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Objective: To analyse the association between determinants of maternal deaths and obstetric haemorrhage in Padang, Indonesia.Methods: A retrospective case-control study was conducted in Padang, Indonesia from 2015 to 2019. Maternal deaths that occurred due to obstetric hemorrhage in Padang Health Department was compared to three mothers who survived from obstetric hemorrhage (controls) in Dr. M. Djamil General Hospital, Padang, Indonesia.Results: There were 20 deaths caused by obstetric hemorrhage during 2015 to 2019. Death records could only be found in 16 cases. The most common etiology of obstetric hemorrhage was uterine atony (62.5%). Determinants associated with maternal deaths due to obstetric hemorrhage were interval between pregnancies (p=0.045; OR:10.846), history of previous labour (p=0.003; OR:8.556), and antenatal care (p=0.003; OR:21.364). Age, parity, birth attendant, and mother’s educational level were not significantly associated with maternal deaths due to obstetric hemorrhage.Conclusion: Uterine atony was the most frequent etiology of maternal deaths due to obstetric hemorrhage. There was a significant association between pregnancy intervals, history of previous labour, and antenatal care with maternal deaths due to obstetric hemorrhage.Keywords: determinant, obstetric hemorrhage, maternal death. Abstrak Tujuan: Menganalisis hubungan determinan kematian maternal akibat perdarahan obstetri di Kota Padang.Metode: Sebuah studi retrospektif case-control dilakukan di Kota Padang dari tahun 2015–2019. Setiap kasus kematian ibu akibat perdarahan obstetri dari tahun 2015–2019 yang dilaporkan oleh Dinas Kesehatan Kota Padang dibandingkan dengan tiga kasus perdarahan obstetri yang tidak berakibat kematian di RSUP Dr. M. Djamil Padang. Analisis data menggunakan uji Chi-square.Hasil: Ada 20 kasus kematian akibat perdarahan obstetri selama tahun 2015–2019. Catatan kematian hanya dapat diperoleh pada 16 kasus. Etiologi terbanyak kematian akibat perdarahan obstetri ialah atonia uteri. Determinan yang berhubungan dengan kematian akibat perdarahan obstetri ialah jarak kehamilan (p=0.045; OR:10.846), riwayat persalinan sebelumnya (p=0.003; OR:8.556), dan antenatal care (p=0.003; OR:21.364). Tidak terdapat hubungan yang signifikan antara usia, paritas, penolong persalinan, dan tingkat pendidikan ibu dengan kematian maternal akibat perdarahan obstetri.Kesimpulan: Atonia uteri merupakan etiologi tertinggi kematian maternal akibat perdarahan obstetri. Ada hubungan yang signifikan antara jarak kehamilan, riwayat persalinan sebelumnya, dan antenatal care dengan kematian maternal akibat perdarahan obstetri.Kata kunci: determinan, kematian maternal, perdarahan obstetri.

B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up.In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF=30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF=33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30-0.67, p0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36-0.67, p0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥0.3mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p0.0001).Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.

Aims Left atrial (LA) size is considered a marker of poor prognosis in heart failure (HF) patients. Prior studies have recruited relatively few subjects limiting their power to adequately analyse the interaction between LA size, left ventricular (LV) systolic and diastolic function, and prognosis. Method and results The MeRGE collaboration combines prospective data from 18 studies in HF patients. In this analysis of data from 1157 patients, the primary endpoint was death or hospitalization for worsening HF. In multivariate analysis (Cox proportion hazard model), LA area was associated with prognosis (HR 1.03 per cm2, 95% CI 1.02, 1.05; P < 0.0001) independently of age, NYHA class, LV ejection fraction, and restrictive filling pattern (RFP). When LA area was used as a categorical variable, the HR associated with larger LA area (above median) was 1.4 (95% CI 1.13, 1.74) and when LA area index was used, the HR was 2.36 (95% CI 1.80, 3.08). When the patients with and without RFP were divided on the basis of either LA area or LA area index, significantly higher event rates were observed in those with larger LA area. Conclusion Left atrial area is a powerful predictor of outcome among HF patients with predominantly impaired systolic function, and is independent of, and provides additional prognostic information beyond LV systolic and diastolic function.

Life Cycle Assessment (the systematic analysis of the environmental impact of products during their entire life cycle), Carbon Footprint and Water Footprint assessments play an important role in decision-making processes. These assessments can help guide land management decisions and will likely play a larger role in the future, especially in natural areas with high biodiversity. Agriculture is a substantial consumer of fresh water, so it is important to identify causes and possible solutions to optimize agricultural water use. Water footprint assessments consider water consumption from several points of view and aid in reaching Sustainable Development Goals. Olive trees are a widespread agricultural crop growing in the Mediterranean Basin and are particularly important in the Umbria region in Italy. This paper estimates the water footprint impact related to the production of 1 kg of olives in a rainfed olive orchard managed using low environmental impact techniques. Eleven years of data collection (meteorological data, olives yield data, processes data) are analyzed for typical rural conditions. The results show that local management techniques have lower water requirements than standard international usages. These results can be used to improve and to further explore agricultural water use.

Background: The relation between systolic pulmonary pressure (sPAP) and left atrium in patients with heart failure (HF) is unclear. Diastolic dysfunction, expressed as restrictive mitral filling pattern (RMP), and functional mitral regurgitation (FMR) are associated with both LA enlargement and increased sPAP. We aimed to evaluate whether atrial dilation might modulate the consequences of RMP and FMR on the pulmonary circulation of patients with HF with reduced ejection fraction (HFrEF). Methods: 1256 HFrEF patients were retrospectively recruited in four Italian centers. Left ventricular (LVD) and atrial (LAD) diameters were measure by m-mode, and EF were measured. RMP was defined as E-wave deceleration time lower than 140 ms. FMR was quantitatively measured. sPAP was evaluated based on maximal tricuspid regurgitant velocity and estimated right atrial pressure. Results: Final study population was formed by 1005 patients because of unavailability of sPAP in 252 patients. Mean EF was 33 ± 3, 35% had RMP, 67% had mild, and 26% moderate-to-severe FMR. 69% of patients had increased sPAP. A significant association was observed between sPAP and EF, RMP, FMR, and LAD (p

AIMS Heart failure is a widespread syndrome involving several organs, still characterized by high mortality and morbidity, and whose clinical course is heterogeneous and hardly predictable.In this scenario, the assessment of heart failure prognosis represents a fundamental step in clinical practice. A single parameter is always unable to provide a very precise prognosis. Therefore, risk scores based on multiple parameters have been introduced, but their clinical utility is still modest. METHODS In this review, we evaluated several prognostic models for acute, right, chronic, and end-stage heart failure based on multiple parameters. In particular, for chronic heart failure we considered risk scores essentially based on clinical evaluation, comorbidities analysis, baroreflex sensitivity, heart rate variability, sleep disorders, laboratory tests, echocardiographic imaging, and cardiopulmonary exercise test parameters. RESULTS What is at present established is that a single parameter is not sufficient for an accurate prediction of prognosis in heart failure because of the complex nature of the disease. However, none of the scoring systems available is widely used, being in some cases complex, not user-friendly, or based on expensive or not easily available parameters. CONCLUSION We believe that multiparametric scores for risk assessment in heart failure are promising but their widespread use needs to be experienced.