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Hypertension is the leading risk factor for cardiovascular disease and premature death among women globally. However, there is a fundamental lack of knowledge regarding the sex-specific pathophysiology of the condition. In addition, risk factors for hypertension and cardiovascular disease unique to women or female sex are insufficiently acknowledged in clinical guidelines. This review summarizes the existing evidence on women and female-specific risk factors and clinical management of hypertension, to identify critical knowledge gaps relevant to research, clinical practice, and women’s heart health awareness. Female-specific risk factors relate not only to reproduction, such as the association of gynecological conditions, adverse pregnancy outcomes or menopause with hypertension, but also to the specific roles of women in society and science, such as gender differences in received medical care and the underrepresentation of women in both the science workforce and as participants in research, which contribute to the limited evidence-based, gender- or sex-specific recommendations. A key point is that the development of hypertension starts in young, premenopausal women, often in association with disorders of reproductive organs, and therefore needs to be managed early in life to prevent future cardiovascular disease. Considering the lower blood pressure levels at which cardiovascular disease occurs, thresholds for diagnosis and treatment of hypertension may need to be lower for women.

Abstract Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.

Objectives: This study was conducted to determine the perceived attractiveness of the face by change in chin position between orthodontic patients and the general public and determine their desire for surgery to correct it. Study Design: Cross Sectional Study Setting: Orthodontic OPD, Period: March 2021- July 2021 Material & Methods: An ideal facial outline was created with a computer software. 150 participants, divided into two groups (pre-treatment orthodontic patients and lay person) were part of the research. Each participant was given a survey and asked to fill it out and rank images on a summative scale Results: Results showed that the aesthetic judgement of both observer groups was the same for most images; The rating was decided by the amount of shift in the chin position, with the scoring being higher when the chin was more forward than when it was backward. Keywords: attractiveness, chin position, esthetics, facial profile, orthodontics

OBJECTIVE: The vast spread of COVID-19 not only affected the major businesses of the world but also the health care facilities like dentistry. Due to the unprecedented closure of dental services, on-going orthodontic patients also suffered the brunt. The aim of this study was to assess the at-home management approaches used by the patients to tackle the complications associated with orthodontic treatment. METHODOLOGY: It was a cross-sectional questionnaire-based study carried out from June 15 to September 15, 2020 in orthodontic OPD of Jinnah Medical and Dental College, Karachi. A total of 300 orthodontic patients, 208 females and 92 males between ages from 15 to 35 years completed a questionnaire on the complications faced by them and management techniques adopted by them during COVID-19 related office closures. Convenient sampling method was used for data collection. RESULTS: The majority of patients reported in this study were females. Approximately 69.33% (n = 300) of the responders were females and 31% were males. The highest numbers of complications reported during the lockdown period were loose brackets, loose bands and poking of archwire. The most common at-home hack used was removing the loose bracket/ bands and cutting of free end of arch wire with nail cutter like instrument. CONCLUSION: It is the responsibility of the clinician to keep in touch with their patients during pandemic like situation through telemedicine portal. In case of emergencies, patients should be provided with an adequate amount of information to tackle any complications with ease and without hurting themselves. KEYWORDS: COVID-19, Pandemic, Orthodontic Emergencies

Globally, cardiovascular diseases (CVDs) are the leading cause of death. Viewed as a threat to the global economy, the United Nations included reducing noncommunicable diseases, including CVDs, in the 2030 sustainable development goals, and the World Health Assembly agreed to a target to reduce noncommunicable diseases 25% by the year 2025. In response, the World Health Organisation led the development of HEARTS, a technical package to guide governments in strengthening primary care to reduce CVDs. HEARTS recommends a public health and health system approach to introduce highly simplified interventions done systematically at a primary health care level and has a focus on hypertension as a clinical entry point. The HEARTS modules include healthy lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, CVD risk-based management, team-based care, systems for monitoring, and an implementation guide. There are early positive global experiences in implementing HEARTS. Led by the Pan American Health Organisation, many national governments in the Americas are adopting HEARTS and have shown early success. Unfortunately, in Canada hypertension control is declining in women since 2010-2011 and the dramatic reductions in rates of CVD seen before 2010 have flattened when age adjusted and increased for rates that are not age adjusted, and there are marked increases in absolute numbers of Canadians with adverse CVD outcomes. Several steps that Canada could take to enhance hypertension control are outlined, the core of which is to implement a strong governmental nongovernmental collaborative strategy to prevent and control CVDs, focusing on HEARTS.

High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.

Digital, Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, Ciencias Médicas y de la Salud

Key Messages About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke). There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring. Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated. Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks. Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care. Urgent sustained action is needed is needed for effective public polcies and health system changes to prevent and control hypertension

The aim of the study is to evaluate and compare the soft tissue chin thickness values among adult patients with different vertical growth patterns. A sample size of 180 adults patients (32 males and 148 females), with an average age of 21.42 years (range 17- 32 years), was selected. The sample was divided into three groups according to the vertical growth pattern using SNMP angle (hypodivergent 37°). The soft tissue chin thicknesses in each group were measured at pogonion (Pog), gnathion (Gn), and menton (Me) and analyzed using the one-way analysis of variance and post-hoc Tukey test. The soft tissue chin thickness values were greater in hypodivergent group at Pog (12.71±2.10 mm), Gn (9.72 ± 2.55 mm) and Me (9.13 ± 2.88 mm) and smallest in hyperdivergent group (Pog 8.05 ±1.20 mm, Gn 6.07±1.47 mm, Me 5.91±1.21 mm). The soft tissue chin thicknesses were greater in men than women. Soft tissue chin thickness was greater in hypodivergent adults than those of normodivergent and hyperdivergent adults. In all the three groups, soft tissue thickness values were greater in men than women. Key words: Vertical pattern, soft tissue, thickness, adult, chin.

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.Cerca de ¼ dos adultos têm hipertensão arterial, que é o fator de risco isolado mais importante para morte (incluídas as mortes por cardiopatia e acidente vascular cerebral).Existem políticas eficazes que poderiam facilitar escolhas pessoais saudáveis para evitar a elevação da pressão arterial e, se plenamente implementadas, podem prevenir a ocorrência da hipertensão arterial.É fácil rastrear e tratar a hipertensão, MAS somente cerca de 50% dos adultos hipertensos estão cientes de sua condição, e apenas cerca de 1 em cada 7 é tratado adequadamente.A prevenção e controle da hipertensão é o principal mecanismo de prevenção e controle das doenças não transmissíveis e um modelo para outros riscos de doenças não transmissíveis.Tratamentos eficazes com mudanças de estilo de vida e medicamentos poderiam prevenir e controlar a hipertensão arterial na maioria das pessoas se aplicados sistematicamente à população; as intervenções simples são viáveis em todos os ambientes e podem melhorar a atenção primária.É necessária a ação continuada e urgente a fim de obter mudanças efetivas nas políticas públicas e no sistema de saúde para prevenir e controlar a hipertensão arterial.

Background Lead is an established toxic substance, with wide-ranging health effects, including neurodevelopmental decrements and behavioural problems, even at low levels in blood. Anecdotal reports of lead melting to make fishing sinkers in South African subsistence fishing communities prompted the conduct of an epidemiological study in two South African fishing villages to investigate the extent of lead melting and the associated risks in children. Objectives The objectives of the study were to determine the extent of lead melting, and the blood lead distributions and associated risk factors in children. Methods Cross-sectional, analytical studies were undertaken among 160 young school children in the fishing villages of Struis Bay and Elands Bay located along the south-eastern and western South African coastline, respectively. Blood samples were collected for lead content analysis, and anthropometric and hemoglobin measurements were taken. Questionnaires were administered to obtain information about socio-economic status and risk factors for lead exposure. Results Blood lead levels ranged from 2.2 to 22.4 µg/dl, with the mean blood lead level equalling 7.4. Around 74% of the children had blood lead levels ≥5 µg/dl and 16% had blood lead levels ≥10 µg/dl. Socio-economic factors, and lead melting practices were strongly associated with elevated blood lead levels. Conclusions Blood lead levels in these remote subsistence fishing communities were unexpectedly elevated, given the absence of local lead industries or other obvious sources of lead exposure. Lead exposure and poisoning is an important, yet neglected, public health concern in South African subsistence fishing communities, and potentially on the entire African continent.

Background South Africa like many other developing countries is experiencing an epidemiologic transition with a marked increase in the non-communicable disease (NCD) burden. Diabetic retinopathy is the most common cause of incidental blindness in adults. A screening programme using a mobile fundal camera in a primary care setting has been shown to be effective in the country. Information on affordability and cost is essential for policymakers to consider its adoption. Methods Economic evaluation is the comparative analysis of competing alternative interventions in terms of costs and consequences. A cost effectiveness analysis was done using actual costs from the primary care screening programme. Results A total of 14,541 patients were screened in three primary healthcare facilities in the Western Cape. Photographs were taken by a trained technician with supervision by an ophthalmic nurse. The photographs were then read by a medical officer with ophthalmic experience. A cost effective ratio of $1206 per blindness case averted was obtained. This included costs for screening and treating an individual. The cost just to screen a patient for retinopathy was $22. The costs of screening and treating all incident cases of blindness due to diabetes in South Africa would be 168,000,000 ZAR ($19,310,344) per annum. Conclusion Non mydriatic digital fundoscopy is a cost effective measure in the screening and diagnosis of diabetic retinopathy in a primary care setting in South Africa. The major savings in the long term are a result of avoiding government disability grant for people who suffer loss of vision.

To establish cephalometric norms of Pakistani adults according to Jarabak's analysis and to evaluate whether a significant difference exists between Pakistani measurements and Jarabak's norms.A prospective cross-sectional study, was carried out at the Department of Orthodontics Dr. Ishratul Ebad Institute Of Oral Heath Sciences/Sindh Dental Hospital, Karachi from July to September 2012. Standardized lateral cephalometric radiographs were taken of 50 selected Pakistanis within age range 18-23 years having normal occlusion. The database was developed in SPSS 12.0 for Windows.A descriptive analysis and independent Student's test was used. A comparison of the angular and linear measurements according to the Jarabak's analysis in the Pakistani and Caucasian population describe that the Pakistani males had all of their angular as well as linear measurements significantly different then the Caucasian namely the saddle angle, gonial angle, articular angle, upper gonial angle and lower gonial angle (p0.0001) and the anterior cranial base, posterior cranial base, ramus height, anterior facial height, posterior facial height and mandibular corpus (p0.05).Pakistani males and females demonstrated a significant difference in saddle angle, gonial angle, articular angle, upper gonial angle and lower gonial angle (p0.0001) as compared to the Caucasian norms. Pakistani females also had a difference in the upper gonial angle and lower gonial angle (p0.0001) and the anterior cranial base, posterior cranial base, ramus height, anterior facial height, posterior facial height and mandibular corpus measurements.

In November 2011, a draft National Development Plan (NDP) was released that addresses two of South Africa's major challenges: poverty and inequity. Health and economic development are interdependent, presenting an important opportunity through the NDP to integrate health within goals of broader socio-economic development. Reviewing the NDP identified gaps based on evidence and the epidemiological risk profile of South Africa. Recommendations to improve the NDP and to deal with poverty and inequity should focus on prevention and addressing the social determinants of health, including: (i) a multisectoral approach to establish a comprehensive early childhood development programme; (ii) fiscal and legislative policies to bolster efforts to reduce the burden of non-communicable diseases; (iii) promoting and maintaining a healthy workforce; (iv) and promoting a culture of evidence-based priority setting. Achieving the goal of 'a long and healthy life for all South Africans' will require healthy public policies, well functioning institutional and physical infrastructure, social solidarity, and an active and conscientious civil society.