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, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
Young indigenous South Asians with PCOS have greater odds of being centrally obese, with a third having the MetS that bears no relationship to the androgenic phenotype. Significant predictors for MetS within the PCOS cohort are advancing age, obesity determined by the Asian cut off (BMI >25 kg/m(2)) and AN, while family history of diabetes, hyperandrogenism and elevated SHBG have no predictive value.
The unprecedented COVID-19 pandemic has indelibly impacted routine healthcare provision across the globe. Nevertheless, management of traumatic injuries has remained a priority patient care service of oral and maxillofacial (OMF) practice. This study aimed to explore the pattern and mechanisms of OMF injuries presenting at a major public dental hospital during a COVID-19 lockdown period in Sri Lanka. An enhanced OMF injury surveillance system was established at the National Dental Hospital (Teaching) Sri Lanka (NDHTSL) on 1 March 2020. OMF injury surveillance data from 1 March 2020 to 31 May 2020 were collated from the “enhanced injury surveillance form”. This period overlapped with the strictly imposed island-wide COVID-19 community lockdown. Pre-COVID-19 period (November 2017 to January 2020) OMF injury data were compared with this period. OMF injuries were categorized as hard tissue, extra-oral or intra-oral soft tissue, upper and middle face fractures and mandibular fractures. Data were analyzed with descriptive statistics, Fisher’s exact and Chi-square tests of significance. A total of 361 OMF injuries were identified among 208 patients who were predominantly males (71.6%); mean age was 24.95 ± 2.76 years. Injuries to gingivae and oral mucosa (26.9%) were the leading type, followed by extra-oral soft tissues (22.1%), periodontal injuries (20.7%) and hard tissue injuries (20.2%). Upper face and mandibular fractures accounted for 2.9% and 1.9%, respectively. Most patients sustained their injuries due to falls at their homes and surrounds. This was significantly increased compared to the pre-COVID-19 period (p = 0.0001). The significant increase in OMF injuries associated with falls around the home during the COVID-19 lockdown scenario in Sri Lanka compared to the pre-COVID-19 period may need further investigation in order to understand the how these injuries may be prevented.
Effective and rapid decision making during a pandemic requires data not only about infections, but also about human behavior. Mobile phone surveys (MPS) offer the opportunity to collect real-time data on behavior, exposure, knowledge, and perception, as well as care and treatment to inform decision making. The surveys aimed to collect coronavirus disease 2019 (COVID-19) related information in Ecuador and Sri Lanka using mobile phones. In Ecuador, a Knowledge, Attitudes and Practices (KAP) survey was conducted. In Sri Lanka, an evaluation of a novel medicine delivery system was conducted. Using the established mobile network operator channels and technical assistance provided through The Bloomberg Philanthropies Data for Health Initiative (D4H), Ministries of Health fielded a population-based COVID-19-specific MPS using Surveda, the open source data collection tool developed as part of the initiative. A total of 1,185 adults in Ecuador completed the MPS in 14 days. A total of 5,001 adults over the age of 35 in Sri Lanka completed the MPS in 44 days. Both samples were adjusted to the 2019 United Nations Population Estimates to produce population-based estimates by age and sex. The Ecuador COVID-19 MPS found that there was compliance with the mitigation strategies implemented in that country. Overall, 96.5% of Ecuadorians reported wearing a face mask or face covering when leaving home. Overall, 3.8% of Sri Lankans used the service to receive medicines from a government clinic. Among those who used the medicine delivery service in Sri Lanka, 95.8% of those who used a private pharmacy received their medications within one week, and 69.9% of those using a government clinic reported the same. These studies demonstrate that MPS can be conducted quickly and gather essential data. MPS can help monitor the impact of interventions and programs, and rapidly identify what works in mitigating the impact of COVID-19.
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