Tuesday, June 30, 2020
F E E D I N G. T H E. P R O T E C T O R S !
Over the past months we have all witnessed the reaction of decent people all over the country to shameful criminal actions of some rogue cops.
However, the overwhelming majority are the good cops protecting us 24/7/365 that are being tainted by actions of the few "bad apples" that will be punished for their crimes.
In support of all good ones, I have started the "Feed a Cop" movement in July of 2019 to replace, then the horrible, trend of pooring water on cops, or God forbid, shooting at them.
So far, we gave out dozens of In&Out Burger, Home Depot, Cheesecake Factory, and Burger King gift cards to CHP, LASD, LAPD and Santa Monica PD officers. Currently, reaching out to Oxnard PD, and Ventura County Sheriff.
It is, in my mind, the best way to thank them for keeping us safe in a practical manner.
We strongly believe that supporting the good cops, while punishing the bad ones, contributes to meaningful changes in our society.
Please join us!
Posted by Dr.Dorodny at 11:48
Monday, June 15, 2020
|Dear Doctor DORODNY,
|In adults with heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF) with or without type 2 diabetes, FARXIGA is now indicated to reduce the risk of cardiovascular death and hospitalization for heart failure.
|With this new indication, FARXIGA is the FIRST and ONLY SGLT2i with FDA approvals across the heart failure risk continuum1-4:
|Of course, FARXIGA is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. But for your patients with type 2 diabetes and multiple cardiovascular risk factors or eCVD, it’s important to consider the role that early treatment with FARXIGA TODAY may play in helping reduce the risk of hospitalization for heart failure TOMORROW.
|FARXIGA is not recommended for patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.
|eCVD=established cardiovascular disease; FDA=US Food and Drug Administration; NYHA=New York Heart Association; SGLT2i=sodium-glucose cotransporter 2 inhibitor.
Posted by Dr.Dorodny at 13:14
JUNE 15, 2020
Brain and pulmonary post-mortem findings in a series of COVID-19 cases
By Denise Baez
NEW YORK -- June 15, 2020 -- Post-mortem brain and pulmonary findings from patients with coronavirus disease 2019 (COVID-2019) have been detailed in 2 separate case studies.
The first case series, published in The New England Journal of Medicine, showed hypoxic-ischaemic changes, but no encephalitis, meningitis, strokes, or changes in olfactory bulbs or tracts in the brains of 18 consecutive patients who died up to 32 days after the onset of symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.
“Autopsies were performed in a uniform manner with sampling of 10 standard brain areas,” reported Isaac H. Solomon, MD, Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues. “Gross inspection showed atherosclerosis in 14 brain specimens but no acute stroke, herniation, or olfactory bulb damage. Microscopic examination showed acute hypoxic injury in the cerebrum and cerebellum in all the patients, with loss of neurons in the cerebral cortex, hippocampus, and cerebellar Purkinje cell layer, but no thrombi or vasculitis. No microscopic abnormalities were observed in the olfactory bulbs or tracts.”
All patients had been treated for COVID-19 at Brigham and Women’s Hospital between April 14 and April 29, 2020. Most (78%) of the patients were male and the median age of all patients was 62 years. The patients had presented a median of 2 days after the onset of symptoms and were hospitalised for a median of 6 days before death. According to a retrospective chart review by neurologists, all patients had a confused state or decreased arousal from sedation for ventilation (61% received mechanical ventilation).
Testing of brain tissue was performed with quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) for the SARS-CoV-2 nucleocapsid protein, and immunohistochemical analysis was performed to detect SARS-CoV-2 in the same tissue blocks analysed by qRT-PCR.
“The virus was detected at low levels in 6 brain sections obtained from 5 patients; these levels were not consistently related to the interval from the onset of symptoms to death,” the authors reported. “Positive tests may have been due to in situ virions or viral RNA from blood. There was no staining in the neurons, glia, endothelium, or immune cells. Nonspecific staining in the choroid plexus was observed in 8 sections obtained from 7 patients; however, this signal was present in negative control brains and did not correlate with the qRT-PCR results.”
The next case series, published in The Lancet Infectious Diseases, showed that the predominant pattern of lung lesions in patients with COVID-19 patients was diffuse alveolar damage.
Luca Carsana, Papa Giovanni XXIII Hospital, Bergamo, Italy, and colleagues analysed lung tissue samples from 38 patients who died from COVID-19 in 2 hospitals in northern Italy between February 29, 2020, and March 24, 2020.
“To our knowledge, these data represent the first relevant provisional information regarding tissue damage specifically induced by SARS-CoV-2, besides the previously described diffuse alveolar damage, a feature that characterises interstitial pneumonia regardless of infectious agent,” the authors wrote.
A median of 7 tissue blocks were taken from each lung, selecting the most representative areas identified at macroscopic examination. To better characterise the inflammatory infiltrate, immunohistochemical staining was done on the most representative areas of randomly selected cases for inflammatory infiltrate and cellular components, including staining with antibodies against CD68, CD3, CD45, CD61, TTF1, p40, and Ki-67.
Upon macroscopic examination, the lungs of all patients were heavy, congested, and oedematous, with patchy involvement. In all cases, histological examination revealed features corresponding to the exudative and early or intermediate proliferative phases of diffuse alveolar damage, which included capillary congestion (in all cases), necrosis of pneumocytes (in all cases), hyaline membranes (in 33 cases), interstitial and intra-alveolar oedema (in 37 cases), type 2 pneumocyte hyperplasia (in all cases), squamous metaplasia with atypia (in 21 cases), and platelet-fibrin thrombi (in 33 cases).
“Hyaline membrane formation and pneumocyte atypical hyperplasia are frequent,” the authors wrote. “Importantly, the presence of platelet-fibrin thrombi in small arterial vessels is consistent with coagulopathy, which appears to be common in patients with COVID-19 and should be one of the main targets of therapy.”
The patients had a mean age of 69 years and most (87%) were male. Time spent in the intensive care unit or intermediate medical ward ranged from 1 day to 23 days. At the time of hospitalisation, all patients had clinical and radiological features of interstitial pneumonia. Of the 26 patients with available D-dimer results, all had high values (>10 × the upper reference limit). Mean time from symptom onset to death was 16 days.
SOURCE: The New England Journal of Medicine and The Lancet Infectious Diseases
Posted by Dr.Dorodny at 12:30