Pregnancy and COVID-19.

Evidence indicates that SARS-CoV-2 infection increases the likelihood of adverse pregnancy outcomes. Modifications in the circulatory, pulmonary, hormonal, and immunological pathways induced by pregnancy render pregnant women as a high-risk group. A growing body of research shows that SARS-CoV-2 infection during pregnancy is connected to a number of maternal complications, including pneumonia and intensive care unit (ICU) hospitalization. Miscarriages, stillbirth, preterm labor, as well as pre-eclampsia and intrauterine growth restriction are also among the most often documented fetal implications, particularly among expecting women who have significant COVID-19 symptoms, often affecting the timing and route of delivery. Thus, prevention of infection and pharmacological treatment options should aim to minimize the aforementioned risks and ameliorate maternal, obstetric and fetal/neonatal outcomes.

Abdominal aortic aneurysms and abdominal wall hernias - a systematic review and meta-analysis.

Background: Abdominal wall hernias (AWHs) share common epidemiological characteristics with abdominal aortic aneurysms (AAAs), typically presenting in male population and older ages. Prior reports have associated those two disease entities. Our objective was to perform a systematic review and meta-analysis and examine whether AAA rates are higher among patients with AWH vs controls and whether the incidence of AWH was higher among patients with AAA vs patients without AAA. Methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The Medline database was searched up to July 31, 2020. A random effects meta-analysis was performed. Results: In total, 17 articles and 738,972 participants were included in the systematic review, while 107,578 patients were eligible for the meta-analysis. Among four studies investigating the incidence of AAA in patients with hernias, AAA was more common in patients with hernias, compared to patients without hernias. [OR: 2.53, 95% CI: 1.24-5.16, I2=81.6%]. Among thirteen studies that compared patients with known AAA vs no AAA, the incidence of hernias was higher in patients with AAA, compared with patients without AAA [OR: 2.27, 95% CI: 1.66-3.09, I2=84.6%]. Conclusions: Our study findings indicate that a strong association between AWH and AAA exists. AWHs could therefore be used as an additional selection criterion for screening patients for AAA, apart from age, gender, family history and smoking.

Supravesical hernias: a systematic review of the literature.

BACKGROUND: A supravesical hernia (SH) is a rare abdominal wall hernia that is defined by the protrusion of abdominal viscera through the supravesical fossa. The objective of this study was to review current literature on SHs and elucidate their clinical manifestations and preferred therapeutic approach. METHODS: PubMed, Embase and Cochrane bibliographical databases were searched (last search: 30 March 2020) for articles reporting on SHs. RESULTS: Thirty-four studies met our inclusion criteria and involved collectively 38 patients (94.7% males) with an age of 59.57 ± 14.84 (mean ± standard deviation) years. Abdominal pain (81.6%) and nausea and vomit (71.1%) were the most frequently encountered symptoms. The majority of patients (78.1%) had signs of bowel obstruction. Twenty-nine patients (76.3%) suffered from an internal SH, while nine (23.7%) had an external one. An open hernia repair was conducted at 29 patients (76.3%), while eight (21.1%) had a laparoscopic approach and in one case (2.6%) the laparoscopic operation was converted to an open one. A mesh was applied at 14.3% of included cases. Eight patients (21.1%) underwent a bowel resection and hernia sac was resected at six (15.8%) cases. Four patients (11.8%) experienced postoperative complications and one patient (2.9%) died on first postoperative day. CONCLUSION: SH is an extremely rare type of hernia occurring through the supravesical fossa between the remnants of urachus and foetal umbilical arteries. All clinicians should be aware of this entity and further studies are necessary in order to clarify their aetiology, true incidence and optimal therapeutic approach.

Blood Pressure and All-Cause Mortality by Level of Cognitive Function in the Elderly: Results From a Population-Based Study in Rural Greece.

This study aimed to investigate whether the effect of blood pressure (BP) on mortality differs by levels of cognitive function. The associations of brachial systolic BP, diastolic BP, mean arterial pressure (MAP), and pulse pressure with all-cause mortality were prospectively explored (follow-up 7.0±2.2 years) in 660 community-dwelling individuals (≥60 years) using adjusted Cox models, stratified by cognitive impairment (Mini-Mental State Examination [MMSE] <24). No association between brachial BP variables and mortality was shown for the total sample in quartiles analysis; however, MAP in the highest quartile, compared with the second, was associated with mortality (hazard ratio, 1.85; 95% confidence intervals, 1.09-3.12) among cognitively impaired individuals. The fractional-polynomials approach for BP confirmed this finding and further showed, solely in the MMSE <24 subcohort, U-shaped trends of MAP and systolic BP, with increased mortality risk in extremely low or high values; no such pattern was evident for patients with MMSE ≥24. Elderly individuals with cognitive impairment might be more susceptible to the detrimental effects of low and elevated MAP and systolic BP.

Risk for childhood leukemia associated with maternal and paternal age.

The role of reproductive factors, such as parental age, in the pathogenesis of childhood leukemias is being intensively examined; the results of individual studies are controversial. This meta-analysis aims to quantitatively synthesize the published data on the association between parental age and risk of two major distinct childhood leukemia types in the offspring. Eligible studies were identified and pooled relative risk (RR) estimates were calculated using random-effects models, separately for childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Subgroup analyses were performed by study design, geographical region, adjustment factors; sensitivity analyses and meta-regression analyses were also undertaken. 77 studies (69 case-control and eight cohort) were deemed eligible. Older maternal and paternal age were associated with increased risk for childhood ALL (pooled RR = 1.05, 95 % CI 1.01-1.10; pooled RR = 1.04, 95 % CI 1.00-1.08, per 5 year increments, respectively). The association between maternal age and risk of childhood AML showed a U-shaped pattern, with symmetrically associated increased risk in the oldest (pooled RR = 1.23, 95 % CI 1.06-1.43) and the youngest (pooled RR = 1.23, 95 % CI 1.07-1.40) extremes. Lastly, only younger fathers were at increased risk of having a child with AML (pooled RR = 1.28, 95 % CI 1.04-1.59). In conclusion, maternal and paternal age represents a meaningful risk factor for childhood leukemia, albeit of different effect size by leukemia subtype. Genetic and socio-economic factors may underlie the observed associations. Well-adjusted studies, scheduled by large consortia, are anticipated to satisfactorily address methodological issues, whereas the potential underlying genetic mechanisms should be elucidated by basic research studies.