Non communicable diseases

causative agent, prevention , care and control of some non communicable diseases

1. Non communicable diseases Devipriya P V M Pharm

2. Non communicable diseases (NCD) Non communicable disease is a disease which is caused due to multiple causes and can not be transmitted directly or indirectly from one person to another by an agency Risk factors for Non communicable diseases: Smoking. Alcohol consumption. Insufficient health services for management and control of NCD. Life style pattern. Environmental factors (air and water pollution etc) Stress.

3. Cancer Cancer is a group of disorders characterized by: An abnormal multiplication of cells. Ability to infiltrate the adjacent tissues or even distant organs. The eventual death of the patient, if the tumour has progressed beyond that stage when it can be removed successfully. Classification: Cancer is classified into 2 main categories: Solid tumours Leukaemias and lymphomas

4. Causes of cancer: (1) Smoking or chewing of tobacco . (2) Excessive alcohol consumption. (3) Dietary factors like high fat diet. (4) Occupational factors : exposure to chemicals such as benzene, arsenic, cadmium, chromium, asbestos etc. (5) Viruses : Eg : Hepatitis B can produce liver cancer. Human papiloma virus (HPV) cause cervical cancer. (6) Parasites: Many infections due to parasites can increase the risk of malignant diseases. (7) Customs, habits and life styles (smoking, chewing tobacco, betel chewing, pan masala etc). (8) Other environmental factors: (Sunlight, radiations etc). (9) Genetic factors .

5. Cancer control: Early diagnosis, proper treatment , after care & rehabilitation. Primary prevention Secondary prevention Control of tobacco and alcohol consumption. Improvement of personal hygiene. Reduction in the amount of radiation. Protect workers from industrial carcinogenic chemicals. Immunization against Hepatitis B Testing of food, drugs and cosmetics for their carcinogenic activity. Control of air pollution. Early detection and treatment of precancerous lesions. Help of law to control known carcinogens. Cancer education to motivate people for early diagnosis and treatment Registration of cancer cases to assess the severity of problem and for providing necessary services. Early detection can be done by cancer screening at a premalignant stage. Treatment facilities should be available to all cancer patients. Cancer treatment consists of: Surgery Radiotherapy Chemotherapy

6. Diabetes mellitus Diabetes is a chronic , metabolic disease characterized by elevated levels of blood glucose (blood sugar), which leads over time to serious damage to heart, blood vessels, eyes, kidneys and nerves. WHO Classification: (1)Diabetes Mellitus(DM) Insulin dependent diabetes mellitus(IDDM type 1) Non insulin dependent diabetes mellitus(NIDDM type 2) Malnutrition related diabetes mellitus (MRDM) Other types (secondary to pancreatic disease, hormonal imbalance, drug induced or genetic disorder). (2)Impaired glucose tolerance (IGT) (3)Gastrointestinal diabetes mellitus(GDM)

7. Clinical classification: (1)The Juvenile onset type (IDDM): Develops during the first 40 years of life in patients of normal or less than normal weight. Insulin administration is required (2)The adult or maturity onset type: In middle aged or elderly persons who are generally obese. It can be controlled by dietary control and by using oral hypoglycemic drugs. Causes of Diabetes mellitus: Insulin deficiency (due to disease of pancreas, defective formation of insulin, destruction of beta cells in pancreas, viral infections , genetic defects, etc). In diabetes glucose utilization is decreased which leads to hyperglycemia (increased blood sugar level) and glycosuria (sugar in urine)

8. Prevention and care of Diabetes: Includes primary , secondary and tertiary prevention. Primary prevention: Two strategies of primary prevention are: Population strategy: Maintain normal body weight, diet control, excercise High risk strategy: change in life style, correction of over eating and control of body weight. Secondary prevention: Adequate treatment to reduce blood glucose level . Control diet, use of oral hypoglycemic drugs, use of insulin. Tertiary prevention: Diabetes produce many complications like blindness, kidney failure etc. The objective of tertiary care is to organize specialized clinics called Diabetic Clinics and Units for the diagnosis and treatment of the disease. Prevention of IDDM is not possible presently

9. Blindness Visual acuity of less than 3/60 or its equivalent. Causes of Blindness: Cataract , trachoma and associated infections of the eye, smallpox, injuries and glaucoma. Malnutrition is an important cause of blindness (vitamin A deficiency) Other causes include congenital diseases, uveitis , tumours of eye, retinal detachment, diabetes, hypertension and diseases of the nervous system. Occupation of the person : people working in industries and mines get injuries of eyes often. Use of infected kajal

10. Prevention of Blindness: Blindness can be controlled by improving nutrition, by proper treatment of infectious diseases, by the control of causative organisms of the infection , by improving safety measures and working conditions. National programmes for prevention of Blindness include: (1)Primary eye care: A number of eye diseases can be treated by a trained health worker. Vitamin A solution, tetracycline ointment and eye bandages are provided for this. (2)Secondary care: The care provided at hospitals or primary health centers for cataract, eye trauma, glaucoma etc. Camps are organized for cataract operations at villages

11. (3)Tertiary care: These services are provided by the medical colleges and medical institutions. The surgery for retinal detachment and corneal grafting is done and eye banks are established. Other measures include education of the blind in the blind’s school Specific programmes for prevention of blindness: Vitamin A prophylaxis is done by giving 200,000 units of vitamin A orally in the form of solution at 6 months interval up to 6 years of age. Eye check up of children is done in schools, Control of trachoma is a measure to control blindness. Proper sanitation, safe water supply, consumption of food rich in vit A, improvement of personal hygiene and health education etc are helpful for the prevention of blindness.

12. Cardiovascular diseases Coronary heart disease (CHD)/ Ischaemic Heart Disease (IHD): IHD is defined as the impairment of heart function due to inadequate blood supply to the heart. IHD is clinically manifested as: Angina Pectoris Acute myocardial infarction Sudden death Cardiac failure Arrhythmias (abnormal heart rate) Conduction defects.

13. Causes of IHD: Smoking, hypertension, high level of cholesterol, low level of high density lipoproteins(HDL), high level of low density lipoproteins(LDL). Other risk factors are diabetes, family history of CHD, lack of physical activity, alcohol consumption, use of oral contraceptives. Genetic factors (high level of triglycerides) Ethnic factors(consume too much milk , lassi , pure ghee, coconut oil etc). Prevention of IHD: IHD is preventable. Reduced fat intake, limited consumption of saturated fat, reduction in LDL, increase in HDL, increase in vegetable consumption, fruits and grains, reduction in salt intake, avoid smoking and alcohol consumption, reduction in blood pressure and increase in physical activity.

14. Hypertension Hypertension is defined as the systolic pressure equal to or greater than 160 mm of Hg and/ or a diastolic pressure equal to or greater than 95 mm of Hg. Causes of hypertension: Idiopathic hypertension: hypertension due to unknown cause. Hypertension due to some disorders are called secondary hypertension. The causes of secondary hypertension include renal disorders, endocrine disorders, pregnancy etc.

15. Risk factors of hypertension: Increasing age, genetic factors, obesity , high salt intake, fatty diet, alcohol consumption, lack of physical activity, smoking, anxiety or stress, consumption of oral contraceptives, noise and handling of vibrating tools Prevention of hypertension: Consumption of less salt and restriction of saturated fat in the diet, weight reduction and exercise. Behavioural changes like avoid smoking and alcohol consumption, avoidance of stress, health education. Secondary prevention is done by early detection of cases and lower the blood pressure by the use of drugs like atenolol , nifedipine , clonidine etc.

16. Stroke Stroke is an acute severe manifestation of cardiovascular disease. WHO definition for stroke: “ A rapidly developed clinical signs of focal or global disturbance of cerebral function lasting more than 24 hours or leading to death, with no appropriate causes other than vascular origin ”. Causes of stroke: Commonest cause of stroke is Hypertension and Diabetes. Control of stroke: Stroke can be prevented by the control of hypertension, control of diabetes and by the elimination of smoking.

17. Rheumatic heart diseases (RHD) Rheumatic fever is a disease of connective tissue particularly in the heart and in the joints. It is caused by the infection of throat by group A beta haemolytic streptococci. Rheumatic fever leads to Rheumatic heart disease (RHD) RHD damages the heart and causes premature death. Clinical features of the disease: Fever, inflammation of joints and carditis . Brain involvement can lead to tremors

18. Prevention of RHD: Primary prevention is done by preventing the attack of rheumatic fever in patients of streptococcal infection of throat. Intramuscular injection of penicillin containing 300,000 units of crystalline penicillin, 300,000 units of procaine penicillin and 600,000 units of benzathine penicillin. Secondary prevention is the prevention of recurrence of rheumatic fever. Intramuscular injection of benzathine benzyl penicillin at intervals of 3 weeks for at least 5 years . Non medical preventive measures includes improvement of living conditions and improvement in the socio-economic status of the population to reduce incidence of streptococcal infection.