1

2 Rawaa Azhari

Non-communicable Disease

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Definition

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non-communicable disease, or NCDs, is a medical condition or disease which by definition is non-infectious and non-transmissible between persons

. NCDs may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of sudden stroke.

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Includes:

Heart disease Chronic respiratory disease Cancer Chronic kidney diseaseInherited diseaseDiabetes mellitus Alzheimer disease

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Auto immune disease Stroke.Road traffic accident and injuriesOsteoporosisBlindnessobesity

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Risk factors

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Modifiable behavioral risk factors:Tobacco use physical inactivity unhealthy dietAlcohol intakes.

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Non modifiable risk factor

age.Sex Hereditary factor.

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Metabolic/physiological risk factorsraised blood pressure overweight/obesity. hyperglycemia (high blood

glucose levels.hyperlipidemia (high levels of fat

in the blood.

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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

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

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

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Epidemiology

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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 middle income country

Nine million of all death occur before the age of 60

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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 challenge as well.

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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

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the resulting NCDs may become an important driver to the downward spiral that leads families towards poverty.

to behavioral risk factors for NCDs and in turn ,

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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.

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Prevention and control

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

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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

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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

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Burden in Sudan

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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 death (2005)

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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 renal disease, RTAs and injury

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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

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Hypertension was 23.6% DM was 19.2% High serum lipids was 19.8%

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Thanks

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Ischemic

heart diseas

eIbrahim Yagoup

Definition

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 countries ( Finland ,Scotland , northern Ireland ) In Africa IHD is Less than other Continent but its still the main cause of death

In sudan .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 IHD23% die due IHD

Burden of the disease

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

Risk factors

.Not modified risk factors :1. Age 2. Sex 3. Family history4. Genetic factors

Modified risk factors

1.Smocking

2.Hypertension

3.Elevated serum cholesterol

4.Diabetes

5.Dicrease Physical activity

6.Obesity

Treatment

Organic Nitrates Beta Blockers Calcium Channel Blockers Statins Aspirin

Prevention

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

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Definition

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:

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

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Epidemiology

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• 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.

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• 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.

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– 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.

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• 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%.

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– 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.

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Classification

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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 beatClassification are made after average a pts resting

blood pressure reading taken on two or more office visits .

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• 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 .

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• 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.

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Risk factor

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• 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.

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• Modifiable risk factors:-• Obesity• Salt in take• Saturated fat• Alcohol• smoking• Physical activity• Environmental stress• Others factors such as oral contraception ,noise,

temperature

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Complications

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

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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 .

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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 .

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

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

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stop Smoking avoid alcohol

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Exercise :

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2- secondary prevention:

# early case detection .# treatment .# patient compliance :

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Thanks 89

StrokeOSMAN 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 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 .

Classification

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

Risk factors

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

ClinicalManifista

tion

• 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

StrokeEffects

Right brain

Left Brain

Treatment

Ischemic Stroke : :

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

Prevention

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

physician • Reduce blood cholesterol levels

Rehabitilation

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

Typesof

rehabilitation

• Hospital programs • Nursing facilities • Outpatient programs • Home-based programs

Thanks

HadeilFakhereldin

Rheumatic Heart Disease

Definition

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

Acute rheumatic fever follows cases of group A beta_hemolytic

streptococcal pharyngitis ..

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Epidemiology

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 ..

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Clinical manifestation

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..

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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..

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A condition called Atrial fibrilation is also commonly seen , together with mitral valve inolvment increase the risk of stroke & blood clot formation ..

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Diagnosis

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 ..

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Treatment& Prevention

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..

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Thanks …

Chronic Obstructive Pulmonary

Diseaseshattir saeed

Definition

•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.

Epidemiology

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 low-

and 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 .

mortility

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 includeoccupational 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, Beta-

carotene.Strong family history

Clinical manifest

ation

.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

SYMPTOMS

coughsputumdyspnea

EXPOSURE TO RISK

FACTORS

tobacco

occupation

SPIROMETRY

indoor/outdoor pollution

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 )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

Treatment

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 pollutionAntibiotic therapy

BronchodilatorsGlucocorticoidsExpectorant Respiratory stimulant Oxygen therapy Rehabilitation care Lung volume reduction surgery

Thanks

By NOOR ELKHAIR ALI KHALF ALLAH

cancer

WHAT IS CANCER

• Cancer regard as a group of disease characterized by

• an abnormal growth of cells• ability to invade adjacent tissue and even

distant organs • Cancer can occur at any site or tissue of the

body and may involve any type of cells.

• The major categories of cancer arecarcinomas which arise from epithelial cells lining

the internal surface of the various organ and from the skin epithelium

Sarcomas ,which arise from meseodermal cell constituting the various connective tissue

Lymphomas , myeloma and leukemia's arising from the cell of bone marrow and immune systems

A

B

C

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

men women

Estimated age-standardised incidence and mortality rates

both sexes

05/03/2023Dr Abdelgadir Eltahir Ahmed NCDs Director KSMOH175

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..

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

Estimated age-standardised incidence and mortality rates SUDAN

men women

Estimated age-standardised incidence and mortality rates SUDAN

Both sex

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 suggestedThat 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.

(2-)Genetic factors:

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

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

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

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

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

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

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

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

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

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

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

I wish cancer got cancer got cancer and died

DiabetesMellitus

Amal hassan204

Definition205

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..

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Epidemiology

207

• 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 ..

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Classification

209

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 insulin-dependent diabetes mellitus..

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

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Clinical Presentati

on212

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

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Diagnosis

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acte• dDiabetes is charaterised by 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..

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Management

218

• 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..

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• controlling diet• exercise• medication & patient education

reduce complications ..

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Medication221

• Metformin is the firt line treatment for type 2 DM

• Routine use of Aspirin to improve uncomplicated DM..• Insulin therapy for type 1 DM..

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Complications

224

• Macrovascular disease related to atherosclerosis is the major

complication …

• Diabetic retinopathy• Diabetic nephropathy

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• Diabetic neuropathy..which contribute the risk of diabetes

foot problem that may require amputation…

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Thanks

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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 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.

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. 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.

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 fold thickness. .Comparison of body mass index (BMI)

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 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)

complicati

ons

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

Coronary Heart Disease Myocardial infarction/ Sudden Death

Vascular Changes

Stress

Obesity

Cerebrovascular Disease

Physical Inactivity

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

Hypertension

Exercise and health

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.

Thanks

Chronic KidneyDise

ase• 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, 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.

ClinicalManifest

ation

• . 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 renin-angiotensin 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.

Causes

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 nephritisoSecondary Glomerular disease:

such as diabetic nephropathy and lupus nephritis

• the kidney can also cause nephropathy• 3/Tubulointerstitial including :• polycystic kidney disease, drug and toxin-

induced 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

Diagnosis

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

.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

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

Treatment

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

medoxomil, sulodexide, and avosentan.

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

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Alzheimer

Maysa Yaseen296

Definition

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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.

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Epidemiology

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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 .

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• 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 .

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ClinicalManifista

tion302

• 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.

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LabDiagnos

is304

• 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

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• 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.

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Prevention and control

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

• diet• exercise

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Treatment

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

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Ahmed M. Albshir

Road Traffic Accident

Definition

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.

Causes

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

1. Ischaemic heart disease2. Unipolar major depression3. Road Traffic Injuries4. Cerebrovascular disease5. Chronic obstructive

pulmonary disease6. Lower Respiratory

infection7. Tuberculosis8. War9. Diarrrhoeal disease10. HIV

1. Lower Respiratory infection

2. Diarrhoeal disease3. Perinatal conditions4. Unipolar major

depression5. Ischaemic heart disease6. Cerebrovascular

disease7. Tuberculosis8. Measles9. Road Traffic Injuries10. Congenital

Abnormalities

Top 10 Leading Contributors to the Global Burden of

Disease1990 Disease or Injury

2020 Disease or Injury

The road traffic death rate by WHO region and income level: Low- and middle-income 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.

Risk factors

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

2. The underlying probability of a crash, given a particular exposure.

3. The probability of injury4. The outcome of injury

Click icon to add picture

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 &Driving

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 middle-income countries these figures may be up to 69%

Prevention of RTA / RTI

What Can We Do?

Prevention

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

Summary Outline

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 !!!

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