Osteoarthritis


What is osteoarthritis(OA)?

Osteoarthritis(OA) is a disease of joints affecting almost all people as they get older. Sometimes, it also affects young people.

breakdown of cartilage bones rub against each other Pain, stiffness and loss of movement

Symptoms

  • Pain
  • Stiffness
  • Loss of movement
  • Swelling
  • Redness and warm

Risk factors

Modifiable

  • Being obese

Non-modifiable

  • Age: Risk of developing OA increases with age.
  • Gender: Women are more likely to develop OA than men, especially after age 50
  • Family medical history: People who have family members with OA are more likely to develop OA.

How is osteoarthritis diagnosed?

Osteoarthritis is diagnosed by a patient’s sign and symptoms and X-ray findings.

Preventive measures

  • Maintain a healthy weight
    • Body Mass Index (BMI)

      Healthy BMI should be between 18.5 – 22.9Kg/m²

  • Do regular exercise (30 min every day)
  • Prevent occupational injury
    • Proper management of related injuries can help prevent osteoarthritis.

Heart Attack


Heart attack occurs when there is a sudden loss of blood flow to the heart muscle. Most heart attacks are caused by coronary heart disease.

Coronary heart disease

  • The coronary arteries (vessels that supply blood to the heart) get narrow due to deposition of fatty materials and cholesterol (plaque).
  • When the plaque breaks, it causes a blood clot to form
  • This blood clot blocks the blood flow to the heart leading to heart attack.

Risk Factors

Non-modifiable

  • Age
  • Gender
  • Family medical history

Modifiable

  • Smoking
  • High blood pressure
  • High cholesterol
  • Physical inactivity
  • Being obese
  • Diabetes mellitus
  • Unhealthy diet
  • Excessive alcohol intake

How is heart attack diagnosed?

After the initial blood test, several invasive and non-invasive tests can be performed to confirm diagnosis of heart disease.

Non-invasive tests

  • ECG: An electrocardiogram (ECG) is a short test that monitors the electrical activity of the heart on a strip of paper. It takes about 5-10 minutes to perform. 
  • Echocardiogram: Echocardiogram is performed to assess heart valves and heart muscles. It is performed by a specialist doctor and takes 15-20 minutes to perform.
  • Chest X-ray: Chest X-ray is performed to determine the cause of shortness of breath and chest pain.
  • Stress test: During a stress test, you will be asked to ride a stationary bicycle, walk or run on a treadmill for several minutes. At the same time doctor will monitor your body’s reaction to exercise as your heart rate increases.
  • Holter monitor: Holter monitor is a device that can monitor heart activity for up to 24 or more hours.
  • CT scan A computed tomography (CT) scan is performed to diagnose several different types of heart diseases, for example, to check for fatty deposit in coronary vessels.

Invasive Test

  • Coronary angiography and cardiac catheterization: A long flexible tube (catheter) is inserted through a blood vessel in your groin or other parts of your body, which is then moved towards your heart to assess coronary artery for any narrowing or blood clot.

Preventive measures

  • Stop smoking
  • Control blood pressure (Hypertension)
  • Control cholesterol levels in the blood (hyperlipidemia)
  • Maintain blood sugar levels in the blood (Diabetes mellitus)
Diabetes
Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl)
or
2-h plasma glucose ≥ 11.1 mmol/L (200 mg/dl)
or
HbA1c ≥ 6.5%
  • Do regular exercise
  • Maintain a healthy diet
  • Maintain a healthy body weight
    • Body Mass Index (BMI)

      Healthy BMI should be between 18.5 – 22.9Kg/m²

Colorectal Cancer


What is Colorectal Cancer?

Colorectal cancer is a cancer that develops in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start.

Note: Colon cancer and rectal cancer are often grouped together because they have many features in common.

08

Statistics

Hong Kong

Hong Kong

Incidence rate: 36.3 per 100,000 populations (male & female)

Mortality rate: 12  per 100,000 populations (male & female)

(Hong Kong Cancer Registry 2020)

Nepal

Nepal

Incidence rate: 5.8  per 100,000 populations (male & female)

Mortality rate: 4.8 per 100,000 populations (male & female)

(IARC, 2020)

Pakistan

Pakistan

Incidence rate: 4.2 per 100,000 populations (male & female)

Mortality rate: 3.3 per 100,000 populations ((male & female)

(IARC, 2020)

India

India

Incidence rate: 4.4 per 100,000 populations (male & female)

Mortality rate: 3.4  per 100,000 populations (male & female)

(IARC, 2020)

Symptoms

Early stage colorectal cancer may not have any symptoms.

  • Blood mixed with feces.
  • Mucus in the feces.
  • Change in bowel habit (e.g. Passing stool more often than usual, diarrhea alternating with constipation).
  • Bloating (stomach feeling full of gas or fluid, that is unpleasant).
  • Abdominal (Tummy) pains.
  • Generally unwell, tiredness and weight loss.

Risk Factors

Modifiable: Mainly related to sedentary lifestyle

  • High consumption of red meat and processed meat
  • Lack of physical activity
  • Being obese
  • Excessive alcohol consumption
  • Smoking

Non-Modifiable:

  • Men aged 50 or above
  • History of colonic polyps
  • Family history of colorectal cancer
    • If your parent, sibling, or children has colorectal cancer, risk of developing the disease increases 2-3 folds.

  • Hereditary bowel diseases
  • Prolonged history of inflammation of the bowel

Please note: Having above risk factor does not mean that you must have colorectal cancer – it only means that your risk of developing colorectal cancer may be higher than average and you should seek further medical advice from your doctor.

Preventive Measures

  • Eat high fiber diet such as, vegetables, fruits, whole grain, etc
  • Reduce consumption of red meat
  • Do regular exercise (30 minutes every day)
  • Maintain a healthy body weight
  • Reduce alcohol intake
  • Do not smoke

Cervical cancer


What is Cervical Cancer?

Cervical cancer_L

Cervical cancer develops as a result of abnormal cell changes at the cervix.

Statistics

Hong Kong

Hong Kong

Incidence rate: 7.6 per 100,000 populations, in females

Mortality rate: 1.9 per 100,000 populations in females

(Hong Kong Cancer Registry, 2020)

Nepal

Nepal

Incidence rate: 21.5 per 100,000 populations in females

Mortality rate: 14.3 per 100,000 populations in females

(IARC, 2020)

Pakistan

Pakistan

Incidence rate: 7.3 per 100,000 populations in females

Mortality rate: 5.2 per 100,000 populations in females

(IARC, 2020)

India

India

Incidence rate: 14.7 per 100,000 populations, in females

Mortality rate: 9.2 per 100,000 populations, in females

(IARC, 2020)

Signs and Symptoms

There may not be any symptoms at an early stage

  • Bleeding between regular menstrual cycle
  • Abnormal bleeding such as after sexual intercourse or pelvic examination
  • Menstrual period that lasts longer than usual
  • Heavy menstrual bleeding
  • Vaginal discharge with foul smell
  • Pain during sexual intercourse
  • Pelvic pain

Risk factors of cervical cancer include:

  • Having multiple sexual partners
  • Weakened immunity
  • Human papillomavirus HPV (major cause of cervical cancer)
  • Use of oral contraceptive for more than 5 years (the risk returns to normal after 10 years of stopping use)
  • Smoking
  • Multiple childbirth and young age at first pregnancy     
  • Having sexual intercourse at an early age

Please note: Having above risk factor does not mean that you must have cervical cancer – it only means that your risk of developing cervical cancer may be higher than average and you should seek further medical advice from your doctor.

Preventive measures

  • Practice safer sex: avoid having multiple sex partners and use condoms
  • Stop smoking
  • Get HPV vaccination before getting sexually active because vaccination provides protection against certain types of HPV.

Hypertension (High blood pressure)


What is Hypertension?

Hypertension is defined as systolic blood pressure (upper reading) higher than 140 mmHg and diastolic (lower reading) higher than 90mmHg.

Categories of hypertension

Blood pressure category Systolic
(upper reading)
Diastolic
(lower reading)
Action
Normal Lower than 120 Lower than 80 Keep it up
Prehypertension 120 – 139 80 – 89 Make healthy lifestyle changes
Hypertension (High blood pressure) Above 140 above 90 Consult your doctor and start medication

Symptoms

Hypertension does not normally cause symptoms unless it is very high.

If blood pressure is very high, patients may experience:

  • Headaches
  • Visual disturbance
  • Seizures

Risk Factors

Modifiable

  • Lack of physical activity
  • Unhealthy diet (e.g. high salt intake)
  • Being obese
  • Excessive alcohol intake
  • Smoking

Non-modifiable

  • Age
  • Family medical history
  • Gender

How is hypertension diagnosed?

Regular blood pressure monitoring: 2 – 3 high readings at several medical appointments to diagnose high blood pressure.  

Complications of High blood pressure

Preventive measures

Preventive measures are focused on reducing modifiable risk factors.

  • Do regular exercise: At least 30 minutes every day, 5 times a week. 
  • Eat a healthy diet: reduce high intake of salt and fat
  • Maintain a healthy body weight
  • Reduce alcohol intake
  • Stop smoking

Stroke


What is stroke?

A stroke is caused when the blood supply to the brain is reduced or blocked, usually because a blood vessel in the brain is ruptured or blocked by a clot.

Types of Stroke

There are 2 main types of stroke

Ischemic stroke

  • Ischemic stroke
  • Transient ischemic stroke (TIA or mini-stroke)

Hemorrhagic stroke

Ischemic Stroke (Clot)

Ischemic stroke occurs when the brain does not receive enough blood due to blockage in the blood vessel carrying blood to the brain.

Ischemic stroke: TIA (Transient ischemic attack)

TIA is also known as “mini stroke”. It is a temporary blockage of blood flow to the brain. The symptoms of TIA last for about 1 to 5 minutes. It does not cause permanent damage or disability but can lead to full blown stroke if untreated.

Hemorrhagic Stroke (Bleed)

Hemorrhagic stroke occurs when weak vessels in the brain are ruptured and bleed into the brain causing compression of the surrounding brain tissues.

Signs and Symptoms

Symptoms of a stroke depend on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death. (WHO)

FAST is an easy way to remember and identify most common stroke signs and symptoms.

Risk Factors

Modifiable

  • Lack of physical activity
  • Unhealthy diet
  • Smoking
  • Excessive alcohol intake
  • Being obese
  • Medical history: The following medical conditions increase your risk of having stroke
  1. Diabetes mellitus
  2. High blood pressure
  3. High cholesterol
  4. Carotid artery disease: Blockage of the neck arteries
  5. Atrial fibrillation: Irregular heartbeat that can lead to blood clots and stroke.
  6. Other heart diseases: Several other heart conditions such as, heart failure, and heart valves diseases increase your risk of having stroke.

Non-modifiable

  • Age
  • Family medical history
  • Gender
  • Previous TIA or stroke

How is stroke diagnosed?

Imaging test

  1. CT scan: CT scan produces a large image of the brain to show the exact reason, type and location of stroke.
  1. MRI scan: MRI scan produces a similar image as CT scan but sharper and more detailed. It shows the extent and location of much smaller injuries in the brain.   

Blood flow test

  1. Ultrasound: : Ultrasound machine is used on the neck vessels that supply blood to the brain to determine the flow of the blood in the vessels. It shows if there is any blockage due to fat deposition (clots) in any of the neck vessels.
  1. Angiography: It gives a picture of the blood flowing through the vessels on the computer screen. 

Preventive measures

Tight control of blood pressure

Reduce salt and fat intake in your diet

Eat more fruits and vegetables every day

Do regular exercise (30 min every day)

Have meals rich in whole grains

Stop smoking

Maintain a healthy body weight

Avoid excessive use of alcohol

Diabetes Mellitus


What is Diabetes Mellitus?

  • Diabetes is a chronic illness in which the body cannot produce enough insulin in the pancreas or the insulin produced does not work effectively in the body.
  • It is a serious complex condition in which blood glucose (sugar) levels are abnormally high and can affect the entire body.
Diabetes
Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl)
or
2-h plasma glucose ≥ 11.1 mmol/L (200 mg/dl)
or
HbA1c ≥ 6.5%

Diabetes mellitus type 2:

It is the most common type of diabetes which occurs when there is low production of insulin in the body or the insulin is not working effectively leading to an increase in the level of blood glucose.

Symptoms

  • Increased thirst
  • Frequent urination
  • Unexplained weight loss

Risk Factors

Modifiable

  • Lack of physical activity
  • Being obese
  • Unhealthy diet

Non-modifiable

  • Family medical history: You are at a high risk if you have a parent, brother or sister with diabetes mellitus type2.
  • Age: Risk increases with advancing age

Complications of diabetes mellitus

Diagnosis

Blood Test

  • Fasting plasma glucose: it is the first thing done in the morning before eating anything.
  • 2-h plasma glucose: Plasma glucose test should be done 2 hours after ingestion of 75g oral glucose load.
Diabetes
Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl)
or
2-h plasma glucose ≥ 11.1 mmol/L (200 mg/dl)
or
HbA1c ≥ 6.5%
  • HbA1c: Performed to check the level of HbA1c in the blood. It is the first thing in the morning before eating anything.
Type
HbA1c
% mmol/mol
Normal <4.0 – 6.1 < 20.0 – 42.1
Prediabetes 6.1 – 6.4 43.2 – 46.4
Diabetes > 6.5 > 47.5

Preventive measures

  • Maintaining a healthy body weight
  • Do regular exercise (30 minutes every day)
  • Reduce alcohol intake
  • Stop Smoking
  • Eat a healthy diet: reduce sugar intake and eat less starchy food
  • Managing optimal blood pressure: Check your blood pressure regularly at home or at clinics.

Prostate Cancer


What is Prostate Cancer?

Prostate cancer develops when cells in the prostate start to grow in an uncontrolled way.

14
  • Prostate is a small gland in the pelvis found only in men.
  • It is located between the penis and the bladder and surrounds the urethra.

Statistics

Hong Kong

Hong Kong

Incidence rate: 25.5 per 100,000 populations in males

Mortality rate: 4.3 per 100,000 populations in males

(Hong Kong Cancer Registry, 2018)

Nepal

Nepal

Incidence rate: 1.1 per 100,000 populations

Mortality rate: 0.79 per 100,000 populations

(IARC, 2018)

Pakistan

Pakistan

Incidence rate: 6.7 per 100,000 populations in males

Mortality rate: 5.0  per 100,000 populations in males

(IARC, 2018)

India

India

Incidence rate: 4.4 per 100,000 populations

Mortality rate: 2.9 per 100,000 populations

(IARC, 2018)

Symptoms

Prostate cancer and prostate enlargement has similar urinary symptoms.

  • Difficulty or delay in urinating
  • Slow or weak stream of urine
  • Blood in urine 
  • Pain in the lower back and hips

Risk Factors

  • Age: Risk increases with age
  • Race/ethnicity
  • Family medical history
    • If your parent, sibling, or children has prostate cancer, you are at a higher risk of developing the disease.

Please note: Having any of the above risk factors does not mean that you must have prostate cancer – it only means that your risk of developing prostate cancer may be higher than average and you should seek further medical advice from your doctor.

Screening test

Two main tests are performed for prostate cancer screening

  1. Digital rectal exam (DRE): The doctor or nurse inserts a gloved, lubricated finger into the rectum and feels the prostate to check for anything abnormal.
  1. Prostate-specific antigen (PSA) test: PSA test is performed to check the level of PSA in the blood.

Department of Health (2017). Prostate cancer prevention and screening. Retrieved at:https://www.chp.gov.hk/files/pdf/5_prostate_cancer_prevention_and_screening_eng.pdf

Preventive measures

  • Eat more vegetables and fruits
  • Do regular exercise (30 minutes every day)
  • Reduce alcohol intake
  • Do not smoke
  • Maintain a healthy body weight

Breast Cancer


What is breast cancer?

Breast cancer is an abnormal growth of breast cells. These abnormal breast cells can grow into surrounding tissues or spread to distant areas of the body.

Statistics

Hong Kong

Hong Kong

Incidence rate: 62.9 per 100,000 populations, in females

Mortality rate: 9.4 per 100,000 populations in females

(Hong Kong Cancer Registry, 2020)

Nepal

Nepal

Incidence rate: 15 per 100,000 populations, in females

Mortality rate: 7 per 100,000 populations in females

(IARC, 2020)

Pakistan

Pakistan

Incidence rate: 114 per 100,000 populations, in females

Mortality rate: 22 per 100,000 populations in females

(IARC, 2020)

India

India

Incidence rate: 24.7 per 100,000 populations, in females

Mortality rate: 11.9 per 100,000 populations in females

(IARC, 2020)

Signs and Symptoms

  • New lump or thickening in the breast
  • Dimples in the breast
  • Enlarged lymph nodes or a lump in the armpit
  • Discharge from the nipples
  • Pitting of the skin (looks like the skin of an orange)
  • Nipple turns inwards into the breast

Risk Factors

Modifiable risk factors

  • Lack of physical activity

Non-modifiable risk factors

  • Family medical History
  • Being obese
  • Getting older
  • Excessive use of alcohol
  • Changes in BRCA1 BRCA 2 genes
  • High fat intake (Unhealthy diet)
  • Long term use of hormone replacement therapy
  • Having first child after the age of 35
  • Never had childbirth 
  • History of breast disease
  • Late menopause (after 55 years)
  • Early menstruation (before the age of 12)

Please note: Having above risk factor does not mean that you must have breast cancer – it only means that your risk of developing breast cancer may be higher than average and you should seek further medical advice from your doctor.

Preventive Measures

  • Do regular exercise (30 min every day)
  • No alcohol use
  • Stop smoking
  • Breastfeeding