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The knowledge of the skeletal maturation and the stage of the growth of the patients seeking orthodontic treatment are of great value in planning efficient orthodontic therapy. However, different craniofacial structures of patient show variation in growth potential. The routine use of hand-wrist radiograph for growth prediction exposes the patient to extra radiation. Cervical vertebrae in the lateral cephalograph have been recommended as an alternative method. The pubertal growth spurt is a vital period in the orthodontic treatment and should be kept in mind when planning orthodontic treatment in growing children. One of the main objectives of taking hand and wrist radiograph is to determine the amount of growth and get used of it in patients with skeletal discrepancy during adolescence. Further, this will help in the selection of the appliances required, the course of the treatment and the retention after active orthodontic therapy.

Background: The menstrual cycle in women is the main indicator of their reproductive health which is affected by the ongoing coronavirus disease 2019 pandemic. This review aims to summarize the effects of the COVID-19 infection and the global pandemic on the menstrual health of women. Methods:The literature search was conducted in PubMed, Cochrane library, and Google Scholar using keywords "COVID-19," "Menstrual Cycle," "Menstrual Cycle Irregularities," "Amenorrhea," "Polymenorrhea," and "Dysmenorrhea." The articles were selected according to the following inclusion criteria: (i) cross-sectional studies, (ii) cohort studies, (iii) surveys, and (iv) other observational studies observing the effects of SARS-CoV-2 infection or COVID-19 pandemic on menstrual health of women. Exclusion criteria included: case reports, gray literature, and website articles regarding menstrual health.Results: A total of 30,510 articles were shortlisted after a comprehensive search.Sixteen articles were included out of which 13 studies investigated the effects of the COVID-19 pandemic on the menstrual cycle while 3 evaluated the possible effects of COVID-19 infection on the menstrual health of women. Menstrual disorders or irregularities were a more common finding during the pandemic as compared to before (p = 0.008). Women affected by pandemic-related stress were more prone to changes in the duration of their menses (p = 0.0008), reported heavier bleeding (p = 0.028), and increased incidence of painful periods (p < 0.0001). COVID-19 infected women also reported changes in their menstrual cycle including irregular menstruation, increased symptoms of premenstrual syndrome, and infrequent menstruation.Conclusions: Women suffering from COVID-19 infection or pandemic-associated stress and anxiety were more likely to experience irregular menstruation, dysmenorrhea,

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Chronic Kidney Disease (CKD) refers to various kidney disorders ranging from mild to severe chronic kidney failure. Because of its escalating incidence and mortality rates, CKD is a serious public health concern in Pakistan. According to a study published in 2018, the overall prevalence of CKD among Pakistani adults was 21.2%, the highest in South Asia. (1) Although there are numerous risk factors for CKD, such as diabetes, cardiovascular disease, smoking, obesity, and genetics, hypertension poses the most serious threat, as the global prevalence of CKD-associated hypertension is between 60 – 90%. (2) In most people with CKD, proteinuria is observed in conjunction with hypertension. (3) As per the Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations, ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) are the preferred treatment choices for diabetic kidney disease and non-diabetic kidney disease patients with proteinuria. In 2013, a cross-sectional study conducted in Karachi, Pakistan, revealed that only 46.1% of General Practitioners opted for ACE inhibitors and ARBs as primary treatment for hypertension and proteinuria associated with CKD. (4) A randomized crossover trial conducted in March 2021 compared  candesartan’s antihypertensive and antiproteinuric effects and the newest ARB, azilsartan medoxomil. The study results revealed that azilsartan (20 mg daily) treatment significantly decreased proteinuria and blood pressure without a noticeable increase in side effects than candesartan (8 mg daily) in patients with CKD who required antihypertensive drugs. (5) Considering the high prevalence of CKD in Pakistan, doctors must follow KDOQI guidelines and prescribe ARBs as the primary therapeutic agents for hypertensive patients with CKD. Azilsartan, the most recent ARB, has been proven to have the most potent antihypertensive and antiproteinuric benefits with the fewest side effects. (5) Therefore, physicians should encourage CKD patients to use azilsartan instead of candesartan and other classes of ARBs.       Furthermore, improved screening techniques for CKD must be introduced and implemented so that doctors can manage the disease more effectively before it progresses into its final stages. Such screening tests would also help to improve blood pressure control among patients recognized to have CKD. Therefore, Pakistan’s public health sector should ensure the implementation of Kidney Disease Improving Global Outcomes (KDIGO) criteria to screen and manage CKD and CKD-associated hypertension and diabetes. Lastly, there is a dire need for awareness programs to educate general health practitioners regarding CKD management and the benefits of timely referral to a nephrologist.