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Posts posted by kalip

  1. How Meditation Renews Your Body and Brain

    If you are looking to renew your vitality, reset your focus, and recharge your body, meditation is the tried and true path that will lead you to the fulfilment of these goals. Here’s how.

    For the vast majority of people, 2020 has been filled with unexpected challenges. Pandemic-induced health concerns, career turbulence, loss of routines, and future uncertainties have left many individuals with a generalized sense of unease.

    Fortunately, stepping into a space of renewal does not require a retreat centre stay nor an elaborately planned vacation. Meditation can provide the necessary escape that will allow you to hit your reset button. Consciously resting in stillness while releasing resistance to the present moment is a powerfully accessible tool, which research has shown can reduce the effects of stress and equip you to better handle whatever experiences lie around the corner.

    For some people, meditation may conjure images of Buddhist monks sitting in lotus posture for hours. However, modern practice looks much more like business executives pausing for five mindful minutes prior to meetings or parents coming into the present moment before responding to a child. Whether you are meditating in a forest or an office, for hours or minutes, using mantra or mindfulness, the practice of meditation has been linked to potent physical and neurological benefits. The following is a small sampling of the myriad ways that meditation can renew your body and brain.

    Decreases the Risk of Chronic Disease

    The first notable effect of meditation is that the parasympathetic nervous system (PNS), which is sometimes called the “rest and digest” system, is activated. This system begins in the brain and sends messages to the body that tell it to lower the heart rate, decrease blood pressure, improve digestion, reduce stress hormones, bolster immunity, and relax muscles. When the PNS is turned on, the body allocates its resources to removing damaged cells, neutralizing toxins, and destroying free radicals. Unfortunately, most people live with mild-to-moderate stress that turns off the PNS, compromises immune function, and contributes to chronic diseases. By regularly entering a state of physical and mental relaxation via meditation, you can support your body’s natural health processes, and thereby mitigate the risk of disease.

    Reduces Anxiety

    Dr. Ilya Monosov, Ph.D., of the Departments of Neuroscience and Biomedical Engineering at Washington University in St. Louis, MO, discovered that anxiety is highly linked with uncertainty. When you know something unpleasant is going to occur, you are actually better able to neurologically adapt than when you do not know for certain. Meditation can help to calm the anxiety that bubbles to the surface when presented with life’s uncontrollable factors.

    Gamma-Aminobutyric Acid, or GABA, is a naturally occurring amino acid that is increased through meditation. GABA attaches to receptors in the brain to produce a calming effect that tones down the effects of stress and anxiety.

    In addition to increasing GABA, meditation reduces anxiety by decreasing activity in the amygdala, the part of the brain responsible for activating fear, anxiety, and stress responses. In one Harvard study, researchers found that meditation decreased activity in the amygdala, thereby pacifying anxiety response patterns.

     Improves Sleep

    Meditation prior to sleep naturally increases levels of melatonin, a hormone that regulates the sleep-wake cycle and contributes to refreshing rest. In addition to promoting sounder sleep, melatonin is credited with enhancing immune function and lowering blood pressure. Recent research even suggests that melatonin may protect against the neurodegeneration seen in Alzheimer’s and Parkinson’s diseases.

    Maintains a Youthful Brain

    A study from UCLA found that long-term meditators maintained more youthful brains than their non-meditating counterparts. A more youthful brain equates to quicker recall, increased focus, easier learning, more enthusiasm, greater adaptability, and better problem-solving skills. By slowing age-related grey matter loss, meditators were able to halt the aging process within their brains.

    Calms Activity in the Default Mode Network (DMN)

    In a study from Yale University, researchers found that meditation helped to quiet down the incessant mental chatter that is typically associated with decreased happiness. By settling activity in the DMN, meditators were able to stop dwelling on past and future thoughts and be present more often. And even when their mind did wander, the new neural pathways created through meditation helped individuals to come back to the present moment more quickly.

    Increases Life Span

    Dehydroepiandrosterone, or DHEA, is a hormone that counteracts the damaging effects of the stress hormone cortisol, as well as provides building blocks for oestrogen and testosterone production. A 12-year study found that DHEA levels were significantly correlated with mortality in men over the age of 50. The less DHEA measured in the test subject’s blood, the shorter their life span was.

    Fortunately, DHEA is naturally increased through the practice of meditation. In simple terms, that means that meditation helps you live longer.

    Leads to Feelings of Renewal in Two Months of Practice

    You may be thinking that you would have to practice meditation for a long time in order to reap all of its benefits. But Harvard University researchers found that the structure of the brain can actually be changed with just eight weeks of meditation. Harvard professor Sara Lazar discovered that the hippocampus, the part of the brain that controls memory, learning, and self-regulation, becomes significantly thicker with just two months of mindfulness practice. That means that in just eight weeks you can create changes in your body and brain that will enliven your physical, mental, and emotional well-being.

    If you are looking to renew your vitality, reset your focus, and recharge your body, meditation is the tried and true path that will lead you to the fulfilment of those goals. You don’t have to go anywhere or spend any money. In fact, you can begin by simply deepening your very next breath. Then when you finish reading this article, close your eyes, and continue those full, nourishing breaths for 10 breath cycles. Notice how just a few minutes of mindful breathing can initiate the renewal process. It really is as simple as that.




  2. How Safe Is it to Use A Public Bathroom?

     With dirty door handles, heavily trafficked toilet bowls, and proximity to strangers, public restrooms can be a germophobe’s worst nightmare. But the COVID-19 pandemic adds a new layer of risk, and infectious disease doctors are urging people to be cautious ahead of the holiday weekend.

    A recent study published in Physics of Fluids outlines the potential dangers of toilet plumes -- clouds of droplets that can rise 3 feet from a flushing toilet and be inhaled by an unsuspecting user. Aside from the obvious ick factor, simulations found that coronavirus remnants in a person’s stool can make their way onto other surfaces or linger in the air nearby.

    But there are things people can do to avoid the dangers of restrooms.

    “What’s the most hazardous part of using a public restroom? It’s the people in it,” says William Schaffner, MD, a professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine. “It’s not necessarily the inanimate environment.”

    Wear a mask, of course. Scope out the bathroom ahead of time to see how congested it is, Schaffner says, and wait to use it until it has cleared out a bit. If it is urgent, try to keep your distance from people -- for men, stay a couple of urinals away from the nearest person. Aim to use larger restrooms to avoid close contact with people and toilet sprays.

    Though it may be tempting to use seat covers, it is not recommended -- they could be covered with their own germs, and it is smart to keep contact with objects to a minimum.

    “If you want, you can carry wipes into the bathroom with you and wipe off the toilet seat before sitting down,” Schaffner says.

    Toilets with lids can be closed before flushing to avoid the plume. If they don’t have lids, back away and exit the stall as quickly as possible. And when approaching the sink for hand-washing, Schaffner says, pay attention to the number of people already using the space. If you can, wait until the area is clear.

    Although studies have shown that high-powered air dryers can blow harmful particles around, infectious disease experts say those machines and paper towels have similar risks. In fact, Schaffner says, the air dryers might be safer.

    “I think air dryers help rather than hurt -- they move air around,” he says. “If there happens to be a person next to you that's infected, the air dryer will disperse the air, and you're much less likely to get an infectious dose of the virus.”

    According to Aaron E. Glatt, MD, chairman of medicine at Mount Sinai South Nassau, the risk of contact with bodily fluids pales in comparison to the dangers of close gatherings. After all, there is always a chance of plume contamination with viruses and bacteria like E. coli.

    “Bodily fluids are always a concern, regardless of COVID,” he says.

    Glatt’s main advice? Be smart and use common sense. If you are going on a trip, try to avoid using a public restroom altogether and go before you leave the house.

    The bigger concern, Glatt says, is the potential spike of COVID-19 cases after fireworks displays and barbeques bring large groups of people together.

    “People aren't being careful. We're seeing it across the country right now,” he says. “This is a formula for disaster.”

    As long as people are mindful of “the big three” -- masks, hand-washing, and distancing -- the country can avoid a post-holiday spike, Schaffner says.

    “There is still plenty of room for people to enjoy themselves,” he says.






  3. Getting Your Protein From Plants a Recipe for Longevity

    Swapping out tofu for your morning eggs or using beans instead of ground beef in your chili could help you live longer, a new study report.

    Getting your daily protein from plants instead of animals appears to reduce your overall risk of early death, researchers found.

    Every 3% of a person's daily energy intake coming from plant protein instead of animal protein reduced a person's risk of premature death by 10%, the results showed.

    The results were particularly strong when people swapped plant protein for eggs (24% lower risk in men and 21% lower risk in women) or red meat (13% lower risk in men, 15% in women).

    Taking red meat out of your diet can be beneficial, but only if you swap for a healthy substitute, said lead researcher Jiaqi Huang, a postdoctoral fellow at the U.S. National Cancer Institute.

    "For example, replacement of 3% energy from egg protein or red meat protein with plant protein such as whole grains or cereals resulted in a protective association for overall mortality," Huang said. "On the other hand, replacement of 3% energy from egg protein or red meat protein with other foods such as sugar-sweetened beverages may or may not result in a reduction in mortality."

    For this study, Huang's team analysed dietary data from more than 237,000 men and 179,000 women gathered between 1995 and 2011 as part of a long-term study on eating patterns and health.

    Protein made up about 15% of people's daily diet, with 40% coming from plants and 60% from animals, the researchers found.

    During 16 years of follow-up, a pattern emerged where plant protein intake appeared to reduce risk of early death. Every 10 grams of plant-for-animal protein swapping per 1,000 calories resulted in a 12% lower risk of death for men and 14% for women, the findings showed.

    According to senior researcher Dr. Demetrius Albanes, a senior investigator with the cancer institute, "Our data provide evidence to support the favourable role for plant-based diets in the prevention of cardiovascular disease mortality, and that modifications in choices of protein sources may influence health outcomes and longevity."

    There are many reasons why choosing plant protein over animal protein could help extend your life, the researchers and experts said.

    Meat protein tends to come with higher levels of saturated fat, cholesterol, sodium and other nutrients that aren't very good for your health, said Connie Diekman, a food and nutrition consultant in St. Louis and a past president of the Academy of Nutrition and Dietetics.

    "For example, one ounce of red meat mixed with whole wheat pasta and veggies would provide much less saturated fat than a 9-ounce steak," Diekman said.

    On the other hand, plant proteins come with loads of fibre, antioxidants, vitamins and minerals, said Kayla Jaeckel, a registered dietitian and diabetes care manager with Mount Sinai Health System in New York City.

    The researchers also added that there might be something specific about the amino acids formed from the breakdown of animal-based protein that could cause arteries to grow harder or inflammation to occur. Animal protein also could affect the health of people's gut bacteria.

    One weakness of the study is that it relied on people's memories, as they were asked to remember what they'd eaten and fill out a questionnaire, Diekman said.

    "This provides a glimpse at diet intake but doesn't show patterns, and patterns are key," Diekman said. "Combining an egg with brown rice and veggies provides a very different nutrient intake than eggs, bacon, biscuits and gravy."

    These findings also run counter to other recent studies that have shown eggs are healthier than folks believed for decades, Jaeckel said.

    "I think eggs can be part of a healthy and balanced diet. I wouldn't want eggs to be painted in a negative light, because I feel like there's always been flip-flopping with them," Jaeckel added.

    Diekman said, "My take on the study, and what I would tell clients, is that evidence continues to grow to support the importance of consuming more plant foods and less animal foods, while also boosting vegetable, whole grain and fruit intake. We can enjoy our favourite, heavy egg or meat dish but probably not every day, and preferably in balance with lots of plant foods."

    The report was published online July 13 in JAMA Internal Medicine.

    More information

    The American Heart Association has more about healthy eating.






  4. COVID-19 May Spike Blood Sugar, Raising Death Risk

    Bodies stressed by severe COVID-19 could produce abnormally high blood sugar levels, even in people without diagnosed diabetes. And that appears tied to a doubling of the odds of dying from COVID-19, Chinese researchers report.

    High blood sugar (glucose) levels, measured at the time of admission to the hospital, were also linked to more severe disease and complications, according to researchers led by Dr. Yang Jin, of the Union Hospital and Tongji Medical College, in Wuhan, China. Wuhan was the originating epicentre of the global pandemic of COVID-19.

    As the researchers explained, diabetes has long been known to greatly raise the odds for severe and even fatal COVID-19 in people infected with the new coronavirus.

    But what about the effect of high blood sugar levels, even in people who don't have a diabetes diagnosis?

    To find out, Jin's group looked over the medical records of more than 600 consecutive patients treated at two Wuhan hospitals for nearly a month in January and February. Patients averaged 59 years of age.

    The researchers looked especially at each patient's blood sugar readings, the severity of their COVID-19-linked pneumonia, and patient outcomes in terms of illness severity and death. None of the patients had been diagnosed with diabetes.

    A total of 114 patients died in the hospital from their illness, Jin's team said. Men were 75% more likely to die than women.

    A high level of fasting blood glucose was found to be highly predictive of death, the researchers reported July 10 in the journal Diabetologia.

    That held true "regardless of whether the patient has [COVID-19-linked] pneumonia that is more or less severe," the team said -- suggesting that the effect of high blood sugar on the death risk is independent of just how severe the patient's respiratory illness might be.

    Of the total patient group, about one-third (29%) fell into a category of very high fasting blood glucose -- so high that, if consistent over time, these patients would be diagnosed with having type 2 diabetes. Another 17% had levels that were similar to people in "pre-diabetes."

    Patients in the very high blood sugar category were 2.3 times more likely to die of COVID-19 than those with the lowest blood sugar readings, the study showed, and even those with readings suggestive of pre-diabetes had a 71% higher risk of death.

    The odds for dangerous complications of COVID-19 were also four times higher in people in the high blood sugar category, and 2.6 times higher in those with a pre-diabetes level of blood sugar, the Chinese team said in a news release from the European Association for the Study of Diabetes.

    Diabetes expert Dr. Minisha Sood is an endocrinologist at Lenox Hill Hospital in New York City. Reading over the new study, she noted that even in non-diabetic people, blood sugar levels can spike in response to serious illness.

    "The rise in blood sugar due to an illness is called stress hyperglycaemia," she explained. "The body, under stress, produces hormones and a reaction to the illness which elevates blood glucose."

    However, such spikes typically don't happen in previously healthy individuals, Sood noted.

    "The higher blood glucose in patients who ultimately succumb to COVID-19 versus other patients with normal blood glucose despite a COVID-19 infection may be a sign that their underlying systems are not as healthy as those who do not have stress hyperglycaemia," she said.

    According to the Chinese authors, stress hyperglycaemia may indeed have stricken many of the Wuhan patients, since the 29% of patients who landed in the highest blood sugar group "is much higher than the estimated prevalence of diabetes in the Chinese population at 12%."

    Based on the findings, the study authors advised that close tracking of blood sugar levels be added to the list of tests that doctors use to monitor risks for patients battling COVID-19.

    Sood agreed.

    "The bottom line is that everyone will respond to illness in their unique way," she said, "and it would be helpful to have ways to predict who may have a worse outcome from a COVID-19 infection. Having a high blood glucose on admission to the hospital may be one of those predictive measures.




  5. Forgiveness and the Power of Letting Go

    Learning to forgive doesn't always come easy, and it's a patient and tender process. Many times, forgiveness can feel more like a weakness than an act of courage and strength.

    Let's explore how elevating awareness around this powerful act can be a catalyst toward greater health—physically, mentally, and spiritually—while helping to transform your family, community, and country. Good health and nourishment aren't just about the vitamins and minerals you ingest; it's also who you are as a human being.

    What Is Forgiveness?

    In simple terms, forgiveness is a choice you make to give up anger or resentment, even while acknowledging that the wrongdoing happened. It's not so much behaviour as it is an internal state of feeling and being. Forgiveness is choosing a higher path and moving through a process of letting go that's not so much about the other person, but your process. Taking it a step further, Bob Enright, Ph.D. at the University of Wisconsin, Madison, describes true forgiveness as offering something positive: "Empathy, compassion and an understanding towards the person who hurt you," making it both a virtue and a robust framework in positive psychology.

     It's also important to acknowledge that forgiveness is not pardoning, excusing, forgetting, condoning, or even accepting bad behaviour. It's a gift of freeing yourself from anger. As described in Psychology Today, forgiveness is ultimately about "freeing ourselves from feelings of anger, resentment, and victimisation, and ending with clarity about our values."

     Why Forgive?

    "There is an enormous physical burden to being hurt and disappointed," says Karen Swartz, M.D., director of the Mood Disorders Adult Consultation Clinic at The Johns Hopkins Hospital. And forgiving is an active process—like learning to ride a bicycle—it's a skill that takes time and gets better with practice. Studies are finding connections between forgiveness and physical, mental, and spiritual health and evidence that it plays a vital role in the health of families, communities, and nations.

     In the book Forgiveness and Health, doctors Loren Toussaint and Everett L. Worthington show in their research that "forgiveness is linked to mental health outcomes such as reduced anxiety, depression and major psychiatric disorders, and fewer physical health symptoms and lower mortality rates." The connection between forgiveness and mental and physical health and well-being suggests stress relief as the primary factor connecting forgiveness and well-being. 

     Neda Gould, a clinical psychologist at Johns Hopkins University, explains, "Anger is a form of stress, and so when we hold on to anger it is as though we are turning on the body's stress response, or fight or flight response, chronically." You are probably aware of the impact of chronic stress and its adverse effects on the body. Amazingly, the act of forgiveness can help release the relational stressors that weigh you down, also helping to reduce blood pressure impacting your cardiovascular health.

     Forgiveness also has benefits such as higher self-esteem, better moods, and happier relationships, according to the Greater Good Science Centre.

    How to Forgive

    When it comes to forgiveness, there's no silver bullet or quick fix to finding peace of mind. And everyone responds differently to various interventions that help people move through the forgiveness process, which is associated with positive outcomes. Learning to forgive is highly unique to each individual. Below are ways Dr. Schwartz suggests for integrating it into your daily life if one chooses:

    Reflect and Remember: Recall the events, your reactions to them, and the feelings. How has hurt and anger impacted you?

    Empathise with the Other Person: Empathy can be described as an “imagine-other” perspective, which focuses on the experiences of another person, according to PsychCentral. It is a way of being present to someone and feeling into their experience.

    Forgive Deeply: Dr. Schwartz says people who forgive from a place of understanding and realise that no one is perfect can return to a normal relationship with the other person, even if that person never apologised.

    Let Go of Expectations: Saying you're sorry may not shift your affiliation with another person or bring forth an apology; however, if neither is expected, you won't be disappointed.

    Decide to Forgive: Dr. Schwartz explains when you choose to forgive, "Seal it with an action." If you're not able to communicate with the person who hurt you, journal, or write about your forgiveness. Try talking about it with a counsellor or therapist or someone else in your life who you trust.

    Forgive Yourself: Cultivating self-forgiveness can be a challenge, and learning to be kind to yourself is another skill that requires practice and deserves your full, most-dedicated, and gentle attention. Your shortcomings are as much a part of your humanity as your individual strengths. Learning to practice self-kindness is an important and critical practice for your well-being. By committing to a self-kindness practice, "We can learn to become more constructive and effective in accepting and rectifying our errors - and, in the process, grow as individuals," according to Carole Pertofsky, MEd, director emerita of student wellness services at Stanford.

    Nourishment and Healing

    Forgiveness is a choice you make over and over again. Both forgiveness and letting go are forms of nourishment that help you grow as an individual, and as a collective. In learning about, and moving into a process of forgiveness, you will see it isn't about giving up—it's about moving into an understanding that the best is yet to come—and nearly everyone can benefit from moving forward in that context. I wish you a regular and healthy dose of vitamin “F” as you continue along your journey to health and healing.




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  6. Coronavirus: Spanish study casts doubt on herd immunity feasibility

    A Spanish study has cast doubt on the feasibility of herd immunity as a way of tackling the coronavirus pandemic.

    The study of more than 60,000 people estimates that around just 5% of the Spanish population has developed antibodies, the medical journal the Lancet reported.

    Herd immunity is achieved when enough people become infected with a virus to stop its spread.

    Around 70% to 90% of a population needs to be immune to protect the uninfected.

    The prevalence of Covid-19 antibodies was below 3% in coastal regions, but higher in areas of Spain with widespread outbreaks, the report said.

    Despite the high impact of Covid-19 in Spain, prevalence estimates remain low and are clearly insufficient to provide herd immunity," the study's authors said in the report.

    "This cannot be achieved without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems.

    "In this situation, social distance measures and efforts to identify and isolate new cases and their contacts are imperative for future epidemic control."

    The study is thought to be the largest of its kind on the coronavirus in Europe.

    There have been studies of a similar kind in China and the US and "the key finding from these representative cohorts is that most of the population appears to have remained unexposed" to the coronavirus, "even in areas with widespread virus circulation," the Lancet article said.

    Prof Danny Altmann, British Society for Immunology spokesperson and Professor of Immunology at Imperial College London, described the study as "sobering".

    "Findings such as this reinforce the idea that faced with a lethal infection that induces rather short-lived immunity, the challenge is to identify the best vaccine strategies able to overcome these problems and stimulate a large, sustained, optimal, immune response in the way the virus failed to do," Prof Altmann said.

    What's the latest in Spain?

    The country has recorded more than a quarter of a million cases and at least 28,385 deaths. But daily fatalities have been in the single figures for most of the past three weeks.

    However, officials in the north-western region of Galicia have re-imposed restrictions on an area of 70,000 people following an outbreak.

    Officials linked local outbreaks to bars in the area. Capacity in bars and restaurants have been limited to 50%.

    There are now 258 cases of Covid-19 in Galicia, including 117 in Lugo province, authorities say.

    On Saturday the autonomous government of Catalonia re-imposed controls on an area of 210,000 residents after a sharp rise in infections there.

    Catalan President Quim Torra said no-one would be allowed to enter or leave Segrià, a district west of Barcelona that includes the city of Lleida

    The search for a fit response

    Herd immunity can be reached either by widespread vaccination or if enough of the population is exposed to an infection and recovers. If enough people are immune to a disease, it is unlikely to keep spreading from person to person. Letting the coronavirus infection run and risking lots of people getting very sick with it is not an option - it would put too many lives in danger.

    And currently, there is no vaccine for coronavirus - even though hundreds are in development. The challenge is to make a jab that provides enough protection. It needs to train the body's immune system to learn and remember how to make antibodies that can fight off coronavirus.

    Scientists are concerned that this "memory" might be too short-lived though, given the nature of the disease. While some people who catch coronavirus develop protective antibodies, experts do not yet know how long these last.

    Common colds are caused by similar viruses and the body's immune response fades quickly to those.






  7. BBQ Tempeh Vegan Ribs


    • 1 pkg Tempeh (12 oz)
    • 2 Tbs Apple Juice
    • 2-3 Tbs BBQ Rub
    • 2 cups Hickory Wood Chips (for outdoor smoking)

    BBQ Rub

    • 1/4 cup Paprika
    • 2 Tbs Kosher Salt
    • 2 Tbs Chili Powder
    • 2 Tbs Brown Sugar
    • 1 Tbs Black Pepper
    • 2 tsp Garlic Powder
    • 2 tsp Onion Powder
    • 1/2 tsp Cayenne Pepper (or more to taste)


    1. If using outdoor grill or smoker:  Soak Hickory Wood Chips in water for at least 30 minutes. 
    2. Prepare ribs by slicing Tempeh into 6" long strips about 1" wide. 
    3. Brush ribs with Apple Juice and then liberally apply rub working it into all the nooks and crannies of the Tempeh.
    4. Place ribs on grate as far away from the coals as possible (indirect-heat). Add a handful of soaked Hickory Chips to coals and allow Tempeh to smoke in low-heat (122 °C) for 1 hour.   Occasionally add more chips to coals for a smokier flavour.
    5. Additionally, spritz (or brush) Apple Juice on ribs occasionally to keep them from drying out.
    6. Finally, move the ribs down to the direct heat and slather with your favourite BBQ sauce.  Cook for 1-2 minutes per side, turn and apply more sauce until a nice crust or bark is formed. 
    7. Serve with your favourite BBQ Sides, like my Coleslaw or Potato Sala

    Servings: 3





    Vegan BBQ Ribs.jpg


    Face Shields May Be Next Step to Prevent COVID

     Face masks have become commonplace in the effort to combat COVID-19, but some doctors say it is time to take protection a step further and try full face shields as restrictions slowly begin to loosen.

    Face shields are nothing new in medical settings -- doctors and nurses who treat coronavirus patients are using them along with standard face masks. Health care professionals are split on whether they should also be worn by children, teachers, and in offices while states reopen.

    “Face shields appear to have a number of advantages: They’re easy to wear correctly and good at blocking droplets,” says Eli Perencevich, MD, an infectious disease doctor at the University of Iowa and the Iowa City Veterans Affairs Health Care System. “They’re really a better option for protection.”

    Perencevich and his colleagues published a report in JAMA last month, arguing that face shields have more COVID-fighting potential than standard masks when used with increased testing, contact tracing, and social distancing.

    A few things make shields superior; he says. For one, many people wear masks that don’t fit well, so they don’t work as well. They also prompt people to touch their faces more, increasing the risk of viral spread. They leave much to be desired in terms of comfort, he says, and they make it harder to breathe.

    Shields come with the perk of being easily sanitised and reused, says Keith Kaye, MD, a professor of medicine and director of research for the division of infectious diseases at the University of Michigan Medical School.

    Unlike masks, clear shields also allow for better communication -- people can read facial expressions, and those who are hearing impaired can read lips, he says.

    “I do think we're going to see more and more face shield use,” Kaye says. “Particularly as COVID continues to cause problems.”

    While there is not a lot of data on how well masks work, one recent study in China found that wearing a mask at home reduced transmission to other members of the same household by nearly 80%.

    Shields, meanwhile, have been found to successfully block droplets. One cough simulation study in 2014 found that a shield may reduce exposure by 96% when worn within 18 inches of someone coughing.

    In addition, face masks are not meant to protect the wearer -- they leave other vulnerable parts of the face exposed, like the eyes. They are meant to keep an asymptomatic or pre-symptomatic person from spreading it to others.

    But not all doctors are sold on everyday use of more extreme protective gear. Dan Kuritzkes, MD, chief of infectious diseases at Brigham and Women’s Hospital in Boston, says the eye coverage that shields provide is likely not necessary for people unless they are providing medical care to COVID-19 patients.

    “In theory, it may be possible that particles could land in someone’s eye and cause infection, but we don’t have good evidence that happens,” he says. “I think the bottom line is for the general public, there's no reason to be wearing face shields.”

    He also says they may not help prevent airborne transmission, because air that has droplets in it could get sucked under the shield from the bottom opening.

    Face shields are important in health care settings because, in those situations, mucous membranes around the caregivers’ eyes that could come into contact with harmful droplets while they do procedures like intubation, says Timothy Brewer, MD, a professor of medicine and epidemiology at the UCLA Fielding School of Public Health and Medicine.

    As long as everyone abides by recommendations to wear a face mask, that risk won’t exist for non-health care workers.

    “It could potentially get in someone’s eyes if someone sneezes -- that's why the person sneezing should also be wearing a mask,” Brewer says.

    Meanwhile, other parts of the world are embracing the use of face shields outside of hospitals. School children in Singapore are being given face shields as they head back to classes in the coming days.

    The Infectious Diseases Society of America has listed widespread use of protective gear, including face shields, in the process of lifting restrictions, but the CDC still recommends just face masks for people outside the health care realm.

    Still, people and companies have jumped in to help supply shields to both health care workers and other people at higher risk of catching the virus.

    Amazon announced this month that its engineers are developing face shields to sell on its site after donating almost 10,000 to people on the front lines.

    Other efforts have come from everyday citizens. Katherine Marcano-Bell and her family have converted part of their 1,300-acre pig farm into a shield-making operation, and have delivered them to hospitals, clinics, meatpacking plants, and families who have made specific requests for them.

    “I think it wouldn't hurt to wear one, especially if you're sick or immunocompromised,” Marcano-Bell says.






  9. Make These Vegan Tempeh Spring Rolls With Peanut Sauce



    • Tempeh:
    • 1/2 block tempeh (113g) thinly sliced
    • 1/4 cup coconut aminos (60ml)
    • 2 tsp chili garlic sauce (5ml)
    • 2 tsp minced ginger (5g)
    • 1 tsp minced garlic (3g)
    • Peanut Butter Sauce:
    • 1/4 cup peanut butter
    • 3 tbsp coconut aminos 45ml
    • 2-3 tbsp water
    • 1 tbsp sriracha 15ml
    • 1 tsp seasoned rice vinegar 5ml
    • 1 tsp agave nectar
    • 1/4 tsp garlic powder
    • 1/8 tsp ginger powder
    • Summer Rolls:
    • Vietnamese rice paper (six)
    • lettuce 36g
    • Shredded Red cabbage 125g
    • 2 sliced Green onions
    • sliced Yellow bell pepper 120g
    • grated carrots 120g
    • cucumber batonnets (sliced lengthwise) 180g


    1. Tempeh:
    2. Slice the half tempeh block in thin slices lengthwise.
    3. In a small bowl, combine the tempeh and the marinade ingredients. Mix to coat the tempeh well.
    4. Heat a pan on medium-low heat, add the tempeh and the rest of the marinade to the pan. Cook until the tempeh is browned on both sides. About 10-15 mins.
    5. Peanut Butter sauce:
    6. Combine ingredients and whisk until smooth. Set aside.
    7. Summer Rolls:
    8. Fill a large bowl with water. Immerse one wrapper in the water to soften. Pull it out, being careful so it doesn't collapse on itself, and lay it on a cutting board.
    9. Fill the wrapper with the veggies, a few pieces each, add three slices of tempeh.
    10. Fold the top and bottom of the wrapper over the filling. Fold the left&right sides, and roll tightly.
    11. Repeat with remaining rice papers. Makes six rolls. Slice in half to serve, if desired.






  10. Drug Combos May Be Advance Against Heart Failure

     Many patients with heart failure might live years longer if they were on a combination of newer medications, a study suggests.

    Researchers estimate that if certain heart failure patients were prescribed a four-pill regimen -- including three recently proven therapies -- they could live up to six years longer, compared with the regimen patients commonly use.

    The findings, published online recently in the medical journal The Lancet, are projections, not guarantees.

    But they do make a strong case for the medication cocktail, said lead author Dr. Muthiah Vaduganathan, a cardiologist at Brigham and Women's Hospital in Boston.

    "Combined use of these four pills would be anticipated to keep patients out of the hospital and alive for more years," he said.

    Heart failure is a chronic condition in which the heart muscle cannot pump blood efficiently enough to meet the body's demands -- causing symptoms such as fatigue, breathlessness and leg swelling.

    The new study focused on patients who had heart failure with reduced ejection fraction, which refers to how much blood the heart pushes out with each contraction. Reduced ejection fraction affects about half of heart failure patients.

    For a long time, the standard medication regimen for those patients was a beta blocker plus an ACE inhibitor or an angiotensin II receptor blocker (ARB). All three drugs lower blood pressure and ease the heart's workload through different mechanisms.

    But more recently, clinical trials have found that three other drug types can help patients live longer, beyond standard drugs alone.

    One is a medication called Entresto, which combines the ARB valsartan with another drug, sacubitril. Another is a diabetes drug called dapagliflozin (Farxiga), which was recently shown to benefit heart failure patients with or without diabetes.

    The third drug class is actually an old one: mineralocorticoid receptor antagonists, which include spironolactone and eplerenone. They help control blood pressure by blocking a hormone called aldosterone.

    Despite the positive findings, though, many doctors still do not prescribe those drugs for heart failure, Vaduganathan said. And there is little evidence on what would happen if patients used all three types of medication.

    "The optimal combination really hasn't been studied," Vaduganathan said.

    So his team tried to estimate the benefits of taking the newer therapies, together, over many years. To do that, they combed shorter-term data from three large clinical trials that tested the drugs against standard treatment. Then they made some projections: What would happen if patients started on a beta blocker plus the three drug classes, instead of an ACE inhibitor or ARB -- and stuck with the regimen for the long haul?

    For a 55-year-old, the researchers estimate, that could translate into an extra six years of life, and eight years free of hospitalisation for heart failure.

    For an 80-year-old, the benefits would be smaller but still important -- an extra year of life, on average, and nearly three extra years out of the hospital.

    In an "ideal world," all eligible patients would be on the medications, said Dr. Mary Norine Walsh, past president of the American College of Cardiology.

    "But here's the rub," she added. "Two of these drugs [Entresto and Farxiga] are not available as generics."

    So, many patients may be unable to afford the pricey medications, even with insurance. Farxiga costs roughly $500 for 30 pills, while Entresto costs about $600 for 60 pills, according to an online search.

    Beyond cost, not all patients should be on the drugs. Walsh, who was not involved in the study, stressed that the findings apply only to patients with reduced ejection fraction -- which leaves out half of people with heart failure.

    And any one patient, she said, might have other health issues that are contraindicated for a given drug.

    "There may be reasons not to take a medication," Walsh said. "But that shouldn't stop patients from asking their doctor questions."

    Specifically, she said, patients who are still on an ACE inhibitor or ARB can ask their doctor why they have not been switched to Entresto -- which guidelines say is the preferred choice.

    The diabetes drug Farxiga was only just approved for treating heart failure with reduced ejection fraction, Vaduganathan noted. So, it's not yet included in treatment guidelines.

    The study received no funding, but the researchers report connections to various drug companies that make heart failure medications.

    More information

    The American Heart Association has more on heart failure treatment.



  11. Another COVID-19 vaccine candidate has achieved good early results, a research team in China reported Friday.

    The experimental vaccine produced important signs of immune response in a small group of adults, a sign that it could potentially protect people against COVID-19, researchers reported May 22 online in The Lancet medical journal.

    "These results represent an important milestone," researcher Wei Chen, part of a team with the Beijing Institute of Biotechnology, said in a journal news release.

    "However, these results should be interpreted cautiously," Chen continued. "The challenges in the development of a COVD-19 vaccine are unprecedented, and the ability to trigger these immune responses does not necessarily indicate that the vaccine will protect humans from COVID-19."

    This particular vaccine candidate used a weakened common cold virus called an adenovirus to safely deliver COVID-19 coronavirus genetic material into human cells.

    This causes the body to produce the "spike" protein that the coronavirus uses to invade human cells. In turn, the immune system responds to the presence of the protein by creating antibodies that potentially could fight off future coronavirus infections, the researchers said.

    Within a month, most of the 108 healthy adult participants in the phase 1 trial had a fourfold increase in binding antibodies. These antibodies can bind to the coronavirus, but don't necessarily attack it.

    Half of the participants who received low or moderate doses and three-quarters of those who received a high dose also developed neutralising antibodies, which can protect the body against the coronavirus, researchers reported.

    "Not only did the virus induce antibodies but also T-cell immunity, which will also be important for confirming protection," said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Centre for Health Security, who called the trial results "very welcome."

    However, Adalja said the vaccine's use of a common cold virus to deliver its genetic payload could hamper its effectiveness.

    "Adenoviruses are very common and there are many people with pre-existing immunity," Adalja said. "In a prior trial using this type of platform for HIV vaccination, there was a paradoxical increase in risk of infection in those who are vaccinated who had pre-existing adenovirus 5 immunity. Whether this phenomenon is present with this vaccine will be important to investigate in detail in phase 2 and phase 3 trials."

    There was some evidence of this in the clinical trial, with people who had existing cold virus immunity showing a reduced immune response to the vaccine, the Chinese researchers noted.

    A full-fledged phase 2 trial has been initiated in Wuhan to see if the results can be replicated in 500 healthy adults, which would include 250 volunteers given a moderate dose, and another 250 given either a low dose or a placebo.

    The U.S. Department of Health and Human Services has entered a full-court press to develop potential COVID-19 vaccine candidates.

    U.S. federal officials said Thursday the agency would provide up to $1.2 billion to the drug company AstraZeneca to develop a potential coronavirus vaccine from a lab at the University of Oxford in England.

    The fourth, and largest, vaccine research agreement funds a clinical trial of the potential vaccine in the United States this summer with about 30,000 volunteers, the New York Times reported.

    The goal? To make at least 300 million doses that could be available as early as October, the HHS said in a statement.

    However, many experts have said that the earliest an effective, mass-produced vaccine would be available won't be until sometime next year, and billions of doses would be needed worldwide.

    The United States has already agreed to provide up to $483 million to the biotech company Moderna and $500 million to Johnson & Johnson for their vaccine efforts. It is also providing $30 million to a virus vaccine effort led by the French company Sanofi, the Times reported.

    More information

    The U.S. Centres for Disease Control and Prevention has more on COVID-19.






    2 white potatoes peeled and cubed
    1 cup of soy sauce
    1/4th white onion diced
    1/2 cup freshly chopped cilantro
    1 cup of snow peas
    3 cups pre-cooked brown rice
    ½ red pepper diced
    ½ green pepper diced
    ½ poblano pepper diced
    2 cups broken up broccoli florets
    1 carrot diced
    ½ cup white button mushrooms
    1 pack of firm tofu drained and cubed
    2 tablespoons of coconut oil
    ½ cup of slivered almonds
    Korean BBQ Sauce Ingredients:
    1 cup soy sauce
    1/2 cup brown sugar
    1 tablespoon of rice vinegar
    1 clove of garlic
    2 table spoons of toasted sesame oil
    1 tablespoon black pepper
    1 teaspoon tapioca flour
    1 teaspoon ground ginger


    Combine ingredients to make Korean bbq sauce into blender and blend until smooth.
    Put chopped potatoes and tofu in a large mixing bowl. Add 1 cup of Korean bbq sauce and ¼ cup chopped cilantro.
    Massage mixture into potatoes and tofu vigorously for 5 minutes. Let stand for another 10 minutes.
    Sauté potato and tofu mixture for 10 minutes until browned on each side.
    Add in the rest of your pre-cut veggies. Then sauté with coconut oil, 1 cup of soy sauce and the remainder of your Korean BBQ mixture until veggies are tender yet firm.
    Spoon 1 cup of stir fry on you plate and top with a tablespoon of silvered almonds.


    Nutrition Facts

    Spicy Tofu and Meaty Mushroom Vegan Korean BBQ Stir-Fry

    Serves: 8

    Amount Per Serving
    Calories 162
    % Daily Value*
    Total Fat 9.5 grams 14.6%
      Saturated Fat 0
      Trans Fat  
    Cholesterol 0
    Sodium 329 milligrams 13.7%
    Total Carbohydrate 11 grams 3.7%
      Dietary Fiber 0
      Sugars 3.5 grams  
    Protein 12 grams  
    Vitamin A  Vitamin C
    Calcium  Iron

    * Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs.






  13. As some countries ease up, others are reimposing lockdowns amid a resurgence of coronavirus infections

    As many parts of the world, including the United States, explore ways to ease restrictions aimed at containing the spread of the coronavirus, countries that had already opened up are closing down again after renewed spikes in infections.

    Such a resurgence of cases had been widely predicted by experts, but these increasing numbers come as a sobering reminder of the challenges ahead as countries chafing under the social and economic burdens of keeping their citizens indoors weigh the pros and cons of allowing people to move around again.

    Lebanon on Tuesday became the latest country to reimpose restrictions after experiencing a surge of infections, almost exactly two weeks after it appeared to have contained the spread of the virus and began easing up. Authorities ordered a four-day, near-complete lockdown to allow officials time to assess the rise in numbers.

    The re-emergence of coronavirus cases in many parts of Asia is also prompting a return to closures in places that had claimed success in battling the disease or appeared to have eradicated it altogether, including South Korea, regarded as one of the continent’s top success stories.

    South Korea last week rescinded a go-ahead for bars and clubs to reopen after a spike in cases, hours after officials announced the lifting of previous social distancing restrictions and the start of a “new everyday life with the coronavirus.”

    South Korean President Moon Jae-in warned his country Sunday to “brace for the pandemic’s second wave,” calling the battle against covid-19 a “prolonged” fight.

    In the Chinese city of Wuhan, where the pandemic first emerged, authorities on Tuesday ordered the testing of all 11 million inhabitants after a cluster of six new infections emerged, five weeks after the city had apparently rid itself of the disease.

    Germany, which is widely regarded as the model in Europe of a balanced coronavirus response, is warning that some areas may have to reinstate restrictions after localised outbreaks caused a rise in cases.

    “We always have to be aware that we are still at the beginning of the pandemic,” German Chancellor Angela Merkel cautioned last week as a cluster of new cases in a meatpacking plant raised fears of an intensified outbreak. “And there’s still a long way in dealing with this virus in front of us.”

    Some countries are going ahead with plans to lift restrictions despite evidence that cases are on the rise and the disease is far from being contained. India and Russia eased their restrictions Tuesday even as the number of infections in both countries continued to soar.

    Iran, the epicentre of the disease in the Middle East, with more than 110,000 reported cases, has ordered a county in the southwestern province of Khuzestan to reimpose a lockdown after cases spiked there. But the government is still planning to proceed with the reopening of schools later this week, despite a marked jump in new infections since restrictions were eased in late April.

    The new spikes underscore the question of when — or whether — it will ever be fully safe for coronavirus-stricken countries to lift their lockdowns.

    The latest cluster in Wuhan demonstrates how hard it will be to measure whether any location is truly free of coronavirus. The new cases there suggest the virus can flare up in patients up to 50 days after they have apparently recovered, said Wu Zunyou, chief epidemiologist at the Chinese Centre for Disease Control and Prevention, in an interview with state broadcaster CCTV.

    “The course of disease could last 30 to 50 days for some patients,” Wu said. “The virus could take longer to manifest itself in patients with weak immunity, who are also prone to ‘ons’ and ‘offs’ of symptoms.”

    He sought to reassure citizens that the new cases did not represent a new wave of the pandemic.

    “There will not be a new minor peak,” Wu said. “We have had the epidemic under control after more than three months of efforts and accumulated considerable experience in both diagnosis and [epidemic] notification. Therefore, we will not allow scattered cases to develop into massive outbreaks.”

    Firass Abiad, who oversees coronavirus efforts at the Rafik Hariri University Hospital in Beirut, Lebanon’s main government hospital, said a country’s success will depend less on how it curtails the spread of disease during a lockdown than on how the country manages the inevitable resurgence after lockdowns end.

    “A lockdown is a means and not an end,” he said. “It’s a means either to allow you to regain control or put measures in place to control coronavirus when it comes back. When we eased the lockdown, we knew there would be an increase in the number of cases.”

    Lebanese government officials said the lockdown was being reimposed for four days starting at midnight Wednesday to allow the authorities time to conduct contact tracing and isolation for several new clusters that have broken out in different parts of the country. They represent 104 cases in the past four days, a big jump in a small country after infections had stabilised at the rate of one or two new cases a day.

    Most are linked to some of the thousands of Lebanese who have been repatriated in recent weeks from around the world, said Souha Kanj, who heads the infectious diseases department at the American University of Beirut.

    All the returnees are tested for the coronavirus and required to quarantine for two weeks even if they are negative. But some have not been adhering to the requirement, she said, citing the case of a man who returned from Nigeria and then held a party for his relatives, infecting at least 10 of them. One was a member of the security forces, who has in turn infected a dozen or so of his colleagues.

    There may also be cases of renewed local transmission, perhaps stemming from people who were asymptomatic but have been silently spreading the disease, Abiad said. Lebanese released from nearly six weeks of lockdown last month have surged onto the streets, openly defying some of the continued restrictions and social distancing rules that remain in force.

    Similar scenes have occurred in other countries that are ending closures. Crowds of Parisians gathered on the banks of the Seine to toast their release Monday from six weeks of one of the world’s toughest confinements, prompting police on Tuesday to ban the consumption of alcohol in the vicinity of the river.

    “In any country where people don’t adhere to social distancing, this is going to happen. You are going to have a surge in cases for sure,” Kanj said.

    Correction: A line in the story about the increase of cases in France was removed because it referred instead to fatalities.




  14. coronavirus attacks the entire body — damaging the brain, kidneys and more

    While the coronavirus is known to cause deadly respiratory problems, research is showing the multitude of ways the disease can ravage the entire body.

    Through a growing number of studies, reports and doctors’ experiences, the deadly virus has been linked to issues in everything from the brain to the toes.

    Here is a breakdown of the ways COVID-19 can affect different parts of the body:


    The coronavirus has been observed to turn eyes red, causing pinkeye, or conjunctivitis, in some patients.

    Physicians have suggested that the condition develops in the severely ill, and one study of 38 hospitalised patients in Hubei, China, found that a third had pinkeye.


    Neurological symptoms such as dizziness, headaches, impaired consciousness and skeletal-muscle injuries have been documented among cases.

    Chinese doctors in April published a study on nervous system function in the Journal of the American Medical Association that found that patients can also experience more serious issues — including seizures and stroke, which occurs when a blood clot reaches the brain, according to the Wall Street Journal.


    Doctors have seen alarming cases of myocarditis — an inflammation of the heart muscle — in addition to irregular heart rhythms that can lead to cardiac arrest in coronavirus patients, according to the Washington Post.

    “They seem to be doing really well as far as respiratory status goes, and then suddenly they develop a cardiac issue that seems out of proportion to their respiratory issues,” Mitchell Elkind, a Columbia University neurologist and president-elect of the American Heart Association, told the outlet.

    Sensory system

    The loss of the ability to taste and smell has emerged as a peculiar symptom strongly associated with the virus.

    The condition, which is known as anosmia, was not initially recognized as a symptom of the virus, but data from a symptom-tracking app in one study found that 60 percent of people who tested positive reported losing their senses of smell and taste, according to researchers from King’s College London.

    About a quarter experienced the strange symptom before developing other conditions, suggesting it may be an early sign of the virus.


    The coronavirus also causes blood thickening and clots in the veins, according to doctors.

    The clots can break loose and travel to the lungs and brain, potentially causing a deadly condition known as pulmonary embolism.

    It’s still not known why the virus causes the blood clots to form, or why the body is unable to break them up.

    Gastrointestinal system

    Digestive issues such as diarrhoea, vomiting and abdominal pain have been among the chief complaints of many patients.

    Nearly half of the virus patients admitted to the hospital in the central Chinese province of Hubei, where the outbreak occurred, reported experiencing digestive problems, according to a study published in the American Journal of Gastroenterology.


    Kidney damage has been reported among hospitalised patients, with an alarming percentage who require dialysis.

    Nearly half of hospitalised patients have blood or protein in the urine, suggesting there is early damage to the kidneys, one nephrologist told the Washington Post.

    And early data showed that between 14 and 30 percent of intensive care patients in New York and Wuhan, China, lost kidney function and required dialysis or continuous renal replacement therapy, according to the report.


    Foot sores nicknamed “COVID toes” have been documented as an odd symptom linked to the virus.

    Physicians have observed the purple foot sores, which are similar to those of chickenpox or measles, among mostly young coronavirus patients in Italy, France and Spain.

    Immune system

    Physicians have found in some cases that a patient’s immune system goes into overdrive to fight the infection.

    The response, which is known as “cytokine release syndrome,” can cause damage that results in severe inflammation and organ failure, NPR reported.


    COVID-19 is well known to cause coughing, trouble breathing and, in some cases, severe pneumonia.

    The infection can work its way into the lungs, filling tiny air sacs with cells and fluid that prevent the flow of oxygen, the Guardian reported.

    When the air sacs become inflamed, pneumonia can develop in the lungs, which then struggle to get enough oxygen to the bloodstream — reducing the body’s ability to take in oxygen and get rid of carbon dioxide, according to the outlet.

    Ultimately, this can lead to death in severe cases, the outlet said.




  15. FDA Approves Drug for Heart Failure

    The FDA has approved a new use for the drug dapagliflozin (Farxiga) -- to reduce the risk of a hospital stay or death in people who have a type of heart failure.

    People with heart failure are more likely to get complications and early death, even when they take other drugs for heart disease such as ACE inhibitors, beta-blockers, and angiotensin receptor blockers.

    Farxiga's new approval is to treat heart failure with reduced ejection fraction, which means the left ventricle, or lower chamber, of the heart is too weak to pump blood out to the body very well.

    “Heart failure is a serious health condition that contributes to one in eight deaths in the U.S. and impacts nearly 6.5 million Americans,” Norman Stockbridge, MD, PhD, director of the Division of Cardiology and Nephrology in the FDA’s Centre for Drug Evaluation and Research, says in a news release.

    The approval is good news for people with heart failure, says Wilson Tang, MD, a heart failure specialist and director of heart failure research at Cleveland Clinic's Heart & Vascular Institute. "This is an area where we have had few significant landmark studies and approvals over the past decade." 

    Farxiga belongs to a class of diabetes drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors, which also includes canagliflozin (Invokana), empagliflozin (Jardiance), and ertugliflozin (Steglatro). All four drugs are already FDA-approved to treat type 2 diabetes. They lower blood sugar by stopping the kidneys from absorbing extra sugar in the urine back into the blood.

    In October 2019, the FDA also approved Farxiga to reduce the risk of a hospital stay for heart failure in people with type 2 diabetes plus heart disease, or risks for heart disease.

     Discovery of a Heart Failure Benefit

    Researchers discovered the benefits of SGLT2 inhibitors for treating heart failure somewhat by accident, while studying the effects of these drugs in people with type 2 diabetes. In four large studies, people with type 2 diabetes who took an SGLT2 inhibitor were 25% to 35% less likely to be hospitalized for heart failure -- whether or not they had heart failure at the start of the study. Heart failure is an early and the most common heart-related complication in people with diabetes.

    The new approval is based in part on a study called DAPA-HF, which was the first to look at the effects of an SGLT2 inhibitor specifically on heart failure. This study randomly assigned more than 4,700 people who had heart failure to take Farxiga or an inactive pill (placebo) along with their regular heart failure drugs.

    After just over 18 months, when Farxiga was added to other heart failure medications, there was an 18% decrease in the risk of death from heart disease and a 17% lower risk of death from all causes. The drug also led to a 26% combined lower risk for a hospital stay due to heart failure, worsening heart failure, or heart-related death. The drug slowed heart failure from getting worse in people both with and without diabetes.

    How Does It Treat Heart Failure?

    "That's a great question. No one's 100 percent sure. There are lots of different theories," says Deepak Bhatt, MD, executive director of interventional cardiovascular programs at the Brigham and Women's Hospital Heart & Vascular Centre. (Bhatt has received funding from AstraZeneca, Farxiga's maker, as well as from Sanofi-Aventis, for his research on SGLT2 inhibitors.)

    "The simplest theory is that it's just a really good diuretic -- a medicine that removes fluid from the body," he says. "People with heart failure are often on a diuretic, also called a water pill, to get extra fluid out of their body." As the drug removes sugar from the urine, it also flushes out salt and fluid.

    It's likely that other mechanisms are also involved. The drug might increase ketone bodies -- chemicals our bodies make when they break down fats to use for energy. Ketones might improve the heart's energy usage. Or Farxiga and other drugs like it might protect heart muscle cells from more damage.

    Bhatt says it will take some time and further research to figure out exactly how Farxiga works to treat heart failure. "I think it could take years to sort it all out."

    Side Effects

    Genital yeast infections, dehydration, and urinary tract infections (UTIs) are the most common side effects, which happen as Farxiga puts extra sugar into the urine. "When urine has more glucose, there is a higher likelihood for patients to get a UTI," says Tang. Your doctor can check you for these infections if you take Farxiga, and treat you with an antifungal or antibiotic drug if you need it.

    You may not be able to take Farxiga if you have severe kidney disease or you're on dialysis, because it could affect how your kidneys work.

    Your doctor might do tests to check how well your kidneys are working while you're on this drug if you:

    • Have kidney problems
    • Have low blood pressure
    • Take diuretics to treat high blood pressure

    Farxiga can cause serious cases of necrotizing fasciitis of the genital area (Fournier’s gangrene) in people with diabetes and low blood sugar when combined with insulin.

     SGLT2 Drugs for Heart Failure

    The big challenge now is for cardiologists to figure out when to prescribe this together with several other drugs in their appropriate doses for their patients with heart failure, Tang says. "This always happens with new drug indications, particularly when the drug cost can be relatively high.”

    A month's supply of Farxiga for diabetes costs $492. AstraZeneca expects the price to remain the same for heart failure treatment. The company says the amount people actually pay for the drug will depend on their health insurance coverage, their doctor, and any drug assistance programs or savings programs they use.

    A remaining question is whether other SGLT2 drugs will also help people who have heart failure. Studies are underway to figure that out. These trials may also shed some light on exactly how this group of drugs works to treat heart failure, and whether they're as effective in people with the other type of heart failure.




  16. Ingredients

    For the vegan mushroom stroganoff:

    • 250 g pasta of choice , (vegan,) 
    • 1 cup vegetable broth 
    • 1 cup non-dairy milk, 
    • 1/4 cup all-purpose flour 
    • 1 teaspoon dried thyme leaves
    • 1 teaspoon salt
    • 1/4 teaspoon black pepper
    • 2 tablespoons vegan butter 
    • 1 yellow onion, chopped
    • 4 cloves garlic, minced
    • 454 g brown or white button mushrooms  sliced (about 6 cups sliced)

    For garnish:

    • 1 handful fresh parsley, roughly chopped
    • Parmegan (vegan parmesan)


    1. Bring a large pot of water to a boil and cook the pasta according to package directions.
    2. In a large measuring cup or medium bowl whisk together the vegetable broth, non-dairy milk, flour, dried thyme, salt, and pepper. Set aside.
    3. Melt the vegan butter in a large skillet or pot. When hot add the onion and garlic and sauté for about 5 minutes until the onion turns translucent and begins to brown. Reduce the heat to medium and add the mushrooms. Continue to cook for about 5 minutes until the mushrooms have softened and begin to release their juices.
    4. Pour in the broth and non-dairy milk mixture and continue to cook, stirring as needed for about 3 to 5 minutes until the sauce thickens. If the sauce gets too thick, add more vegetable broth or water if needed to thin. If the sauce is too thin, simply cook a little longer until you reach desired consistency.
    5. Add in the cooked pasta and toss well to combine. Divide among plates and serve, garnishing with parsley and Parmegan to taste. 


    Calories: 345 kcal | Carbohydrates: 60g | Protein: 13g | Fat: 6g | Saturated Fat: 1g | Sodium: 873mg | Potassium: 552mg | Fibre: 3g | Sugar: 5g | Vitamin A: 475IU | Vitamin C: 6.7mg | Calcium: 33mg | Iron: 2.2mg







    A growing body of evidence indicates that a healthy plant-based diet can positively impact certain autoimmune diseases. In many cases, individuals report a significant reduction—or even total reversal—of autoimmune disease symptoms when they cut out meat and dairy.

    Autoimmune diseases are chronic illnesses that occur when healthy cells are destroyed by the body’s own immune system. There are more than eighty different types of autoimmune diseases, including type 1 diabetes, coeliac disease, lupus, psoriasis, and rheumatoid arthritis.

    Some studies, including YorkTest Laboratories 2017 survey, specifically highlighted animal products such as eggs and milk as aggravators of arthritis symptoms. According to a study published by the National Centre for Biotechnology Information, accumulating scientific evidence supports the health benefits of a vegetarian diet.

    “Both vegetarian and vegan diets typically emphasize vegetables, fruits, grains, legumes, and nuts,” says the study. “These results suggest that a vegan diet, with a high intake of fruits and vegetables and the elimination of animal products, could protect against the development of autoimmune conditions.”

    “In contrast, diets high in animal products and low in fibre might increase the risk of developing these autoimmune conditions,” adds the study.

    In general, red and processed meat consumption is increasingly linked to chronic health conditions such as cardiovascular disease, cancer, and diabetes. And consumers are turning to plant-based alternatives as a healthier option for themselves, the animals, and the planet. Plant-based whole foods are widely considered some of the most healthy.

    Rheumatoid Arthritis

    According to a review published in the scientific journal Frontiers in Nutrition, a plant-based diet can help alleviate the symptoms of rheumatoid arthritis. The review suggests that changes in diet “might play an important role in RA management and remission.”

    “Several studies have shown improvements in RA symptoms with diets excluding animal products,” said the review. “Studies have also shown that dietary fibre found in these plant-based foods can improve gut bacteria composition and increase bacterial diversity.”

    “Although some of the trigger foods in RA patients are individualized,” explains the review. “A vegan diet helps improve symptoms by eliminating many of these foods.” However, the study also notes that “further research is needed to test the effectiveness of plant-based diets.” Specifically how it impacts joint pain, inflammation, and the general quality of life in patients with RA.

    Review co-author Dr. Neal Barnard is also the founding president of the Physicians Committee for Responsible Medicine (PCRM), a plant-based advocacy group. And according to PCRM, a plant-based diet is effective in the reduction of arthritis symptoms in several ways.

    PCRM suggests that plant-based diets can help to reduce inflammation, swelling, and pain. It also suggests that they can help lower body mass index (BMI) and encourage healthy gut bacteria. Study co-author Hana Kahleova, MD, PhD, and the director of clinical research for PCRM, echoes this theory.

    “A plant-based diet comprised of fruits, vegetables, grains, and legumes may be tremendously helpful for those with rheumatoid arthritis,” says Kahleova. “This study offers hope that with a simple menu change, joint pain, swelling, and other painful symptoms may improve or even disappear.”


    Lupus is a long-term autoimmune disease with symptoms including inflammation and swelling. As with other autoimmune conditions, it occurs when the body’s immune system targets healthy tissue. It can also cause damage to a person’s joints, skin, and organs. As with rheumatoid arthritis, many of those with experience of lupus promote a plant-based diet to help alleviate symptoms.

    Brooke Goldner, MD, is the bestselling author of “Goodbye Autoimmune Disease and Goodbye Lupus” (2015). The now-celebrity doctor says that switching to a plant-based diet actually reversed her lupus diagnosis. She staunchly advocates for a plant-based diet and has inspired others to treat ongoing health conditions by changing their lifestyle.

    One person inspired by Goldner is the Australian writer and model Robyn Lawley, who recently announced that her lupus has improved to the point that she no longer needs medication. Lawley said that going vegan and following Goldner’s anti-inflammatory diet has helped her improve her condition.

    “I’m no doctor but this is what’s happening in my life,” explained Lawley on Instagram. “After being vegan for almost a year I’m just beyond happy that it’s helping me.”

    The Grammy-award winning singer Toni Braxton is also transitioning to a plant-based diet to help manage the symptoms of lupus. She recently told the healthy lifestyle magazine Prevention: “I’m becoming plant-based. I’m in the process. But I’m going fully plant-based. It’s making me feel better, so there is some truth to it.”

    Those diagnosed with lupus are generally encouraged to avoid foods that can cause inflammation. Some animal products—and dairy items, in particular—are linked to increased inflammation. Conversely, research suggests that plant-based alternatives can help to reduce inflammation and swelling.

    Multiple Sclerosis

    Multiple sclerosis (MS) is a lifelong condition, the symptoms of which can range from serious to mild. In the case of MS, the immune system destroys myelin—the fatty coating surrounding nerve fibres in the brain and spine. The primary symptom of MS is fatigue. But other potential symptoms include problems with vision and movement.

    Saray Stancic, MD, says that adopting a plant-based diet helped her treat her own MS. After nearly a decade of other treatment, Stancic was dependent on a walking stick and several medicines that caused difficult side effects. Adopting a plant-based diet had such a positive impact on her that she founded Stancic Health and Wellness in 2012, to help others treat chronic disease holistically.

    According to PCRM, there are several studies that indicate adopting a diet low in saturated fat may play a key role in MS management. Nutritionfacts.org, a plant-based advocacy group founded by Dr. Michael Greger M.D., echoes this belief. Roy Swank, an academic neurologist, first proposed a low-saturated-fat diet for the treatment of MS in 1949.

    According to Nutritionfacts, one study reported 95 percent of patients with early-stage MS experienced no progression in their disease 34 years after adopting a low saturated fat, meat, and dairy restricted diet. Some patients, who already displayed advanced symptoms, also experienced significant benefits from adopting the diet.

    The Irish author, public speaker, and vegan athlete Conor Devine is also vocal about the benefits of a plant-based diet for MS. In 2018, Devine spoke to LIVEKINDLY about how he overcame his MS symptoms and became a plant-powered athlete.

    “I have intermittent MS symptoms every day. But since I went plant-based my health has improved substantially,” he said. While others also support the benefits of a plant-based diet, Devine noted that his positive experience was personal to him.



  18. Positivity Isn’t Naïve—It’s Exactly What the World Needs Today

    In times when people are struggling with their health, finances, loneliness, and tragic circumstances beyond their control, it might seem simplistic or patronising to encourage them to be more positive. Here’s why it’s crucial to stay positive right now.

    Have you heard of being a Pollyanna? It is a common way to label someone whose glass is always half full, despite any circumstance. The term came from a film about an irrepressibly optimistic young girl named Pollyanna. I’ve never seen the movie, but I do know that characters like Olaf from Frozen, Phoebe from Friends, or Kimmy Schmidt from The Unbreakable Kimmy Schmidt all share that Pollyanna brand of positivity. Like Pollyanna, people with high levels of optimism are often judged as immature or uneducated. But what if science supported that positivity is, in fact, the smarter way to be?

    Positivity 101

    There is a strong body of evidence that the right kind of positive thinking can change the world. Let’s look at the biology, psychology, and wisdom in the practice of positivity. First, let’s consider what positivity is and is not.

    • Positivity is about making an effort to experience and prolong positive emotions (the ones that feel good). It is also the ability to quickly recognise and move through negative emotions (the ones that feel yucky).
    • Positivity is not pushing negative feelings away or pretending not to experience them.

    When you spend more time experiencing positive emotions rather than negative ones, you are said to be flourishing—or thriving.

    Biology—The Evolutionary Role of Negative Emotion

    Emotions and your ability to regulate them is what separates you and other humans from other species. All emotions serve a function. But until recently, researchers spent more time looking at the negative ones.

    The oldest part of your brain, sometimes called the reptilian brain, has the job of keeping you safe. This part of your biology is primitive and animalistic, and is responsible for the fight-or-flight-or-freeze response, which is designed to protect you from potential dangers.

    For example, we used to live in groups of around 150 people. This helped with our health and physical safety and the sharing of responsibilities. People would know everyone in their tribe. Our strong ability to pick out things that were different in our environment helped us to notice strangers who might carry disease or threaten our safety as well as other predators who posed a real threat. There was an important evolutionary reason for negative emotions.

    What has not been as clear to scientists is the role of positive emotions. Your emotional responses are like the gear system in a car. All gears are important, but the last thing you want is to get stuck in a gear that isn’t right for the type of driving you’re doing. When you get stuck in the emotional response loop, you might be making fear-based decisions about things that would not normally be scary. This is like being stuck in high gear while trying to get up a hill. Simply put, you need to be able to shift emotional gears when you need to.

     Psychology—What Are Positive Emotions?

    Emotions impact your relationships, how you make choices and decisions, what you pay attention to, and your personal identity. Positive emotions help with open-minded thinking; they build your resilience and have the power to undo the impact of negative emotions. Think of how strongly you can connect with someone over an inside joke, or how good you feel when you stand at the edge of a vast forest. Positive emotions have power.

    The following list contains many helpful positive emotions from Barbara Fredrickson, a leading expert from UNC-Chapel Hill and author of Positivity:

    • Awe
    • Gratitude
    • Hope
    • Inspiration
    • Interest
    • Joy
    • Love
    • Pride
    • Serenity

     Examples of unhelpful emotions include the following:

    • Anger
    • Displeasure
    • Fear
    • Frustration
    • Guilt
    • Loneliness

     How Wisdom Practices Help

    While negative emotions demand attention, positive emotions tend to be more fleeting and subtle. Meditators often experience greater emotional atonement over time. This is good because, in order to keep your emotions working, you need to drive them as opposed to letting them take the wheel. Try these wisdom practices to help you balance out your emotions:

    Loving-Kindness Meditation

    It has been shown that loving-kindness meditations enhance interpersonal relationships and increase compassion. Even Charles Darwin, who is more commonly remembered as the mind behind the survival-of-the-fittest theory, believed that compassion was a key to flourishing communities according to his book Sociability. Meditation helps you to avoid rumination and to transform suffering. In meditation, the practice of present-moment awareness helps put space between emotion and reaction.


    Mindfulness is a path to become more aware of how you think. As you practice, you become more attuned to your emotional sensations and more equipped to catch yourself when your negative emotions take over.


    Another wisdom practice for building positive emotions is gratitude. Giving thanks for the things and the people who surround you (or maybe who you can’t wait to see) is shown to lift moods and counteract depression and negativity.

    How to Become More Positive

    If you are considering that Pollyanna may have had it right and that positive emotions might help you to cope or to thrive during this current pandemic, here are a few ways to cultivate optimism.

    1. Create a positive bedtime ritual. Think of a time where you felt a very strong positive emotion and replay that story in your head as you fall asleep. Think of telling the story to someone who wasn’t there by recreating the physical environment, the physical sensations behind the emotion, and the emotional word you would use to describe the event.
    2. Look for opportunities to have positive experiences. Even though we cannot go outside, we can look through yearbooks, spend time looking at the stars, or have a call with an old friend. Schedule time in your day to create experiences designed to provoke positive emotions.
    3. Notice and name the negative. When a negative emotion happens, notice the sensation, name the emotion, then move through it as quickly as possible.
    4. Keep hope close at hand. Hope is the one emotion that can flip a negative to a positive almost instantly.

    In the words of The Stress-Proof Brain author and neuroplasticity expert, Melanie Greenburg, “Positive emotions and mental states may make people more resilient to stress, like sturdy tree branches that bend but don’t break when battered by a storm.”

    Optimism and positivity do help, and they have a contagious effect that can spread despite social distancing.





  19. What Is the Best Self-Care during the COVID-19 Crisis?


    Self-care should be uppermost in our minds during the COVID-19 crisis, for several urgent reasons. Self-care returns a sense of control over your own life. It gives you an integrative approach to mind and body. It aligns you with the best knowledge currently available about who is more at risk for developing acute symptoms after being infected.

    Your immune status is complex, and in mainstream medicine, the chief determining factor is traditionally considered to be genetic. However, there are strong links to underlying low-level chronic inflammation connected to lifestyle that is found in most if not all common disorders including heart disease, type 2 diabetes, some cancers, and even obesity. COVID-19 has a mortality rate that increases with age and pre-existing conditions, as we all know by now.

    What is less publicised is that the hospitalisation rate, which is very high at over 15%, also affects younger age groups even though their death rates are lower. In those who are most susceptible, the virus creates an acute and severe form of inflammation referred to as a “cytokine storm”, which then leads to severe symptoms and respiratory damage, even death. Cytokines are the chief protein mediators of inflammation in the body.

    We can use this information about the dangers of having an elevated pre-existing state of low-level chronic inflammation to perhaps offset the possibility of the kind of acute inflammation that puts a person at risk for severe infection and hospitalisation. Let me emphasise the “perhaps” caution. The research on low-level chronic inflammation grows by the year and is very significant. You can go to many websites or our recent book “The Healing Self” to discover the kinds of foods and lifestyles that are either inflammatory or anti-inflammatory.

    But it is only in the field of integrative medicine that there is a cumulative understanding that anti-inflammation practices need to embrace mind and body. The general public, including mainstream doctors, are more often than not ill-informed of the research that connects meditation and yoga to the benefits of anti-stress, anti-inflammation, and anti-infection. Without a doubt, meditation and yoga have no side effects and are backed by decades of research over their benefits. To this has been added so-called “vagal breathing”, related to the ability of the vagus nerve to induce a relaxed state simply by doing regular deep breathing that equalises breathing in and breathing out (there are numerous websites providing instructions on this simple but effective technique, which is now a standard recommendation for countering stress).

    Biophysical anthropologist William C. Bushell points to the damage created by the body’s own immune defences. To quote a recent article at Medium.com by Maureen Seaberg, “Bushell says that inflammation is the primary way COVID-19 kills. ‘Spread of the virus through the body leads to widespread and intensive activation of the inflammatory defences throughout the body, though originally intended to combat the pathogen, but at this point instead resulting in widespread tissue damage, and fatally, to acute respiratory distress syndrome (ARDS), in which the lungs become flooded and respiratory failure ensues; the viral toxins themselves play a much lesser role in the tissue damage that ultimately can produce extreme critical disease states (pulmonary aspiration, septic shock), and potentially death.”

    The uncharted frontier is whether chronic inflammation, which is thought to be widely prevalent in our stress-filled, junk food eating, sleep-deprived society, increases the odds that the body might erupt into acute inflammation, e.g. a cytokine storm, when infected with viruses like COVID-19. One can think of this storm as a kind of over-reaction by our immune system. The big question is whether low-grade chronic inflammation may set the stage for this over-reaction and increase the odds of a “cytokine storm” in the presence of a nasty virus like COVID-19. Meanwhile, meditation, yoga, vagal breathing, and other relaxation techniques might provide an edge in the current crisis by reducing the chronic inflammatory state of the body. We’ve joined Bushell and other concerned figures, including Michelle Williams, S.D., Dean of Harvard’s School of Public Health, in advising that meditation and yoga (in addition to a healthy diet and ample sleep) be included in front-line efforts against COVID-19.

    The public is woefully uninformed about the mind-body benefits of these simple, effective measures, and every model of the pandemic foresees a huge overload on this country’s hospitals. The virus is more contagious and infectious than the flu, and it hospitalises and kills a much higher percentage of cases. The message about COVID-19 and inflammation is very important. It needs to be received by all of us for our common well-being at any time, but most urgently, now, we all must strive to reduce our base level of chronic inflammation.





  20. Blood Clots Are Another Dangerous COVID-19 Mystery

    Hooman Poor, MD, was tired of watching his patients die, and it looked like another was slipping away.

    She was on a ventilator, but it wasn’t helping. Oxygen wasn’t getting to her organs. Acid was building in her blood. Her body was in shock. Her kidneys were failing, but he couldn’t put her on dialysis. She was too sick and probably wouldn’t survive it.

    Poor, a pulmonologist and critical care specialist at Mount Sinai Hospital in New York City, was about to call her family to deliver the crushing news.

    As he studied her lab results, he noticed that like many other COVID-19 patients, she had high levels of protein pieces called D-dimers, which are left over when the body breaks up blood clots. Her body was desperately trying, but failing, to clear blood clots, Poor believed.

    A Medical Mystery
    Around the world, doctors caring for COVID-19 patients have been trying to make sense of the same thing. When they draw blood from COVID patients, it clots in the tubes. When nurses insert catheters for kidney dialysis and IV lines to draw blood, the tubes quickly become clogged with clots.

    “Patients are making clots all over the place,” says Adam Cuker, MD, a hematologist and associate professor of medicine at the Hospital of the University of Pennsylvania. “That’s making management of these patients very challenging.”

    In addition to the well-known breathing problems, blood clots are a significant danger for COVID-19 patients. Clots are causing patients with COVID to have heart attacks and strokes; form strange rashes on their skin; and get red, swollen wounds that look like frostbite on their fingers and toes. On autopsy, the small vessels of the lungs and bowels, liver, and kidneys of COVID patients are choked with clots.

    With his patient desperately ill, Poor suspected he had nothing to lose, so he punted.

    “This is screaming blood clots. Why don’t we try tPA and see if it works?” he said.

    He gave his patient a powerful clot-busting drug that’s normally used to treat strokes. It’s risky. If used improperly, it can cause uncontrolled bleeding, which can be deadly.

    Within 30 minutes of getting the drug, his patient showed signs of improvement. Her carbon dioxide levels dropped, and other signs linked to shock seemed to improve. She lived for about another week, before ultimately dying. Poor has tried the drug on other COVID-19 patients, too. It hasn’t helped them survive, but he feels like it has shown him something about the disease.

    “It did bring to light the possibility that blood clots are playing a bigger role in this disorder than we previously appreciated,” he says.

    Lessons from the Dead
    Sharon Fox, MD, PhD, agrees with him. She’s a pathologist at Louisiana State University Health in New Orleans and has been doing autopsies on patients who have died with COVID-19. She’s finished 20 cases so far, and they share something in common: They are riddled with blood clots in the smallest vessels of the body. Lungs seem to be especially hard-hit. There, clots appear to have cut off blood flow to the small air sacs where blood cells would be exchanging oxygen and carbon dioxide.

    “There’s no ability for the blood to flow through and exchange oxygen like it should,” she says.

    Fox says the pattern of damage is striking.

    “I’ve never had a series of cases like this, where they all look the same, and all of the lungs have a similar pattern. There are types of vascular injury at autopsy that I haven’t seen before. I would say it’s new,” she says.

    Dangerous blood clotting is always a risk for critically ill patients. That’s especially true for those who are immobilized and on mechanical ventilators, as patients with COVID-19 often are. But a recent French study, which compared 150 patients with COVID-related respiratory failure who were treated in intensive care units to 145 patients who had respiratory failure, but were not infected with the new coronavirus, found significantly higher rates of blood clotting in the COVID patients.

    “We still need more controlled data, but based on clinical observations and the few studies that have been published, it looks like thrombosis [blood clotting] is more common in these patients,” Cuker says.

    Why blood congeals the way it does in some COVID patients is still an open question.

    One theory is that the body launches an immune attack called a cytokine storm to fight the virus that becomes self-directed, causing cells to kill themselves in an attempt to shut down the infection. Doctors believe that for some patients, the immune attack can end up doing the body more damage than the virus itself. This hyper-inflamed state is itself a well-known risk for blood clots. Cytokine storms can cause a condition called disseminated intravascular coagulation, or DIC, where patients both bleed uncontrollably and clot too much at the same time.

    Another possibility is that the virus may more directly cause the clotting.

    New Insights into ‘Why’
    A research letter published this week in The Lancet reported evidence of viral bodies of the new coronavirus invading endothelial cells. The endothelium is the lining of our blood vessels. It directs important functions of the vascular system like clotting and swelling.

    Images captured with an electron microscope found traces of the coronavirus in endothelial cells in the heart, kidney, small bowel, and lung -- pretty much all over the body. Researchers collected the tissues during autopsies of three patients who died of COVID-19.

    Study co-author Mandeep Mehra, MD, medical director of the Brigham and Women’s Heart and Vascular Centre in Boston, says the findings suggest that the virus can directly infect the endothelium. He says that while COVID-19 can certainly cause breathing problems, he doesn’t think it’s just a lung disease.

    “This is actually a disease of the endothelium,” he says.

    Mehra says the infection starts in the lungs because breathing is the easiest way for the virus to enter the body. Once it infects the lung cells and begins to destroy them, it travels into the bloodstream. There, it infects endothelial cells, causing endotheliitis.

    Mehra thinks this endotheliitis comes from not only the direct infection of the blood vessel cells, but also from the haywire cytokine storm that the body launches to fight it off. “We’ve shown evidence of both.”

    He says this theory of infection explains some things that doctors have been trying to puzzle out.

    For example, certain conditions like high blood pressure, diabetes, and heart disease stress the endothelium. It’s no surprise, then, that people who have these conditions are also the ones who get the sickest when they catch COVID-19.

    It also helps to explain why patients have such low oxygen in their blood, but their lungs may not be as stiff as they typically are in patients who have respiratory distress with pneumonia.

    Mehra explains that one consequence of endotheliitis is that blood vessels can’t constrict the way they normally would. Typically, when a part of the lung becomes damaged, tiny blood vessels in that area close off so that blood will flow to a part of the lung that’s still working, where it can collect oxygen. This system protects the body from a sudden drop in oxygen, and it appears to break down in patients with severe COVID-19 infections. Mehra believes the infection of the endothelium is to blame.

    The bottom line, he says, is that clotting is a feature of the COVID-19 syndrome. When it becomes a big problem, the disease is advanced and very severe. For that reason, treating the resulting blood clots probably won’t work.

    He believes something worth trying might be to give patients drugs to support the endothelium, like ACE inhibitors and statins, along with anti-inflammatory drugs to tackle the cytokine storm, early in the course of the disease, but more research is needed to know for sure.

    If COVID-19 is really an endothelial infection, Mehra thinks that also helps to explain why ventilators aren’t helping more patients. A study of 5,700 patients hospitalized with COVID-19 in New York City found that while just 12% needed a ventilator to help them breathe, 88% of those patients died.

    “It’s not acting like influenza or other bacteria pneumonia where you get inflammation in the lungs and fluid buildup and very stiff lungs. That doesn’t seem to be the case, at least early on,” Poor says.

    “The virus is acting as if its primary target is the endothelium,” he says.

    That means the clots are just part of a much larger problem, one Poor says doctors don’t yet know how to solve.






  21. COVID-19 May Mimic Heart Attack Signs in Some


    Eighteen patients with severe COVID-19 treated at a New York City hospital showed the classic signs of a heart attack on their electrocardiograms.

    But a closer look at each case revealed that more than half of these patients didn't have a blockage in a major artery, the typical trigger of a heart attack. Thirteen of the 18 patients died of cardiac causes while in the hospital, said a team from the New York University Grossman School of Medicine.

    These findings, published April 17 in the New England Journal of Medicine, suggest that there's something about the stress of severe COVID-19 that may be harming the heart in atypical ways, said one cardiologist who wasn't involved in the report.

    "As we continue to learn about the impact COVID-19 has to our heart, we have begun to identify unique and unusual effects," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital, also in New York City. "Some patients present with abnormal EKGs, which can classically look as an acute heart attack, but without a true finding of a blocked artery."

    The real underlying cause for some cardiac deaths in these patients may be the stress, physical and otherwise, caused by COVID-19, Bhusri theorized.

    "This disparity is also seen in stress-induced heart disease, otherwise known as broken heart syndrome," he noted.

    The new report was led by Dr. Sripal Bangalore, a professor of medicine at NYU Langone Health. His team looked at the cases of 18 patients admitted with COVID-19 whose EKG readings indicated they had experienced a heart attack.

    The EKGs displayed a classic "elevated ST segment" reading that's indicative of heart attack, the doctors said. Ten patients displayed ST elevation at the time they were admitted to hospital, while eight others showed it during their hospital stay.

    However, based on coronary angiography scans and/or cath-lab investigations, 10 of the patients (56%) were found to have "non-coronary myocardial injury," Bangalore said. In layman's terms, that means a heart attack that was not caused by a blockage in an artery.

    So what might have caused the fatal or near-fatal heart injuries experienced by those 10 patients? It's not clear, but Bangalore's team said COVID-19 might injure the heart through a range of causes, including a rupturing of plaques in blood vessels, injury due to poor oxygenation, coronary spasm, tiny clots undetected by angiograms or more "direct" injury to vascular tissues.

    "This case series highlights the complexity in caring for patients with COVID-19 who have EKG changes suggestive of a heart attack," Bangalore noted.

    That's because using the standard heart treatment -- clot-busting drugs -- may sometimes be useless in these patients, as "half of them may not have major blockages," he explained.

    "Overall, the in-hospital death rate for these patients is very high and we urgently need studies to figure out how to best care for them," Bangalore said.

    Dr. Guy Mintz directs cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. Reading over the new report, he noted that the patients were "relatively young, with a median age of 63 years." The group had traditional heart risk factors: Two-thirds had high blood pressure, one-third had diabetes and 40% had high cholesterol.

    Mintz noted that similar findings were observed for Chinese COVID-19 patients who experienced heart crises during their care at hospitals in Wuhan, the original epicenter of the pandemic.

    Besides the formation of dangerous clots, severe COVID-19 "also stimulates the inflammatory system causing a cytokine storm -- an out-of-control inflammatory response to infection -- which can lead to more organ damage, whether it's the heart, lungs or kidneys," Mintz explained.




  22. How The COVID-19 Pandemic Will Change the Way We Live

    Large-scale social and behavioural changes — only some of which we can begin to predict — will follow the global catastrophe.

     The tsunami-like impact of a global pandemic has a way of drowning out foresight. Right now, it feels impossible to predict what the world will look like next week, let alone next year. Yet behavioural science and the broad sweep of history suggest that COVID-19 will transform our daily lives in the long run.

    The changes in progress — some predictable, others still hard to fathom — started brewing as soon as case counts began to escalate. An ongoing University of Southern California study published its first round of results in March, reporting that the coronavirus had already created significant shifts in people’s behaviour. Among the top findings: 85 percent of people reported washing their hands or using sanitizer more often than before, and 61 percent reported following social distancing guidelines. Twenty-two percent reported stockpiling essentials like food or water.

    Behavioural changes like these may be fear-driven to some extent, says Yale School of Medicine health psychologist Valeria Martinez-Kaigi, who is not affiliated with the study. Large numbers of respondents reported bracing for the possibility that they would lose their jobs or contract the virus. However, “fear-based behaviour modification is not proven to be sustainable,” Martinez-Kaigi says. After the initial coronavirus threat has passed, she predicts, new habits like hand washing, isolating and hoarding will scale back considerably.

    But that doesn’t mean they’ll disappear altogether. Survivors of collectively traumatic events tend to be especially vigilant in situations that burned them in the past. When people are forced to react to a deadly virus running rampant, they may be especially keen to keep future viruses at bay.

    Lessons from the Past

    The 1918 influenza pandemic, which killed about 675,000 people in the U.S., bent the arc of hygiene in lasting ways. In the following years, signs bearing the message “Spitting is Unlawful” sprouted up in places like train stations. Covering your cough grew to be considered common courtesy — before the pandemic, this etiquette was almost unheard of.

    In the wake of COVID-19, certain habits we’ve adapted will likely stick around as well, says Kate White, a behavioural scientist at the University of British Columbia. “Our vigilance around things like disinfecting surfaces — that’s probably going to continue,” she says.

    Our new ways of interacting with each other — “live long and prosper” salutes instead of handshakes, video chats instead of conference-room huddles — are also likely to stick to some degree. The old social norm is, “you meet someone, you automatically shake hands. Those social exchanges are going to evolve,” White says. “When you’re having meetings for work, people are going to start asking, ‘Do we have to meet in person?’ which is not something we would say before.”

    But what lingers most after a pandemic, or any large-scale catastrophe, is a pervasive sense that the world is fundamentally unpredictable — that life feels more fragile than it once did. The prospect theory of behaviour, popular among behavioural scientists and economists, states that we often give more weight to potential losses than gains in making a decision, and that we tend to overestimate the chances of an unlikely event like dying of a certain disease. Following a disaster, the tendency to believe that a threat is imminent may be magnified in some people.

    Those with more obsessive personalities, White says, might become hyper-avoidant in an attempt to construct a smaller, safer world for themselves. “Maybe they won’t go to certain social events. Maybe they won’t want to take the bus anymore.”

    Shifting Priorities

    A watershed event like this might also reorient broader attitudes about how the government should address public health issues. “If there’s anything that could underscore the interdependence, we all have, it’s this situation,” says Cornell University political scientist Suzanne Mettler.

    It’s possible, Mettler says, that our new embrace of this interdependence could drive us to demand a more supportive social safety net. If hundreds of thousands of Americans do die of COVID-19, and if people decide better health coverage could have prevented many of these deaths, a universal health care system might seem like an urgent necessity to more residents, she notes.

    Past pandemics have ushered in dramatic governmental shifts on this level. After British colonial authorities failed to protect India from the worst of the 1918 flu pandemic, the population’s fury helped fuel the Indian independence movement led by Mahatma Gandhi. It’s possible that fighting the coronavirus will inspire this kind of unity-seeking in the U.S. and elsewhere. “One would assume a pandemic would be something that could do that,” Mettler says. “This is, in many ways, like fighting a war. The enemy is the disease.”

    Mettler cautions that even in the wake of a pandemic, it will be difficult to dislodge the extreme polarization and mistrust that has divided Americans for years. White, however, sees the potential for some degree of post-pandemic solidarity, even if our philosophical differences persist. “People are appreciating that if we all act at the same time, we can see big changes,” she says.




  23. Is 2 metres enough for social distancing?

    MIT researcher says droplets carrying coronavirus can travel up to 8 metres

    The novel coronavirus has prompted social distancing measures around the world. One researcher believes what's being done isn't enough

    Lydia Bourouiba, an associate professor at MIT, has researched the dynamics of exhalations (coughs and sneezes, for instance) for years at The Fluid Dynamics of Disease Transmission Laboratory and found exhalations cause gaseous clouds that can travel up to 27 feet (8.2 meters).

    Her research could have implications for the global COVID-19 pandemic, though measures called for by the Centres for Disease Control and Prevention and the World Health Organisation call for six and three feet (0.9 m and 1.8 m) of space, respectively.

    "There's an urgency in revising the guidelines currently being given by the WHO and the CDC on the needs for protective equipment, particularly for the frontline health care workers," Bourouiba told U.S. TODAY.

    Bourouiba's research calls for better measures to protect health care workers and, potentially, more distance from infected people who are coughing or sneezing. She said current guidelines are based on "large droplets" as the method of transmission for the virus and the idea that those large droplets can only go a certain distance.

    In a Journal of the American Medical Association article published last week, Bourouiba said peak exhalation speeds can reach 33 to 100 feet per second (36 km/h and 110 km/h) and "currently used surgical and N95 masks are not tested for these potential characteristics of respiratory emissions."

    The idea that droplets "hit a virtual wall and stop there and after that we are safe," is not based on evidence found in her research, Bourouiba said, and also not based on "evidence that we have about COVID transmission."

    Bourouiba argued that a "gaseous cloud" that can carry droplets of all sizes is emitted when a person coughs, sneezes or otherwise exhales. The cloud is only partially mitigated by sneezing or coughing into your elbow, she added.

    "In terms of the fluid regime—how the exhalations are emitted—the key point that we have shown is that there's a gaseous cloud that carries droplets of all sorts of sizes, not 'large' versus 'small' or 'droplets' versus 'aerosols,'" she said.

    Dr. Paul Pottinger, an infectious disease professor at the University of Washington School of Medicine, said questions remain about the distances at which the virus is effective.

    "For me, the question is not how far the germs can travel, but how far can they travel before they're no longer a threat. The smaller the germ particles, the lower the risk that they might infect somebody who would breathe them in or get them stuck in their nose or their mouth," Pottinger told U.S. TODAY.

    "The biggest threat—we think—with the coronavirus is actually the larger droplets. Droplets of saliva, snot, spit. Droplets that almost look like rain, if you will, when someone sneezes. Those droplets are large enough that gravity still acts on them. Usually, within about six feet of leaving somebody's body, those larger, more infectious droplets will drop to the ground. That's where the six-foot rule comes from."

    WHO referred to a recent scientific brief on the methods of transmission, which recommended "droplet and contact precautions for those people caring for COVID-19 patients." The CDC did not respond to an emailed request for comment.

    "WHO carefully monitors emerging evidence about this critical topic and will update this scientific brief as more information becomes available," WHO said in a statement. "WHO welcomes modelling studies, which are helpful for planning purposes. WHO teams work with several modelling groups to inform our work."

    If the coronavirus were effective at ranges of up to 27 feet (8.2 meters), as Bourouiba contends in her research, Pottinger said he believes more people would be sick.

    "It takes a certain number of viral particles, we call them 'virions,' or individual viruses, it takes a certain number of individual viruses to actually get a foothold inside the body and cause that infection to get going," he said.

    "Now, we don't know exactly what that number is, but it's probably more than a single virus. If you think about it, if this really travelled very efficiently by air, we wouldn't be having this conversation. Everybody would know it's true because everybody would be infected. If it was a 27-foot radius that was a high risk to somebody, this would be a totally different conversation. It's not."

    Bourouiba said she wants to see recommendations made based on current science not "policies based on supply, for example, because we don't have enough PPE (personal protective equipment)." It's well-known PPE is in short supply nationwide and health care workers have been desperately trying to find effective ways to deal with shortages.

    "Although there remains a lot of questions to be addressed about how much virus is at a given distance or not, we have no answer one way or another at this time," she said. "Therefore, the precautionary principle should drive the policies to state that we should have high-grade respirators used for health care workers."

    "Once that's decided, that's the thrust that's needed to now mobilise most effectively the kind of tremendous high production level that is possible to reach in a great country like the United States. This thrust is not happening."





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