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Context: Hypertension is one of the most common medical disorders complicating pregnancies and complicates 5 to 10% of all pregnancies. Aims: To estimate the prevalence of hypertension among pregnant women and to determine the associated obstetric risk factors of hypertension among them in rural areas of Dibrugarh district, Assam. Settings and Design: Community-based cross-sectional study. Materials and Methods: The present study was conducted on pregnant women of villages under two health blocks at that point of time from May 2017 to April 2018. The sample size was calculated to be 384. The estimated number of pregnant women in each block was noted, and the pregnant women to be included from each block and from each sub-centre was determined by proportional allocation. Data were collected by house-to-house survey in the villages of the respective sub-centre. A pre-designed and pre-tested proforma was used to collect the data. Statistical Analysis Used: Data were analysed using Chi-square test, Fisher’s exact test, and logistic regression. Results: A total of 384 pregnant women gave consent for participation. The prevalence of hypertension in pregnancy was 9.1%. Among the obstetric factors, multigravidity, multiparity, period of gestation >20 weeks, history of hypertension in previous pregnancy, and history of prior still birth were statistically significant risk factors of hypertension in pregnancy. Logistic regression analysis showed period of gestation >20 weeks to be independent predictor of hypertension in pregnancy. Conclusion: The awareness of obstetric risk factors for hypertension in pregnancy may give ways for prevention in this population.

An extensive survey was performed covering all the regions of the country to find out the overall impacts of bio-digester on the economy of livestock farmers. Five districts were selected; ten farmers with having bio-digester of 3.2 m3 on average and ten farmers who have no bio-digester were selected from each district. Through direct interviewing and farm monitoring, all farm characteristics, i.e., diurnal biogas production, power generation, cooking time, income and expenditures, farmer’s gross earnings, and manure management practices data were collected accordingly. Descriptive statistics and student t-test was made to express the comparison response of the farms by using XL and SPSS software. It was observed that the owners of anaerobic digesters earned significantly (p < 0.001) more than the traditional farmers by selling animals and biogas (1715 & 306; 1146 & 0.00 USD, respectively). Not only that, by selling milk and fresh manure, the owners of bio-digester harvested more (p < 0.05) annual income than non-bio-digester farmers (4162, 3408 & 60.91, 44.63 USD, respectively). Though the expenditure of farmers having digester was high, but in a single fiscal year, they earned more (p < 0.05) profit than the conventional farmers (USD 4329 & 2842, respectively). However, owners of bio-digester used 67.2 % of their produced manure for gas production. Regarding storing manure as biomass and using it for cooking purposes significant difference (p < 0.001) was observed that was also reflected in the total manure management system of a farm. The farmers having no bio-digester stored 71.95% of their total manure in solid form, whereas the farmers who had bio-digester only stored 20.4% of their manure, which made a significant (p < 0.001) difference. From the biogas chamber, in an average one farmer used a gas stove for 4-5 hours and a gas lamp for 6-8 hours, which saved at least the expenditure of 18 USD per month/household. The notable thing was that the bio-digester alone contributed 7% to those farmers’ gross economy by producing gas. It can be recommended that the rural householders could generate power by installing bio-digester and turn a small bio-digester as a beneficial avenue of their household economy.

Context: Hypertension is one of the most common medical disorders complicating pregnancies and complicates 5 to 10% of all pregnancies. Aims: To estimate the prevalence of hypertension among pregnant women and to determine the associated obstetric risk factors of hypertension among them in rural areas of Dibrugarh district, Assam. Settings and Design: Community-based cross-sectional study. Materials and Methods: The present study was conducted on pregnant women of villages under two health blocks at that point of time from May 2017 to April 2018. The sample size was calculated to be 384. The estimated number of pregnant women in each block was noted, and the pregnant women to be included from each block and from each sub-centre was determined by proportional allocation. Data were collected by house-to-house survey in the villages of the respective sub-centre. A pre-designed and pre-tested proforma was used to collect the data. Statistical Analysis Used: Data were analysed using Chi-square test, Fisher's exact test, and logistic regression. Results: A total of 384 pregnant women gave consent for participation. The prevalence of hypertension in pregnancy was 9.1%. Among the obstetric factors, multigravidity, multiparity, period of gestation >20 weeks, history of hypertension in previous pregnancy, and history of prior still birth were statistically significant risk factors of hypertension in pregnancy. Logistic regression analysis showed period of gestation >20 weeks to be independent predictor of hypertension in pregnancy. Conclusion: The awareness of obstetric risk factors for hypertension in pregnancy may give ways for prevention in this population. [ABSTRACT FROM AUTHOR]

Eliana Ferroni,1 Paolo Giorgi Rossi,2 Stefania Spila Alegiani,3 Gianluca Trifirò,4 Gisella Pitter,1 Olivia Leoni,5 Danilo Cereda,5 Massimiliano Marino,2 Michele Pellizzari,1 Massimo Fabiani,6 Flavia Riccardo,6 Janet Sultana,4 Marco Massari3 On behalf of The ITA-COVID Working Group1Azienda Zero of the Veneto Region, Padua, Italy; 2Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, Italy; 3National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy; 4Department of Biomedical and Dental Sciences and Morphofunctional Imaging – University of Messina, Messina, Italy; 5Department of Health of Lombardy Region, Milan, Italy; 6Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, ItalyCorrespondence: Stefania Spila AlegianiIstituto Superiore Di Sanità, Viale Regina Elena, 299, Rome 00161, ItalyTel +39 0649904249Fax +39 0649904248Email stefania.spila@iss.itPaolo Giorgi RossiAzienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, via Amendola 2, Reggio Emilia 42122, ItalyTel +39 0522335490Email paolo.giorgirossi@ausl.re.itIntroduction: COVID-19 case fatality rate in hospitalized patients varies across countries and studies. Reliable estimates, specific for age, sex, and comorbidities, are needed to monitor the epidemic, to compare the outcome in different settings, and to correctly design trials for COVID-19 interventions. The aim of this study was to provide population-based survival curves of hospitalized COVID-19 patients.Materials and Methods: A cohort study was conducted in three areas of Northern Italy, heavily affected by SARS-CoV-2 infection (Lombardy and Veneto Regions, and Reggio Emilia province), using a loco-regional COVID-19 surveillance system, linked to hospital discharge databases. We included all patients testing positive for SARS-CoV-2 RNA by RT-PCR on nasopharyngeal/throat swab samples who were hospitalized from 21 February to 21 April 2020. Kaplan–Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex, and the Charlson Index.Results: Overall, 42,926 hospitalized COVID-19 patients were identified. Patients’ median age was 69 years (IQR: 57– 79), 62.6% were males, and 6.0% had a Charlson Index ≥ 3. Survival curves showed that 22.0% (95% CI 21.6– 22.4) of patients died within 14 days and 27.6% (95% CI 27.2– 28.1) within 30 days from hospitalization. Survival was higher in younger patients and in females. The negative impact of comorbidities on survival was more pronounced in younger age groups.Conclusion: The high fatality rate observed in the study (28% at 30 days) suggests that studies should focus on death as primary endpoint during a follow-up of at least one month.Keywords: COVID-19, survival, cohort study, hospitalized patients, Italy

Janet Sultana,1,2 Andrea Fontana,3 Francesco Giorgianni,1 Giorgio Basile,1 Elisabetta Patorno,4 Alberto Pilotto,5 Mariam Molokhia,6 Robert Stewart,7 Miriam Sturkenboom,2 Gianluca Trifirò1,2 1Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy; 2Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands; 3Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; 4Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA; 5Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy; 6Department of Primary Care and Public Health Sciences, King’s College, London, UK; 7Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King’s College London, UK Background: Functional and cognitive domains have rarely been evaluated for their prognostic value in general practice databases. The aim of this study was to identify functional and cognitive domains in The Health Improvement Network (THIN) and to evaluate their additional value for the prediction of 1-month and 1-year mortality in elderly people.Materials and methods: A cohort study was conducted using a UK nationwide general practitioner database. A total of 1,193,268 patients aged 65 years or older, of whom 15,300 had dementia, were identified from 2000 to 2012. Information on mobility, dressing and accommodation was recorded frequently enough to be analyzed further in THIN. Cognition data could not be used due to very poor recording of data in THIN. One-year and 1-month mortality was predicted using logistic models containing variables such as age, sex, disease score and functionality status.Results: A significant but moderate improvement in 1-year and 1-month mortality prediction in elderly people was observed by adding accommodation to the variables age, sex and disease score, as the c-statistic (95% confidence interval [CI]) increased from 0.71 (0.70–0.72) to 0.76 (0.75–0.77) and 0.73 (0.71–0.75) to 0.79 (0.77–0.80), respectively. A less notable improvement in the prediction of 1-year and 1-month mortality was observed in people with dementia.Conclusion: Functional domains moderately improved the accuracy of a model including age, sex and comorbidities in predicting 1-year and 1-month mortality risk among community-dwelling older people, but they were much less able to predict mortality in people with dementia. Cognition could not be explored as a predictor of mortality due to insufficient data being recorded. Keywords: elderly, frailty, database, mortality

Paraganglioma of the infratemporal fossa is exceedingly rare, with no more than a handful of documented cases. Undiagnosed paraganglioma poses a great challenge. We present a 39-year-old hypertensive female, who presented with giddiness and headache for 3 months and four episodes of syncope over 3 months. CT and MRI revealed an enhancing infratemporal region space-occupying mass close proximity to petrous carotid artery. Intraoperatively, the patient had hemodynamic instability (tachycardia and hypertension) when the mass was surgically manipulated. Diagnosis of paraganglioma was suspected, based on hemodynamic instability, which was later confirmed by histopathology. Undiagnosed paraganglioma pose a great challenge to the anesthetic management. Low-threshold of suspicion has to be there to avoid significant morbidity and mortality.

Background: Periodontitis is one of the most common chronic inflammatory disorders in adults. Although clinical studies have suggested a causal relationship between periodontitis and major depression (MD), the biological mechanisms by which periodontitis instigates MD are unknown. We investigated whether a systemic administration of lipopolysaccharide (LPS) from Porphyromonas gingivalis (Pg), a major Gram-negative pathogen of periodontitis, causes depressive-like behavior and glial activation in the hippocampus and the prefrontal cortex (PFC), which are MD-related brain regions. Materials and Methods: Eight-week-old male Sprague Dawley rats were randomly divided into a behavioral test group and an immunohistochemistry group. The rats in each group were further assigned to the sham injection (saline) and Porphyromonas gingivalis-lipopolysaccharide (Pg-LPS) injection protocols. The rats received an intraperitoneal injection of saline or Pg-LPS with gradually increasing doses (day 1: 0.5, day 2: 0.5, day 3: 0.75, day 4: 0.75, day 5: 1.0, day 6: 1.0, and day 7: 1.0 mg/kg of body weight) for seven consecutive days. After the systemic administration, the behavior test group underwent the forced swimming test (FST) and Y-maze test. For the immunohistochemistry group, we quantified the immunoreactivity for microglial Iba-1 (ionized calcium-binding adapter molecule 1) and astrocytic glial fibrillary acidic protein (GFAP) in the hippocampus (dentate gyrus [DG], cornu ammonis [CA1 and CA3]) and PFC (prelimbic [PrL] and the infralimbic [IL]) areas. Results: The FST immobility time in the Pg-LPS group was significantly longer than that in the sham group. In the Y-maze test, a significant decline in spontaneous alternation behavior was observed in the Pg-LPS group compared to the sham group. The peripheral administration of Pg-LPS significantly increased the immunoreactivity for Iba-1 in the CA3 and PrL. Pg-LPS injection significantly increased the immunoreactivity for GFAP in the DG, CA1, and CA3. Conclusions: The major result of this study is that a repeated systemic administration of Pg-LPS caused depressive-like behavior and both microglial and astrocytic activation in rats. This finding may comprise biological evidence of a causal relationship between periodontitis and MD. [ABSTRACT FROM AUTHOR]

Background: Cystic artery injury is a common complication during laparoscopic cholecystectomy, which transfers laparoscopic surgery to open surgery. If surgery is performed incorrectly, injury to the extra hepatic bile duct or intra-abdominal organs is un-avoidable. The reported rate of changing to open surgery because of blood vessel injuries is approximately 0%-1.9% during laparoscopic cholecystectomy. Aim: To assess the pattern and magnitude of cystic artery variations by laparoscopy among patients undergone laparoscopic cholecystectomy in southern region, Saudi Arabia. Material and Methods: A descriptive approach was used including all patients undergone cholecystectomy procedures in Aseer Central Hospital and Military Hospital in Khamis Mushayt. Anatomic variations of the cystic artery were viewed during laparoscopic or open cholecystectomy procedures and recorded by the surgeon. The course, origin and length of the cystic artery was recorded besides patients' demographic data. Results: The study included 199-cases with ages ranged from 13 to 97 years old and mean age of 47.7 18.6 years old. Exact of 94.5% of the cases were females. As for cystic artery variation, only two cases (1%) recorded abnormality. The abnormality was more among females at middle ages. Conclusions: The study revealed that cystic artery variations recorded among Saudi patients in southern region was very rare as only 2-cases out of about 200-cases were positive for cystic artery variations. [ABSTRACT FROM AUTHOR]