Cardiovascular disease (CVD)

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels.

There are many different types of CVD. 4 of the main types are described on this page.

  1. Coronary heart disease, Coronary heart disease occurs when the flow of oxygen-rich blood to the heart muscle is blocked or reduced.
  2. Strokes and TIAs, A stroke is where the blood supply to part of the brain is cut off, which can cause brain damage and possibly death.
  3. Peripheral arterial disease, Peripheral arterial disease occurs when there’s a blockage in the arteries to the limbs, usually the legs.
  4. Aortic disease, Aortic diseases are a group of conditions affecting the aorta. This is the largest blood vessel in the body, which carries blood from the heart to the rest of the body.

The exact cause of CVD isn’t clear, but there are lots of things that can increase your risk of getting it. These are called “risk factors”.

This include; High blood pressure, Smoking, High cholesterol, Diabetes, Inactivity, Being overweight or obese, Family history of CVD, Ethnic background, Other risk factors.

The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of heart attack, stroke, heart failure and other complications.

Heart Failure

This term can be scary. It doesn’t mean your heart has “failed,” or stopped working. It means your heart doesn’t pump as strongly as it should. This will cause your body to hold in salt and water, which will give you swelling and shortness of breath.

Your valves sit at the exit of each of your four heart chambers. They keep blood flowing through your heart.

Sometimes, there are problems with these valves. Examples of heart valve problems include:

Aortic stenosis. Your aortic valve narrows. It slows blood flow from your heart to the rest of your body.

Mitral valve insufficiency. Your mitral valve doesn’t close tightly enough. This causes blood to leak backward, leading to fluid backup in the lungs.

Mitral valve prolapse. The valve between your left upper and left lower chambers doesn’t close right.

A healthy lifestyle can lower your risk of CVD. If you already have CVD, staying as healthy as possible can reduce the chances of it getting worse. The key to cardiovascular disease reduction lies in the inclusion of cardiovascular disease management interventions in universal health coverage packages, although in a high number of countries health systems require significant investment and reorientation to effectively manage CVDs

Basic medicines that should be available include: Aspirin,beta-blockers, angiotensin-converting enzyme inhibitors; and statins.

Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.

Monkeypox Cases Worldwide

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-year-old boy in a region where smallpox had been eliminated in 1968.

Monkeypox is a disease of global public health importance as it not only affects countries in west and central Africa, but the rest of the world. In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana. This outbreak led to over 70 cases of monkeypox in the U.S. Monkeypox has also been reported in travelers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, and to the United States of America in July and November 2021. In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns.  

 Signs and Symptoms

In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.

The illness begins with:

  • Fever, Headache, Muscle aches, Backache, Swollen lymph nodes, Chills, Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off:

  • Macules, Papules, Vesicles, Pustules, Scabs

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.


Vaccination against smallpox was demonstrated through several observational studies to be about 85% effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public.

JYNNEOSTM  (also known as Imvamune or Imvanex) is an attenuated live virus vaccine which has been approved by the U.S. Food and Drug Administration for the prevention of monkeypox. The Advisory Committee on Immunization Practices (ACIP) is currently evaluating JYNNEOSTM for the protection of people at risk of occupational exposure to orthopoxviruses such as smallpox and monkeypox in a pre-event setting.

Description of the outbreak

As of 21 May, 13:00, 92 laboratory confirmed cases, and 28 suspected cases of monkeypox with investigations ongoing, have been reported to WHO from 12 Member States that are not endemic for monkeypox virus, across three WHO regions (Table 1). No associated deaths have been reported to date.

Table 1.Cases of monkeypox in non-endemic countries reported to WHO between 13 to 21 May 2022 as at 13:00.

United kingdom21-30
United States of America1-5

To date, all cases whose samples were confirmed by PCR have been identified as being infected with the West African clade. Genome sequence from a swab sample from a confirmed case in Portugal, indicated a close match of the monkeypox virus causing the current outbreak, to exported cases from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019.

The identification of confirmed and suspected cases of monkeypox with no direct travel links to an endemic area represents a highly unusual event. Surveillance to date in non-endemic areas has been limited, but is now expanding. Available information suggests that human-to-human transmission is occurring among people in close physical contact with cases who are symptomatic.


There are number of measures that can be taken to prevent infection with monkeypox virus:

  • Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
  • Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
  • Isolate infected patients from others who could be at risk for infection.
  • Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
  • Use Personal Protective Equipment (PPE) when caring for patients.


Types of Diabetes

Diabetes is a group of deases in which the body doesn’t make any insulin or the body cannot make good use of insulin it produces. When any of these things happens, the body is unable to get sugar from the blood into cells. That lead to high blood sugar levels.

There are three main types of diabetes:

Type 1 Diabetes

Type 1 diabetes often develops more quickly and cause symptoms like weight loss, it can develop at any age. but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control.

Type 2 Diabetes

Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes start as insulin resistance. This means your body does not make good use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with type 2 diabetes will require oral drugs or insulin to keep their blood glucose levels under control.

Gestational Diabetes

Gestational Diabetes is a type of diabetes that can develop during is usually diagnosed from a blood test 24 to 28 weeks into pregnancy. That means you have high blood glucose and its associated with complications to both of mother and fetus. this type of diabetes usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.

Types of diabetes treated

For all types of diabetes, you’ll need to work closely with your doctor to keep it under control. The main goal is to keep blood glucose levels within your target range. Your doctor will let you know what your target range should be. Targets vary with the type of diabetes, age, and presence of complications. If you have gestational diabetes, you blood glucoses targets will be lower than people with other types of diabetes.                                                       Physical activity is an important part of diabetes management. Ask your doctor how many minutes per week you should devote to exercise. Diet is also crucial to good control.

Treating type 1

All people with type 1 diabetes must take insulin to live because damage to the pancreas is permanent. There are different types of insulin available with different times of onset, peak, and duration. Insulin is injected just under the skin. Your doctor will show you how to properly inject and rotate injection sites. You can also use an insulin pump, which is a device worn outside your body that can be programmed to release a specific dose. There are now continuous blood glucose monitors as well that check your sugar 24 hours a day.                                        

Treating type 2

Type 2 diabetes is managed with diet and exercise, and can also be treated with a variety of medications to help control blood sugar. The most common tablet is metformin but if metformin doesn’t work, your doctor can add other medications or try something different.

Treatment for gestational diabetes

Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications.                                                                      Your doctor also will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin which can lead to low blood sugar right after birth


Parallel Trade Definition

Parallel trade or parallel import in pharmaceutical market simply refers to buy medicinal products in a country that sells them at a reasonable price and then to distribute such products outside the distribution channels set up by the drug manufacturer or its recognized distributor in one’s own country of origin. It is named ‘parallel’ as it takes place beside and usually in parallel to the producer’s distribution networks.

The EU Commission’s policy position is that parallel imports increased price competition, and that this in turn increases consumer welfare as the import of goods from a country with lower prices forces sellers in the country of destination to reduce prices. The commission’s overall approach is based on two principles (Competition Policy Newsletter 1, 2007):

  1. The single market in pharmaceuticals requires the unhindered free movement of products – private companies cannot erect barriers to undermine this without distorting intra-brand competition.
  2. The efficiency claims defence advanced by the research based pharmaceutical industry is unsubstantiated – i.e. there is no evidence that partitioning the common market would spur on global investment in inter-brand competition.

Parallel Trade in the Pharmaceutical Sector

The Reasons for Parallel Trade in the Pharmaceutical Sector The pharmaceutical industry is a special sector in two respects: Firstly, innovative pharmaceutical companies incur high research and development costs for novel medicines. Secondly, in many cases, the buyer of a pharmaceutical product does not directly pay for it but is reimbursed by a national health system. Prices and reimbursement schemes vary considerably between countries in Europe: Price differentiation allows companies to allocate contributions to research and development costs efficiently among different payers, which improves cost recovery.

1) This results in considerable price differences between Member States. A price comparison of pharmaceuticals in 16 EU Member States in 2013 shows differences between 25% and 100% for two thirds and between 100% and 251% for one third.

2) Such price differences are a strong incentive for parallel trade: An importer, usually a wholesaler, purchases pharmaceuticals in a low-price country and then sells them in a high-price country.

Parallel Trade of Pharmaceuticals and its Problems in the EU

Parallel trade, on the one hand, lowers expenditure on pharmaceuticals for high-price countries which is, of course, welcomed by them. The larger the share of parallel imported medicines, the greater this effect is. On the other hand, parallel trade adds to the non-transparency of price structures and may cause certain difficulties for pharmaceutical companies regarding cost calculations.

1) Shortages of Medicines

Parallel trade is exports of pharmaceuticals from low-price countries to high-price countries, may lead to shortages in the former unless the manufacturer is willing to make up for it and supply higher quantities of the product.

2) Risk to the safety of pharmaceuticals

Parallel trade can increase the potential risk of falsified pharmaceuticals because extra steps are added to the supply chain through parallel imports. Complex supply chains, routes of transport, changes of outer packaging and relabeling make it difficult for national authorities to trace the history of pharmaceuticals bought and sold by intermediaries in different EU Member States. The EU has taken measures against falsified medicines through the Falsified Medicines Directive. So far, however, this has not eliminated the problem completely.

3) Lack of transparency and calculation problems

Prices in the pharmaceutical sector are not transparent. The negotiated prices that health insurers pay are generally not published. Such lack of transparency protects the producers by blocking price signals to other insurers and other countries.


Parallel trade is a form of arbitrage: A product, sold by the manufacturer in country A at a lower price than in country B, is bought by a dealer in country A and sold in country B. It is particularly relevant for pharmaceuticals in the internal market of the EU.

Parallel trade may lead to pharmaceutical shortages in low-price countries and increase the potential risk of falsified pharmaceuticals. It adds to the non-transparency of pricing of pharmaceuticals and can lead to calculation problems for manufacturers.

There are three basic options for addressing parallel trade: the exclusion of pharmaceuticals from the internal market rules, open redistribution among the national health systems by a subsidisation fund, and a unitary price that has to be paid everywhere in the EU.