A pulsar in a binary with a compact object in the mass gap between neutron stars and black holes.

Some compact objects observed in gravitational wave events have masses in the gap between known neutron stars (NSs) and black holes (BHs). The nature of these mass gap objects is unknown, as is the formation of their host binary systems. We report pulsar timing observations made with the Karoo Array Telescope (MeerKAT) of PSR J0514-4002E, an eccentric binary millisecond pulsar in the globular cluster NGC 1851. We found a total binary mass of 3.887 ± 0.004 solar masses (M⊙), and multiwavelength observations show that the pulsar's binary companion is also a compact object. The companion's mass (2.09 to 2.71 M⊙, 95% confidence interval) is in the mass gap, indicating either a very massive NS or a low-mass BH. We propose that the companion formed in a merger between two earlier NSs.

Patients with COVID-19 Pneumonia Admitted to an Intensive Care Unit (ICU) at a Community Hospital in Flint, Michigan, in Early 2020: Characteristics and Mortality.

INTRODUCTION: Despite the many studies conducted on the factors affecting mortality in patients with COVID-19, there is ongoing debate about the role of race as a risk factor. Several studies have reported a geographic and racial disparity in COVID-19 cases in Michigan. This study aimed to examine the characteristics of the 2020 first cohort of Intensive Care Unit (ICU) COVID-19 patients admitted to a community teaching hospital in Flint, Michigan, and to determine the factors associated with ICU mortality, including race. METHODS: This cross-sectional study included adult patients (≥ 18 years) with severe COVID-19 pneumonia admitted to the ICU between March and May 2020. Potential risk factors associated with ICU mortality included demographic characteristics, comorbidities, treatments, and complications. RESULTS: The study sample consisted of N = 48 patients, aged 24-85 years, (mean 59.7; SD = 12.8); 56.2% (n=27) were male and 51.1% (n=24) were Black adults. The mortality rate was 51.1%. Age (aOR 1.1, 95% CI [1.01, 1.20]; p =0.03), type 2 diabetes (aOR 5.7, 95% CI [1.2, 29.1]; p =0.03), and essential hypertension (aOR 6.2, 95% CI [1.1, 34.5]; p =0.04) were all found to have statistically significant independent associations with increased risk of ICU mortality in this study sample. On the other hand, race was not found to be associated with ICU mortality. CONCLUSIONS: These findings support the literature regarding the association of comorbid conditions, including type 2 diabetes and hypertension, with poorer outcomes in ICU hospitalized patients with severe COVID-19 pneumonia. This study provides insight into mortality of an ICU patient cohort earlier on during the COVID-19 pandemic in Flint, Michigan.

A Review of Community Awareness for Colorectal Cancer Screening and Prevention in North and Central Asian Countries.

OBJECTIVES: Colorectal cancer (CRC) incidence and mortality rates are increasing in low- and middle-income countries (LMIC), including North and Central Asian countries (NCAC). Screening and risk factor reduction can aid in the prevention of colorectal cancer, but communities lack awareness of these screening programs. The review assessed community awareness about CRC screening and prevention in NCAC to facilitate cancer control policies. Study type and methods: For this scoping review, we searched PubMed/Medline, Embase, and the Cochrane Library for articles on community awareness about CRC screening and prevention in NCAC according to inclusion and exclusion criteria. RESULTS: Eight of 677 articles from five of the 15 NCAC countries met the criteria. Most of the studies utilized a survey design. The results indicated low awareness of the availability of CRC screening and poor knowledge of CRC symptoms. Knowledge of CRC screening modalities was also inadequate. Some countries also lack CRC screening programs. CONCLUSION: Community unawareness is a significant barrier to screening program utilization and sustenance. Community health awareness programs (CHAP) are needed to improve the uptake of CRC screening in NCAC. The NCAC should include CHAP as an integral component of the CRC control plan. Long-term cancer control in LMIC could be adapted using the step-ladder pyramidal approach.

Colorectal Cancer: A Systematic Review of the Current Situation and Screening in North and Central Asian Countries.

The prevalence of colorectal cancer (CRC) is increasing in the past few decades. A significant proportion of this increase is from low to middle income countries (LMIC). CRC prevalence is also increasing in North and Central Asian Countries (NCAC). Screening for colorectal cancer has decreased CRC mortality but data regarding screening practices in NCAC is limited.  A literature search was conducted in PubMed/Medline, Embase and Cochrane for current colorectal cancer screening practices in NCAC. Incidence and mortality rates were derived from public health agency websites to calculate age-standardized CRC mortality-to-incidence ratios. Web-based online break-point testing defined as statistical major changes in CRC mortality trends was completed. Among the 677 screened studies, 37 studies met the criteria for inclusion for review. CRC screening in NCAC is not organized, although most countries have cancer registries. The data availability is scarce, and most data is prior to 2017. Most studies are observational. There is minimal data about colonoscopy preparations, adenoma detection and complications rates. The polyp detection rates (PDRs) and adenoma detection rates (ADRs) seem low to optimal in this region. Commonly measured outcomes include participation rate, fecal immunochemical tests (FIT) positivity rate and cost-benefit measures. Lower mortality-to-incidence ratios is seen in countries with screening programs. Kazakhstan and Lithuania with screening programs have achieved breakpoint suggesting major changes in CRC mortality trends. Data about CRC screening varies widely within NCAC. High human developmental index (HDI) countries like Lithuania and Estonia have higher incidence of CRC and mortality. Seven NCAC have CRC screening programs with most utilizing non-invasive methods for screening. Data collection is regional and not organized. The ADR and PDR are low to optimal in this region and cancer detection rates are comparable to other high-income countries (HIC). CRC detection rate is 0.05% for screening in Kazakhstan and 0.2% for screening in Lithuania. Very limited information is available on the actual cost and logistics of implementing a CRC screening program. All NCAC have a cancer registry, with some having a high-quality registry showing national coverage with good validity and completeness. Establishing guideline-based registries and increasing screening efficacy could improve CRC outcomes in NCAC.

Police abuse and care engagement of people with HIV who inject drugs in Ukraine.

Police abuse affects people who inject drugs (PWID), including those with HIV, and negatively impacts care engagement. This cross-sectional study evaluated police abuse among PWID receiving MOUD (medication for opioid use disorder) living with HIV and associations with HIV treatment adherence and receipt of NGO services. We assessed lifetime and past six-month rates of police abuse among a cohort of Ukrainian PWID with HIV receiving MOUD (n = 190) from August to September 2017. Logistic regression models evaluated associations between past six-month police abuse and past 30-day antiretroviral therapy (ART) adherence, and past six-month NGO service receipt. Almost all (90%) participants reported lifetime police abuse: 77% reported physical violence and 75% reported paying the police to avoid arrest. One in four females (25%) reported police-perpetrated sexual violence. Recent police abuse was reported by 16% of males and 2% of females and was not associated with ART adherence (aOR: 1.1; 95% CI:0.3-5.0) or NGO service receipt (aOR: 3.4; 95% CI:0.6-18.3). While lifetime police abuse rates were high, few participants reported recent police abuse, which was not linked to care engagement. These trends should encourage the Ukrainian government for public health-public safety partnerships and legal interventions to eliminate human rights violations against PWID living with HIV.

Gastric ischaemia: a rare cause of gastric ulcers.

Gastric ulcers secondary to gastric ischaemia is rare because of the rich blood supply of the stomach. We present a case where a patient with history of atherosclerotic vascular disease (ASCVD) presented with unintentional weight loss and failure to thrive for several months. Initial imaging studies ruled out any active malignancy. Oesophagogastroduodenoscopy revealed multiple shallow gastric ulcers. CT angiography was performed in later course of the hospital stay, which demonstrated a high-grade stenosis at the origin of both the superior mesenteric artery and the coeliac trunk. This combination stenosis is a rare finding, which can lead to ischaemia of the stomach by blocking the stomach's dual blood supply. Although the patient underwent revascularisation attempt with stent placement, she expired due to critical postoperative condition. This case signifies the importance of keeping a low threshold for suspicion for gastric ischaemia in patients with ASCVD risk factors and unexplained weight loss.

Unusual presentation of superior mesenteric artery syndrome after trauma.

Superior mesenteric artery (SMA) syndrome is a rare but severe condition. SMA syndrome's association with trauma has been reported to present weeks to months after significant weight loss due to head or spinal cord injury. We present an unusual case of SMA syndrome presenting with obstructive symptoms, which developed immediately after clavicle fracture and was not associated with weight loss. CT of the abdomen showed small bowel obstruction in the third part of the duodenum. CT angiogram of the abdomen confirmed SMA syndrome. The patient was managed conservatively with enteral nutrition via jejunostomy tube. He was discharged after symptoms resolved, and repeat imaging revealed resolution of obstruction. This case emphasises the importance of having SMA syndrome as one of the differential diagnoses for patients presenting with obstructive symptoms after trauma because early diagnosis can be managed with conservative treatment.

Stigma and quality of co-located care for HIV-positive people in addiction treatment in Ukraine: a cross-sectional study.

INTRODUCTION: Co-located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV-positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co-located care for HIV-positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services. METHODS: This cross-sectional study enrolled 191 HIV-positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co-located care (both OAT and HIV treatment) in six regions in Ukraine during July-September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes. RESULTS: Study participants were 75% male, mean age 40 ± 7 years; 47% received co-located care, and 10.5% had both high HIV and substance use stigma. Co-located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (aß): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (aß: -0.26; 95% CI: -0.44, -0.08) and lower likelihood of receipt of services from non-governmental organization (NGO; aß: -6.40; 95% CI: -10.23, -2.57). CONCLUSION: One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co-located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.

Cyclophosphamide, bortezomib and dexamethasone (CyBorD): a promising regimen for renal light chain deposit disease.

Renal light chain deposit disease is a rare disease with rapid progression to renal failure when left untreated. There is no standard treatment available. We present a unique case of renal IgA kappa deposit disease who developed severe decline in renal function within a few months of diagnosis. She was started on a single regimen of cyclophosphamide, bortezomib and dexamethasone (CyBorD) followed by maintenance treatment with bortezomib and dexamethasone leading to rapid improvement of renal function. This is the first case to be reported on renal IgA kappa deposit disease who have responded dramatically to CyBorD without the need for any modification of the regimen or stem cell transplant.

DEGREE AND FACTORS OF BURNOUT AMONG EMERGENCY HEALTHCARE WORKERS IN INDIA.

OBJECTIVE: 'Burnout' among emergency healthcare workers needs focus as they make crucial life changing decisions every day and thus, their state of physical and mental wellbeing is an absolute necessity. We aimed to find the level and factors contributing to burnout among the healthcare workers in the busiest Emergency Department of Northeast India. This is the first study done in this department to assess burnout. METHOD: This cross-sectional, questionnaire-based study assessed burnout of the doctors, nurses, and paramedics working in an emergency department of a busy tertiary care teaching institute. Association of demographic variables and factors influencing burnout was explored. Results were analyzed by descriptive and inferential statistics. RESULTS: Low level in emotional exhaustion, moderate level in depersonalization, and moderate level in the lack of personal accomplishment was reported by participants. Children and partner were found to be protective factors. Working hours, duration and status (permanent/contractual) of service influenced burnout. CONCLUSION: Knowing the level of burnout and their determinants can help in formulating measures of improving the work environment. A healthy workforce ensures high quality of healthcare and patient satisfaction.

PATTERN OF SUBSTANCE USE IN A DRUG DEADDICTION CENTRE IN DIPHU- NORTHEAST INDIA-BASED STUDY.

BACKGROUND: India is a multicultural and multilingual democracy; the use of different substances is found to be regionally diversified. Ethnic variations have contributed to this diversification and so a single study on a particular region cannot be generalised to the whole Indian population. Alcohol is one of the most popular substances used in India which can be traced backed to the scriptures. The local homemade liquor is the most common form of liquor used by the Indian population. The traditional winemaking process is common among the different ethnic tribes of Northeast India and thus most of the alcohol use is unrecorded in this part of the country. MATERIALS AND METHODS: An observational study was conducted in the Drug Deaddiction Centre of Diphu Civil Hospital, Assam where patients' recorded data over a four-year period was used. The data was reviewed retrospectively to understand the pattern of substance use in this region and the results were described using descriptive statistics. RESULTS: Alcohol was found to be the most used substance and significant gender difference was noted among the users. Both tribal and nontribal groups were almost equally seen to use alcohol while around one-fifth of the population belonged to the age group of less than 30 years. Early initiation of alcohol use due to cultural reasons was suspected. Various health issues ranging from gastrointestinal (GI) symptoms to death due to alcohol misuse were reported. Due to the retrospective review process, missing data was found to be a significant limitation to this study. CONCLUSION: Adequate health promotion focusing on effects of alcohol on health should be undertaken in this region and proper follow-up of the treated patients should be done to prevent relapse.

An exploratory study from eastern India on neurological soft signs and spontaneous movement disorders in schizophrenia spectrum disorders.

BACKGROUND: Apart from the traditional symptoms of delusion and hallucination, soft signs of neurological dysfunction in psychotic disorder has the potential for addressing neurodevelopmental and neurodegenerative aetiology. AIM: The study explored the neurological soft signs (NSS) and spontaneous movement disorders (SMD) in the same patient population of schizophrenia spectrum disorder (SSD) and other psychotic disorders. MATERIALS AND METHODS: Patients were diagnosed with SSD and other psychotic disorders as per ICD-10 diagnostic criteria and were evaluated with the Heidelberg manual for NSS and Modified Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Rating Scale (SARS), Barnes Akathisia Rating Scale (BARS) for assessing dyskinesia. RESULTS: Total 16 patients with mean age of 28.7 (±7.7) years had a mean duration of 63.2 (±68.8) months' disorder. Patients with schizophrenia had the mean Heidelberg score of 6.75 (±3.304). The scores of complex motor task, right/ left spatial orientation, integrative functions, and hard signs varied but the motor coordination score was unwaveringly high in all the participants with SSD. Sixty six per cent of SSD patients had dyskinesia. None had scored more than the upper limit of normal range in SARS. None of the participants had scored enough to qualify for akathisia. CONCLUSION: NSS and SMD emerge as distinct objective parameters for a group of psychotic disorder patients, especially SSD.

Impact of stress, coping, social support, and resilience of families having children with autism: A North East India-based study.

Children with autism (CWA) is a segment of population in North East India who are marginalized due to lack of resources like skilled manpower and perceived stress. In comparison to other states and countries whether these children are unique in terms of care and rehabilitation from adult caregivers was the focus of our study. The study assessed level of parental stress, social support, coping mechanisms used by family and resilience in meeting the challenges as caregivers. Parents were selected by simple random sampling from a multi-specialty center dedicated to CWA. They were assessed with the help of structured tools like the Parental Stress Scale, the social support appraisals scale, the coping self-efficacy scale, and the Family Resilience Assessment Scale. Results were analyzed with descriptive statistics and findings suggest definite stress among the parents of CWA. Personal time constraint was noticed in majority of parents, which had adversely affected their professional lives. Despite wide array of stress factors, family members had satisfactory coping skills to work in harmony in adverse circumstances. Regarding secondary social support in terms of family, friends, and neighbors, responses were mixed; religious and spirituality were often resorted avenues. Social desirability, fatigue and the sample being restricted to only one center were though the limitations but, this study throws light on pertinent issues related to families with CWA from a region where specialty centers are a rarity. The future implication could focus on CWA's future, rehabilitation, care and parental concerns which are grossly neglected in North East India.