Prevalence, Awareness, Treatment, and Control of Hypertension in the PERSIAN Cohort Study: JNC7 Versus ACC/AHA Guidelines Short Title: The Impacts of Hypertension Definition in Iran

In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163770 participants, aged 35 to 70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI: 20.6-24.1) based on the JNC7 guideline and 36.5% (31.1-41.8) based on the ACC/AHA guideline. A total of 24312 participants [14.1% [10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran.

UNWTO/GTERC Asia Tourism Trends – 2020 Edition

The UNWTO/GTERC Asia Tourism Trends – 2020 Edition is the seventh report in this series. In light of the severe impacts that the COVID-19 pandemic has had on the tourism sector, the first chapter provides an analysis on the socioeconomic environment in Asia and the Pacific, supported by the latest international tourism trends for the region. The second chapter offers an overview of the recovery measures being taken in Asia and the Pacific to mitigate the effects of the pandemic and explore how the crisis may affect the achievement of the Sustainable Development Goals. The final chapter focusses on community development through tourism in rural settings. It offers a set of guidelines for policymakers and highlights the potential for the development of cultural routes across Asia and the Pacific.

UNWTO/GTERC Asia Tourism Trends – 2020 Edition, Executive Summary

The UNWTO/GTERC Asia Tourism Trends – 2020 Edition is the seventh report in this series. In light of the severe impacts that the COVID-19 pandemic has had on the tourism sector, the first chapter provides an analysis on the socioeconomic environment in Asia and the Pacific, supported by the latest international tourism trends for the region. The second chapter offers an overview of the recovery measures being taken in Asia and the Pacific to mitigate the effects of the pandemic and explore how the crisis may affect the achievement of the Sustainable Development Goals. The final chapter focusses on community development through tourism in rural settings. It offers a set of guidelines for policymakers and highlights the potential for the development of cultural routes across Asia and the Pacific.

Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort

Background The impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated. Methods and Results We studied dementia‐free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2. Conclusions Risk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Incidence of Prehypertension and Hypertension in Rural India, 2012–2018: A Sex-Stratified Population-Based Prospective Cohort Study

BACKGROUND India is home to the largest number of hypertensive individuals, and factors responsible for the incidence of hypertension are poorly understood. This study examines predictors of transition to different stages of hypertension—incidence of hypertension, incidence of prehypertension, and incidence of prehypertension to hypertension. METHODS Population-based survey data from the Birbhum Population Project, located in West Bengal, India were used. A cohort of 8,977 individuals (male: 3,934, female: 5,043), participated in the 2012–13 survey, and were followed up for resurvey in 2017–18. The Seventh Report of the Joint National Committee (JNC 7) guidelines were followed to define hypertension. Bivariate and multivariate Poisson regression analyses were conducted to attain the study objective. RESULTS The incidence of hypertension, prehypertension among males (7.9% and 45.3%, respectively) is higher than that among females (5.9% and 32.7%, respectively). However, the incidence of prehypertension to hypertension is lower among males (23.6%) than among females (33.6%). Among both sexes, with age, the incidence of hypertension, and incidence of prehypertension to hypertension appeared to increase, whereas incidence of prehypertension among females increased with age. Findings indicate a diverse gradient of socioeconomic, behavioral, and anthropometric characteristics influencing the incidence of different stages of hypertension. CONCLUSIONS With a focus on females and the richest individuals, this study proposes that an appropriate intervention be designed in keeping with the socioeconomic, behavioral gradient of incidence of different stages of hypertension. The role of anthropometric indicators in hypertension is proposed to be further studied for better population-based screening.

Studies on the life cycle of Pleurogenoides wayanadensis Shinad & Prasadan, 2018 (Digenea: Pleurogenidae) from the Western Ghats, India

The life cycle of Pleurogenoides wayanadensis Shinad & Prasadan, 2018, infecting the frogs Hoplobatrachus tigerinus and Euphlyctis cyanophlyctis, is elucidated in this study. All the life cycle stages from egg to egg-producing adults were elucidated under natural conditions and successfully established in the laboratory. The life cycle took about 58 to 65 days for completion. Miracidia were released by teasing the eggs with fine needles. Sporocysts were found in the freshwater snail, Bithynia (Digoniostoma) pulchella, collected from paddy fields at Payode, Western Ghats, Wayanad region, in the months of October and November 2019. Cercariae were of the virgulate xiphidiocercous type. Metacercariae were recovered from the eyes of the damselfly naiads of the species Ischnura sp. and Copera sp., and the thorax and abdomen of the dragonfly naiads, Orthetrum sp. The metacercariae showed progenetic development. The growth and development of the metacercariae in the naiads that were exposed to cercariae, and development of the trematode in frogs that were force-fed with encysted metacercariae, have been studied at regular intervals. The prepatent period is 14–19 days. The present life cycle study of a Pleurogenoides spp. forms the seventh report from the world, fourth report from India and the third from Kerala.

Ovarian Teratoid Carcinosarcoma Is an Aggressive Tumor of Probable Mullerian Derivation with a Carcinosarcomatous and Mixed Germ-Cell Morphology

Ovarian carcinosarcoma is also referred to as malignant mixed Mullerian tumor (MMMT). It is a rare neoplasm, and although it represents less than 5% of malignant ovarian tumors, it remains generally well-known among clinicians and pathologists. Rarer yet is ovarian teratoid carcinosarcoma, defined as carcinosarcoma with the added feature of immature neuroectodermal tissue, with or without elements of primitive germ cell tumor. To our knowledge, six ovarian teratoid carcinosarcomas have been reported in the literature [Matsuura et al. J Obstet Gynaecol Res. 2010 Aug; 36(4): 907–11]. These tumors resemble nasopharyngeal tumors of the same name. We report a 55-year-old woman seen at Orlando Health’s division of gynecological oncology whose pathology showed ovarian teratoid carcinosarcoma, and present what we believe to be a seventh report of this entity.

Giant Penile Lymphedema Caused by Chronic Penile Strangulation with Rubber Band: A Case Report and Review of the Literature

We treated a 65-year-old Japanese man with a giant penile lymphedema due to chronic penile strangulation with a rubber band. He was referred to our hospital with progressive penile swelling that had developed over a period of 2 years from chronic use of a rubber band placed around the penile base for prevention of urinary incontinence. Under a diagnosis of giant penile lymphedema, we performed resection of abnormal penile skin weighing 4.8 kg, followed by a penile plasty procedure. To the best of our knowledge, this is only the seventh report of such a case worldwide, with the present giant penile lymphedema the most reported.