COVID-19 presenting as stroke

© 2020 Elsevier Inc. Objective: Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. Methods: We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained. Results: We identified four patients who presented with radiographic confirmation of acute stroke and PCR-confirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course. Conclusions: Timely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and should dawn appropriate personal protective equipment in every suspected patient. Further studies are urgently needed to improve current understandings of neurological pathology in the setting of COVID-19 infection

SN 2022oqm: A Multi-peaked Calcium-rich Transient from a White Dwarf Binary Progenitor System

We present the photometric and spectroscopic evolution of SN 2022oqm, a nearby multi-peaked hydrogen- and helium-weak calcium-rich transient (CaRT). SN 2022oqm was detected 19.9 kpc from its host galaxy, the face-on spiral galaxy NGC 5875. Extensive spectroscopic coverage reveals a hot (T >= 40,000 K) continuum and carbon features observed ~1 day after discovery, SN Ic-like photospheric-phase spectra, and strong forbidden calcium emission starting 38 days after discovery. SN 2022oqm has a relatively high peak luminosity (MB = -17 mag) for CaRTs, making it an outlier in the population. We determine that three power sources are necessary to explain SN 2022oqm's light curve, with each power source corresponding to a distinct peak in its light curve. The first peak of the light curve is powered by an expanding blackbody with a power law luminosity, consistent with shock cooling by circumstellar material. Subsequent peaks are powered by a double radioactive decay model, consistent with two separate sources of photons diffusing through an optically thick ejecta. From the optical light curve, we derive an ejecta mass and 56Ni mass of ~0.89 solar masses and ~0.09 solar masses, respectively. Detailed spectroscopic modeling reveals ejecta that is dominated by intermediate-mass elements, with signs that Fe-peak elements have been well-mixed. We discuss several physical origins for SN 2022oqm and favor a white dwarf progenitor model. The inferred ejecta mass points to a surprisingly massive white dwarf, challenging models of CaRT progenitors.Comment: 33 pages, 17 figures, 5 tables, Submitted to Ap

Depression and HIV in Botswana: A Population-Based Study on Gender-Specific Socioeconomic and Behavioral Correlates

Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV prevention and a common serious HIV co-morbidity. However, depression screening and treatment are limited in sub-Saharan Africa, and there are few population-level studies examining the prevalence and gender-specific factors associated with depression.We conducted a cross-sectional population-based study of 18–49 year-old adults from five districts in Botswana with the highest prevalence of HIV-infection. We examined the prevalence of depressive symptoms, using a Hopkins Symptom Checklist for Depression (HSCL-D) score of ≥1.75 to define depression, and correlates of depression using multivariate logistic regression stratified by sex.Of 1,268 participants surveyed, 25.3% of women and 31.4% of men had depression. Among women, lower education (adjusted odds ratio [AOR] 2.07, 95% confidence interval [1.30–3.32]), higher income (1.77 [1.09–2.86]), and lack of control in sexual decision-making (2.35 [1.46–3.81]) were positively associated with depression. Among men, being single (1.95 [1.02–3.74]), living in a rural area (1.63 [1.02–2.65]), having frequent visits to a health provider (3.29 [1.88–5.74]), anticipated HIV stigma (fearing discrimination if HIV status was revealed) (2.04 [1.27–3.29]), and intergenerational sex (2.28 [1.17–4.41]) were independently associated with depression.Depression is highly prevalent in Botswana, and its correlates are gender-specific. Our findings suggest multiple targets for screening and prevention of depression and highlight the need to integrate mental health counseling and treatment into primary health care to decrease morbidity and improve HIV management efforts

Supernova 2020wnt: An Atypical Superluminous Supernova with a Hidden Central Engine

We present observations of a peculiar hydrogen- and helium-poor stripped-envelope (SE) supernova (SN) 2020wnt, primarily in the optical and near-infrared (near-IR). Its peak absolute bolometric magnitude of −20.9 mag (L bol, peak = (6.8 ± 0.3) × 1043 erg s−1) and a rise time of 69 days are reminiscent of hydrogen-poor superluminous SNe (SLSNe I), luminous transients potentially powered by spinning-down magnetars. Before the main peak, there is a brief peak lasting <10 days post explosion, likely caused by interaction with circumstellar medium (CSM) ejected ∼years before the SN explosion. The optical spectra near peak lack a hot continuum and O ii absorptions, which are signs of heating from a central engine; they quantitatively resemble those of radioactivity-powered hydrogen/helium-poor Type Ic SESNe. At ∼1 yr after peak, nebular spectra reveal a blue pseudo-continuum and narrow O i recombination lines associated with magnetar heating. Radio observations rule out strong CSM interactions as the dominant energy source at +266 days post peak. Near-IR observations at +200-300 days reveal carbon monoxide and dust formation, which causes a dramatic optical light-curve dip. Pair-instability explosion models predict slow light curve and spectral features incompatible with observations. SN 2020wnt is best explained as a magnetar-powered core-collapse explosion of a 28 M ⊙ pre-SN star. The explosion kinetic energy is significantly larger than the magnetar energy at peak, effectively concealing the magnetar-heated inner ejecta until well after peak. SN 2020wnt falls into a continuum between normal SNe Ic and SLSNe I, and demonstrates that optical spectra at peak alone cannot rule out the presence of a central engine

Comparison of P-POSSUM Score and NELA Score as Prime Predictors of Mortality in Emergency Laparotomies at a Tertiary Care Centre: A Retrospective Cohort Study

Introduction: Emergency laparotomies carry significant morbidity and mortality. Preoperative risk assessment is the key part for all emergency laparotomies. Therefore, the use of Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and National Emergency Laparotomy Audit (NELA) scores helps stratify the risk and highlight the importance of high-risk patients, aiding in the provision of appropriate treatment plans and care. Aim: To determine and compare the Portsmouth-POSSUM (P-POSSUM) score and NELA score in predicting mortality at 30 days and 60 days in patients undergoing emergency laparotomies. Materials and Methods: This retrospective cohort study included all patients who underwent emergency laparotomy at a tertiary care centre from January 2021 to March 2023. A total of 116 patients were included, and demographic variables, laboratory values, and operative details were recorded. Mortality on postoperative day 30 and 60 was observed. All data were recorded in an MS excel spreadsheet, and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 19.0. An independent sample t-test was used. Results: Among the total study sample of 116 patients, the 30-day mortality rate was 8.6% (10 out of 116), and the 60-day mortality rate was 13.8% (16 out of 116). The area under the ROC curve (AUC) for mortality prediction was 0.533 (0.361-0.726) for the P-Possum score and 0.873 (0.799-0.948) for the NELA score, which was significantly higher. Conclusion: The NELA Score demonstrated greater accuracy in predicting early and late mortality compared to the P-POSSUM score in this study. Therefore, the authors highly recommend the use of the NELA score for risk assessment in all emergency laparotomies

Static and free time-dependent fractal systems through an extended hydrodynamic model of the scale relativity theory

Considering that the motions of the particles take place on ‘arbitrary’ fractals, an extended hydrodynamic model of the scale relativity is built. In this approach, static (particle in a box) and time-dependent (free particle) systems are analyzed. The particle in a box can be associated with a fractal fluid: the zero value of the real (differentiable) part of the complex speed field specifies the coherence, while the non-zero value of the imaginary (non-differentiable or fractal) part implies, through a quantization relation, a Reynolds criterion. For a minimal value of the Reynolds number, a Heisenberg’s ‘egalitarian’ relationship results, whereas for big Reynolds numbers, the flow regime of the fractal fluid becomes turbulent. In such a context, the microscopic-macroscopic scale transition could be associated with an evolution scenario towards chaos. The free time-dependent particle can be associated with an incoherent fractal fluid: the differentiable and fractal components of the complex speed field are inhomogeneous in fractal coordinates due to the action of a fractal potential. There exists a momentum transfer on both speed components and the ‘observable’ in the form of a uniform motion is generated through a specific mechanism of ‘vacuum’ polarization induced by the same fractal potential

Spinal dysraphism illustrated; Embroyology revisited

Spinal cord development occurs through three consecutive periods of gastrulation, primary nerulation and secondary neurulation. Aberration in these stages causes abnormalities of the spine and spinal cord, collectively referred as spinal dysraphism. They can be broadly classified as anomalies of gastrulation (disorders of notochord formation and of integration); anomalies of primary neurulation (premature dysjunction and nondysjunction); combined anomalies of gastrulation and primary neurulation and anomalies of secondary neurulation. Correlation with clinical and embryological data and common imaging findings provides an organized approach in their diagnosis