
Retinopathy: Damage to eyes
Nephropathy: Damage to kidney
Neuropathy: Damage to nerves
Diabetic foot disorders
Macro-vascular complications
Cardiovascular diseases such as
heart attack and stroke
Insufficiency in blood flow to
legs.

10. Prevention of foot ulcer
Check for:
• Blisters, cuts, sores, ingrown toenails
• Change in temperature or color
• Pain, swelling or any signs of infection
• Dry cracking skin
• Rashes foot
• Corns and calluses
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11. Diabetes & Diet: 7 Foods That Control Blood Sugar
• Raw, Cooked, or Roasted Vegetables.
• whole wheat or soya breads and
unpolished rice
• Melon or Berries.
• Higher-fiber Foods.
• A Little Fat and protein .
• Substitute sucrose with natural sugar,
like honey, jaggery
• Avoid white rice, potatoes, carrots,
breads and banana
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Requirement :
• An obese middle aged or elderly patient with
mild diabetes 1000 -1600 kcal.
• An elderly diabetic but not over weight 1400 -
1800 kcal.
• A young active diabetic 1800 -3000 kcal.
• Daily intake of carbohydrate: 1/10th of total
calories approximately 180gm.
• Daily intake of protein: 60gm to 110gm.
• Daily intake of fat: 50gm to 150gm.

12. Diabetes diet chart:
Morning at 6: teaspoon fenugreek (methi) powder + water.
Morning at 7: 1 cup sugar free tea + 1-2 mary biscuits.
Morning at 8.30: 1 plate upma or oatmeal + half bowl sprouted grains + 100ml cream-free milk without
sugar
Morning at 10.30: 1 small fruit or 1 cup thin and sugar free buttermilk or lemon water
Lunch at 1: 2 roti of mixed flour, 1 bowl rice, 1 bowl pulse, 1 bowl yogurt, half cup soybean or cheese
vegetable, half bowl green vegetable, one plate salad
4 pm: 1 cup tea without sugar + 1-2 less sugar biscuits or toast
6 pm: 1 cup soup
8.30 pm: 2 roti of mixed flour, 1 bowl rice, 1 bowl pulse, half bowl green vegetable, one plate salad
10.30 pm: take 1 cup cream free milk without sugar.
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13. Case :- A 58-year-old gentleman working as a lawyer, known to
have T2DM for 10 years, systemic hypertension, and dyslipidemia, is
on tablet metformin 1 g bd, tablet glimepiride 4 mg bd, tablet
telmisartan 40 mg OD, and tablet atorvastatin 10 mg OD, HS. His
biochemical evaluation shows fasting plasma glucose of 210 mg/dl,
postprandial plasma glucose of 280 mg/dl, What would you advise?
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14. Hypertension
Category Systolic Diastolic
Normal Less than 120 Less than 80
Pre hypertensive 120–139 80–89
Hyperte
nsive
Stage
I
140–159 90–99
Stage
2
160 or higher 100 or higher
Stage
3
180 or higher 110 or higher

15. Risk assessment of hypertension
1. Assessment of medical history:
– Family history
– Symptoms of consequences of hypertension
– Frequent intake of pain relieving drugs
(NSAIDS)
– Steroid intake for asthma
– Breathing difficulty particularly on exertion
– Swelling of feet
– Urinary difficulties, history of passing stones in
the past.
2. Risk factors
• Lack of physical activity (or
sedentary lifestyle)
• Obesity or being overweight
• Abdominal obesity (Waist
circumference more than 90 cm in
male and 80 cm in females)
• High sodium intake/high salt intake
• Excess alcohol consumption

16. Pathophysiology
1. Renin angiotensin aldosteron system
Renin is secreted form kidney & with the help of renin
enzyme , angiotensin converted to angiotensin I
Angiotensin converting enzyme converts to
angiotensin I to angiotensin II.
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Stimulates adrenal cortex to
secretes aldosteron
Increase aldosteron
Increase Na reabsorbtion
Increase water reabsorbtion
Increase blood volume
Increase CO
INCREASE BP
Vasoconstriction
and
stimulates the sensation of
thirst
Increase vascular resistance
Increase BP
2. Stimulation of sympathetic nervous system
release epinephrine and nor –epinephrine from
adrenal medulla
Increase heart rate and myocardial contraction
Increase CO
increase BP

17. Important Symptoms of a hypertensive
emergency include:
• Headache or blurred vision
• Increasing confusion
• Seizure
• Increasing chest pain
• Increasing shortness of breath
• Swelling or edema (fluid buildup in the tissues)
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18. GUIDELINE FOR HYPERTENSIVE EMERGENCY TREATMENT
Hypertensive Emergency Drugs of Choice To Avoid
Hypertensive Encephalopathy :-
dystole 100-110 mm Hg within first hour
then gradual reduction in BP to normal
range over 48-72 h
Labetalol intravenous infusion Centrally acting agents:
clonidine, methyldopa. Nitrates
may decrease cerebral blood
flow and increase ICP.
Ischemic stroke :- thrombolysis, treat if
BP greater than 185/110mmHg.
Labetalol bolus, Labetalol infusion
only after bolus
Nitroprusside intravenous infusion if
blood pressure not controlled with
labetalol
Nitrates
Intracerebral hemorrhage:- If SBP
150-220 mmHg, target SBP 140 mmHg.
Monitor BP every 5 minutes and aim for
target within 1 h.
Labetalol intravenous infusion
Esmolol intravenous infusion
Nitrates
Subarachnoid hemorrhage :- SBP less
than 160 mm Hg but no lower than 120
mm Hg
Labetalol/ Esmolol intravenous
infusion, Nimodipine PO used as
adjunct for reducing vasospasm but not
Nitrates
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19. Left ventricular failure :- lowered to
60–100 mmHg or by 20-25% and
symptomatic improvement
Nitroglycerin intravenous infusion
Nitroprusside intravenous infusion
Beta blockers if
decompensated heart
failure
Postoperative hypertension :- Less
than 180/110 mmHg
Labetalol intravenous infusion
Esmolol intravenous infusion
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20. Other management
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Modification Recommendation Approximate
systolic BP
reduction
Weight reduction Maintain normal
body weight
5–20 mmHg/10 kg
Dietary sodium no more than 2.4 g
sodium/day
2–8 mmHg
Physical activity Engage in regular
aerobic physical
activity at least 30
minutes daily, most
days of the week
4–9 mmHg

21. Complications of Hypertension
Heart:
Left ventricular hypertrophy
Diastolic dysfunction
CHF
Cardiac arrhythmias
Brain:
Brain infarction
Hemorrhage
Eye:
Micro-aneurysms
Hemorrhages
Cotton-wool spots
Kidneys
Macro albuminuria
Micro albuminuria

22. Stroke
• A stroke means that part of the brain is suddenly damaged. If an artery in
the brain becomes blocked by a thrombus, it causes a stroke
Identification of an acute event:
• Sudden onset of weakness of one half of body or one part of body
• Sudden onset of inability or difficulty in speech
• Sudden onset of imbalance
• Sudden onset of blindness
• Sudden onset of dizziness or spinning
• Sudden severe headache
• Sudden loss of consciousness

23. Types of Stroke
• Ischemic Stroke (Clots) Occurs when a blood vessel supplying
blood to the brain is obstructed.
• Hemorrhagic Stroke (Bleeds) Occurs when a weakened blood
vessel ruptures.
• TIA (Transient Ischemic Attack) Called a “mini stroke,” it's
caused by a serious temporary clot.
• Cryptogenic Stroke. a stroke is caused by a blood clot that blocks
the flow of blood to the brain.
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24. Emotional and Behavioral Conditions
• Depression
• Anxiety
• Memory Loss
• Pseudobulbar Affect (PBA) (crying or laughing at unexpected, sometimes inappropriate times)
• Dementia
Physical Effects
• Fatigue
• Dysphagia (swallowing problems)
• Shoulder Pain (on the affected/recovering side of the body}
• Central Pain Syndrome (unexplainable pain, temperature sensitivity, sensitivity to light and
touch)
• Vision Problems
• Balance Issues
• Seizures
• Spasticity (tightening of the muscles in the affected limb)
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25. Management
• Patients of stroke presenting within 6 hours of onset of symptoms should be
referred to a secondary care for initial assessment and management
• The follow-up of patients presenting with a completed stroke not requiring acute
care (such as respiratory distress) can be managed at the PHC level

26. Rehabilitation services may include:
• Rehabilitation nursing
• Physical therapy
• Occupational therapy
• Speech, language, and/or hearing therapy
• Recreational therapy
• Nutritional care
• Rehabilitation counseling
• Social work
• Psychiatric or psychological treatment
• Patient/family education
• Support groups
• Vocational evaluation
• Driver’s training
• Programs to improve physical and emotional stamina to return to work
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27. Process of Atherosclerosis
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28. Conditions that affect the structures or function heart
because of atherosclerosis
• Coronary artery disease (narrowing of the arteries)
• Heart attack
• Abnormal heart rhythms, or arrhythmias
• Heart failure
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29. Cardiac rehabilitation programme
• Physician-prescribed exercise
• Cardiac risk factor modification (education,
counseling, and behavioral intervention)
• Psychosocial assessment
• Outcomes assessment
• Individual treatment plans
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30. 7 symptoms of cancer
• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
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32. Oral cancer
Signs and symptoms of oral cancer may include:
• A lip or mouth sore that doesn't heal
• A white or reddish patch on the inside of your mouth
• Loose teeth
• A growth or lump inside your mouth
• Mouth pain
• Ear pain
• Difficult or painful swallowing
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34. Examples of blood tests used to diagnose cancer include:
• Complete blood count (CBC)
• A bone marrow biopsy.
• Blood protein testing. A test (electrophoresis) to examine multiple
myeloma.
• Tumor marker tests:- prostate-specific antigen (PSA) for prostate cancer,
cancer antigen 125 for ovarian cancer, alpha-fetoprotein (AFP) for liver
cancer
• Circulating tumor cell tests.:-to detect cells that have broken away from
an original cancer site and are floating in the bloodstream.
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35. Cancer prevention: 7 tips to reduce your risk
• Don't use tobacco.
• Eat a healthy diet.
• Maintain a healthy weight and be physically active.
• Protect from the sun.
• Get vaccinated.
• Avoid risky behaviors( safe sex and don’t share needles ) .
• Get regular medical care.
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