A review on Noncommunicable Diseases (NCDs) burden, its socio-economic impact and the strategies for prevention and control of NCDs in India

Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. A large national survey in India found that spending on NCDs accounted for 5.17% of household expenditure. According to a macroeconomic analysis, it is estimated that each 10% increase in NCDs is associated with a 0.5% lower rate of annual economic growth. The income loss due to hypertension is the highest, followed by diabetes and cardiovascular diseases. The macroeconomic impact of NCDs is profound as they cause loss of productivity and decrease in gross domestic product. Since the health sector alone cannot deal with the “chronic emergency” of NCDs, a multisectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.

Safety of 0.1% topical tacrolimus in the treatment of vitiligo.

Cure rates for vitiligo are significantly lower because of problems to different studies have reported different response rate and different adverse effect for the treatment of vitiligo. This study was conducted to evaluate the response rate and adverse effect of topical tacrolimus 0.1% ointment in the treatment of vitiligo patients in the department of Dermatology and venereology, Bangladesh Medical college (BMC), Dhaka from January 2010 to July 2010. In this clinical trial, 30 newly diagnosed vitiligo (focal and segmental) patients, aged between 10 to 50 years were assigned for therapy and to observe the response and adverse effect. Each individual lesion was treated with topical tacrolimus 0.1% ointment twice daily for three months. All the patients completed three months treatment and available for statistical analysis. The highest percentage 13(43.3%) was in the age of 11-20 years. Sex ratio revealed higher in case of female 18(60%), with a male-female ratio 1:1.5 and 5(16.67%) patients had vitiligo among their families. Repigmentation was observed in 8 (26.7%) subjects at the end of 4th week, 15 (50.1%) subjects at 8th week and 25 (83.3%) subjects after 12 weeks of therapy. 25 (83.33%) subjects did not complain any adverse effect (like pruritus, burning etc.) and 5 (16.67%) subjects were suffered from different adverse effect of drug, like pruritus observed in 2 (6.7%) subjects and burning in 6 (20%) subjects. This study found that tacrolimus 0.1% ointment to be safe in the treatment of vitiligo, with reduction in the number of vitiliginous spots by increased repigmentation significantly.

Review of Treatment of Reflex Sympathetic Dystrophy.

A review study was done by searching literature through PubMed. Reflex sympathetic dystrophy is a life altering disease pathogenesis of which are not yet clearly known likewise its management protocol has not been established. Treatment of longstanding Reflex sympathetic dystrophy is empirical and of limited efficacy. This disease may lead to dreadful squeal which may need amputation for their management and few of these patients may even develop suicidal tendency. Patient with Reflex sympathetic dystrophy usually present late. It was found that the clinical presentation of RSD are too much variable, although different modalities of treatment are used either alone or in combination, the outcomes are often unpredictable and of variable efficacy. Understanding of the treatment modalities and proper selection of treatment option are essential for best outcome. Preventive measure does play a role in management of these patients. Option of treatment includes pharmacological method, sympathetic nervous system interruption, use of calcitonin and bisphosphonate. More study is required to find out the mechanism that triggers the pain and other clinical manifestation so that a standardized protocol for its management can be developed.

Diarrhea management among under fives.

This study was conducted to assess the magnitude of the problem of diarrhea and time of initiation of its management in under five children of different socio economic status, in an urban area of West Bengal. Overall prevalence of diarrhea was 31.67%, highest in lower socio economic class (41%). Prevalence was higher in the girls, though not significant. Acute watery diarrhea was most common (58.9%), followed by dysentery (24. 2 %) and persistent diarrhea (16.9%). Persistent type was inversely proportional to socioeconomic status. Majority of mothers administered fluids or sought treatments within six hours in the middle socioeconomic class but beyond six hours in lower socioeconomic group (P < 0.001). Percentage of children where doctors' advice was implemented within 12 hours was inversely proportional to socio economic status (P <0.001).

Changing scenario of transfusion-related viral infections.

OBJECTIVE: To study the changing incidence of blood transfusion-related viral infections consequent to compulsory screening of blood and greater awareness of the problem, over the last five years. METHODS: This is a cross-sectional study carried out at Medical College, Calcutta. Three groups each consisting of 100 subjects were selected for this study. Group A comprised multiple transfused patients who have also received transfusion before 1995. Group B comprised patients who had received transfusions only since 1995. Group C comprised of control patients who have never been transfused. The incidence of HBsAg +ve, anti-HCV +ve and HIV +ve cases were calculated and expressed as percentages and compared using the chi square test. RESULTS: The incidences of HBsAg +ve and anti-HCV +ve cases in the three groups were 20% and 16% in Group A, 7% and 6% in Group B and 4% and 2% in Group C. The difference between Group A and Group B were statistically significant. CONCLUSION: The incidence of HBsAg and anti-HCV positive cases among the multi-transfused has decreased over the last five years.

People living with HIV infection / AIDS - A study on lymph node FNAC and CD4 count.

Between July 1997 and December 2000, 1616 HIV seropositive persons were identified by Western Blot test at the School of Tropical Medicine, Kolkata. Four hundred seventy two (29.2%) of them had generalized lymphadenopathy. CD4 count could be done in only 54 of these 472 subjects (11.4%). These 54 patients, consisting of 40 males (74%) and 14 females (26%) were the subjects of the study. Their mean age was 29.5 years. In all these subjects, FNAC was done from the enlarged lymph nodes (non-inguinal). Reactive hyperplasia was seen in 30 cases (55.5%) whose absolute CD4 count varied between 411-945 cells/microL (median value 670 cells/microL). Evidence of tuberculous lymphadenitis was detected in 22 (41%) with CD4 counts varying between 113 and 422 cells/microL (median value 212 cells/microL). Non-Hodgkin lymphoma was diagnosed in 2 cases (3.7%) with CD4 count 79-113 cells/microL. All patients had evidence of HIV-1 infection, excepting one case of dual infection (HIV-1 and 2).

Patterns of tobacco use amongst school teachers.

Indulgence in tobacco is a known health risk. The example of school teachers in this regard is likely to have far reaching influence on their pupils and the community. A cross sectional study among 257 teachers from 30 schools revealed that as high as 51.0% teachers consumed tobacco in one form or the other. Smoking was the most popular form of tobacco use (72%). Marked gender differences were noted with 73.9%. Male teachers hooked to tobacco habit in comparison to 13.9% of female teachers. Educational qualification had paradoxical effect on tobacco habit as fewer (20.0%) graduate teachers used tobacco in comparison to non graduate teachers (55.7%). However proportion of Post graduate teachers consuming tobacco was still higher (64.2%). Initiation to tobacco habit in majority began at age 21 years and beyond. Common reasons given for tobacco consumption were curiosity (37.9%), to be social (22.0%), enjoyment (21.2%), to relieve stress (8.17%) and improving performance (5.8%). 21.9% smokers consumed more than 20 cigarettes a day. More than four fifth teachers consciously avoided tobacco use in school premises. Nearly half (45.3%) of tobacco users reported reduction in tobacco use in preceding two years. By and large teachers (92.4%) were aware of harmful consequences of tobacco on health. But only in 29.6% it was a cause for concern. 71.2% respondents intended to give up tobacco habit. 33.7% smokers were aware of hazards of passive smoking to others.

The utility of waist circumference in assessment of obesity.

The objective of this study was to assess the correlation between waist circumference and waist hip ratio and body mass index. Also to assess if a simple measurement like the waist circumference can be used as an independent indicator for detecting health risk and management. 500 men and 500 women were included in this study from the out patient department and indoor wards of Medical College, Calcutta. Only 7% of the males and 16% of the females had body mass index > or = 25. About 50% of both males and females had waist hip ratio above the desirable range (0.80 for females and 0.95 for males). About 99% of females with, waist circumference > or = 72 cm. had either body mass index > or = 25 or high waist hip ratio > or = 0.80 or both. Similarly 99% of males with waist circumference > or = 80 cm. had either high body mass index > or = 25 or high waist hip ratio > or = 0.90 or both. Waist circumference is simple to assess and can be used as an independent measurement to identify those at risk from either increased body weight or central fat distribution or both.

Immunomodulation with corticosteroids and levamisole in leprosy as gauged by in vivo lepromin and in vitro CMI responses.

Corticosteroids and Levamisole are known to be immuno suppressive and immuno stimulating agents respectively. Their effects on polar types of leprosy, tuberculoid and lepromatous have been studied using in vivo lepromin and in vitro lymphocyte count, rosette formation, L.T.T. and L.M.I.T. parameters. Immunosuppressive effect of corticosteroids on tuberculoid leprosy is marked with reduced and negative lepromin sensitivity but same does not hold true with other in vitro C.M.I. tests. Similar results are obtained with levamisole exhibiting its ineffectiveness in lepromin conversion in lepromatous cases although some improvement is observed in other in vitro C.M.I. tests. Evaluation of the results showed: lack of correlation between in vivo lepromin and in vitro other C.M.I. parameters with corticosteroids and levamisole lepromin sensitivity has some unknown influence other than thymic factors, prolonged corticosteroid therapy may produce permanent immunosuppression in tuberculoid cases making them more vulnerable towards lepromatous pole and lepromin sensitivity is more reliable, stable and easy to perform.

Prothionamide and dapsone therapy in leprosy--a clinical study.

Combined therapy with prothionamide and dapsone was instituted in fifteen active untreated lepromatous leprosy cases for a period of 18 months. Clinical improvement was good with attainment of zero morphological index in about 66% cases. Bacteriological improvement was rather unsatisfactory as one case only reached zero level. Side effects were observed in few cases necessitating withdrawal of combined therapy and patients' prothionamide compliance was rather unimpressive.

Evaluation of multidrug therapy with rifampicin, clofazimine and D.D.S. in multibacillary leprosy cases.

Rifampicin, Clofazimine and D.D.S. have been tried in fifteen active untreated lepromatous cases for a period of two years. Compared to dapsone monotherapy remarkable clinical and bacteriological improvement was observed with this combined therapy with attainment of negative BI in ten cases. Use of this combination therapy is thus advocated to achieve noninfectivity in a shorter period and to prevent emergence of dapsone resistance thereby causing the path of leprosy control before it becomes unmanageable due to dapsone resistance.