Archive | April 2020

QUOTE FOR THURSDAY:

“Cerebrum: is the largest part of the brain and is composed of right and left hemispheres. It performs higher functions like interpreting touch, vision and hearing, as well as speech, reasoning, emotions, learning, and fine control of movement.”
 
Mayfield Clinic (mayfieldclinic.com)

QUOTE FOR WEDNESDAY:

“You can become infected by coming into close contact (about 6 feet or twoarm lengths) with a person who has COVID-19. COVID-19 is primarily spreadfrom person to person.• You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks.• You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.”

cdc.gov

” A number of environmental factors influence the spread of communicable diseases that are prone to cause epidemics. The most important of these are:

water supply
sanitation facilities
food
climate.

A lack of safe water, inadequate excreta disposal facilities, poor hygiene, poor living conditions and unsafe food can all cause diarrhoeal diseases. These diseases are a major cause of suffering and death in an emergency situation.”

WHO World Health Organization  https://www.who.int/www.who.int

Environmental Risk Factors that affect certains areas in US with highier count of COVID!

Global coronavirus epidemic outbreak concept – 3D illustration

                     

“What you get is the initial damage and rush of inflammatory cells, but the damage is so extensive that the body’s immune response is completely overwhelmed — which causes even more immune response, more immune cells and more damage,” said Matthew Frieman, a virologist at the University of Maryland School of Medicine.

PMC U.S. National Library of Medicine/National Institutes of Health states, “Inflammation is a biological response of the immune system that can be triggered by a variety of factors, including pathogens, damaged cells and toxic compounds. These factors may induce acute and/or chronic inflammatory responses in the heart, pancreas, liver, kidney, lung, brain, intestinal tract and reproductive system, potentially leading to tissue damage or disease.

With infection, the virus probably begins to multiply inside cells lining the airway, which are fringed with hairlike structures. Coronaviruses that cause common colds are excellent at infecting the upper airway, while SARS tended to go deeper in the lungs. As the coronavirus gains strength, Frieman said, dead cells are sloughed off and collect in the airway, making breathing difficult.

Inflammation is the immune system’s response to harmful stimuli, such as pathogens, damaged cells, toxic compounds, or irradiation [], and acts by removing injurious stimuli and initiating the healing process []. Inflammation is therefore a defense mechanism that is vital to health []. Usually, during acute inflammatory responses, cellular and molecular events and interactions efficiently minimize impending injury or infection. This mitigation process contributes to restoration of tissue homeostasis and resolution of the acute inflammation. However, uncontrolled acute inflammation may become chronic, contributing to a variety of chronic inflammatory diseases [].

At the tissue level, inflammation is characterized by redness, swelling, heat, pain, and loss of tissue function, which result from local immune, vascular and inflammatory cell responses to infection or injury []. Important microcirculatory events that occur during the inflammatory process include vascular permeability changes, leukocyte recruitment and accumulation, and inflammatory mediator release [, ].

Various pathogenic factors, such as infection, tissue injury, or cardiac infarction, can induce inflammation by causing tissue damage. The etiologies of inflammation can be infectious or non-infectious (Table (Table1).1). In response to tissue injury, the body initiates a chemical signaling cascade that stimulates responses aimed at healing affected tissues. These signals activate leukocyte chemotaxis from the general circulation to sites of damage. These activated leukocytes produce cytokines that induce inflammatory responses [].

The inflammatory response is the coordinate activation of signaling pathways that regulate inflammatory mediator levels in resident tissue cells and inflammatory cells recruited from the blood []. Inflammation is a common pathogenesis of many chronic diseases, including cardiovascular and bowel diseases, diabetes, arthritis, and cancer []. Although inflammatory response processes depend on the precise nature of the initial stimulus and its location in the body, they all share a common mechanism, which can be summarized as follows: 1) cell surface pattern receptors recognize detrimental stimuli; 2) inflammatory pathways are activated; 3) inflammatory markers are released; and 4) inflammatory cells are recruited.”

This is why you see constant commercials stating to stay home especially if you have HEALTH RISK FACTORS like lung disease, diabetes, low immunity, and heart disease/high B/P.  Including obesity. that put you at highier risk in getting or fighting off COVID-19.  The homeless and the older age (60 years old and up) to find it harder to fight off especially with disease present.  It’s like a car in that the longer you have the car the more wear and tear on the car well the same with the body for elderly and homeless.  The older the patient the harder it is to fight the disease.  So there are factors that involve bad turn outs for patients with Covid-19 virus that can go to lung damage to death.

Through worldometer.info as of this past Weekend 976,176 cases of corona virus in the USA.  Close to one million cases and where is the worst cases NY being in NYC and NJ (there next door neighbor).  NY cases are 293,354 with total deaths 22,275

Through nyc.gov in NYC Total cases are 153,204, Hospitalized cases are  39, 635 Confirmed Deaths 11,460 Probable Deaths 5213

Through MSNBC/NBC/John’s Hopkins as of this past Weekend at 1126 they show:

WORLDWIDE CASES OF CORONA CONFIRMED CASES:   2,989,493

Total America Confirmed Cases:  974,500

Worldwide with most confirmed cases:

United States:   974, 500   Spain:  226,629

Italy:  197, 675 France:  162, 220 Germany:  167, 770

Cases in America:

New York:  294, 491        New Jersey: 109, 038  

Massachusetts: 54, 938  Illinois:  43, 903   California: 43, 672

(source of counts is John Hopkins/NBC NEWS this past weekend)

New York City: cases 153, 204 as of this past weekend (Source is https://projects.thecity.nyc/2020 at 1708)

New York City: cases 158, 000 (Source from 2hrs ago by wikipedia, time at the end of this past weekend)

Why is NYC over 1/2 the cases of America as of today at 1100 this past Monday?  You need to look at the environmental risk factors with the pt’s health status that all play roles with all diseases or infections to fight off.

Size of NYC – of the 5 bureau cities only covers 321 square miles, over 205,000 acres.

Population The population of people in NYC are 8.399 million not including illegals .

One of the Dirtiest City in America –  NYC (within the top 10) who has the highest count of Corona Virus in America.

The top five cities in the US by population density (in order) were New York City, San Francisco, Boston, Miami, and Chicago — but the dirtiest cities (in order) were:

  1. New York City
  2. Los Angeles
  3. TIE: Chicago (for litter), Houston (for pests)
  4. TIE: Philadelphia (for litter), Miami (for pests)
  5. TIE: San Francisco (for litter), Atlanta (for pests)

Resource: apartment therapy (apartmenttherapy.com)

“This is the harsh, lung-searing, rash-inducing reality for millions of people in some of America’s biggest cities. Is your town on the list? (Pictured is the Gowanus Canal Superfund site in Brooklyn, New York.) For an explanation of how the rankings were done, click on the article link above.”

Resource: FORBES

Sanctuary City –  Acknowledging both sides of the issue,  Leaders of sanctuary cities say they want to reduce fear of deportation and possible family break-up among people who are in the city illegally, but the otherside is this can definitely put a city at a potential risk for disease.  Why? they live in low economical environment, for the majority.

Low income groups in the city.  This means that in New York City income of $68,720 for a family of four is considered to be low income.   (Resource: https://www.povertycenter.columbia.edu/poverty-disadvantage-in-new-york-city).   Putting the math together these families are not living in Pent houses or a house but a small apt. for the majority and in a poor economic area unfortunately.

About 1.7 million New Yorkers lived below the poverty line in 2011-2015. This number is larger than the population of Philadelphia or Phoenix, and would be the country’s 7th largest city if ranked separately. The overall poverty rate in New York City has remained relatively steady since 1980, hovering at around 20%.  Living in a poverty line effects health anywhere especially over a million people.  You have homeless in the streets.

Homes – primarily apartments and small. Since the cities started with buildings and this was primarily the homes and in most cities. which is the case.

Subways & Buses – a major way of transportation in NYC.  Standing right next to each other made it easier to catch COVID19.  Your not living in a area of transportation that isn’t driving by yourself or 6 feet apart from each other on average and in general your on top of each other during work hours in buses on subways.

Two international airports – J.F.K. and La Guardia.  Traveling in and out of America all over the world including China.  Airports are in the top 10 areas to easily pickup infections.

Pollution in NYC – in 1oth place the worst pollution by Yahoo Finance (the 7 of the 9 before it where all in California).  By Environment & Science blog it states NYC is #10 (https://www.scpr.org).  New York-Newark-Jersey City, NY-NJ-PA is documented as one of the worst air pollution areas in America by USA Today.  Must I go on.

See the pattern why NYC is highest with Covid19 virus? 

There are numerous factors putting NYC at risk for where they are in count of Covid19 unfortunately and Governor Cuomo also pointed out this past Monday .  “we need to learn and act on this pandemic to be better prepared for the next one.” and he gave examples in American history has gone through disasters before from Great Chicago Fire, Depression, and others which made our nation stronger.

Know this America had worse pandemics and we got through them and we will with this pandemic Corona Virus!

QUOTE FOR WEDNESDAY:

“You can become infected by coming into close contact (about 6 feet or twoarm lengths) with a person who has COVID-19. COVID-19 is primarily spreadfrom person to person.• You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks.• You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.”
 
cdc.gov

“Environmental Risk Factors factors that affect certain areas in US with highier count of COVID-19!”

Global coronavirus epidemic outbreak concept – 3D illustration

                     

“What you get is the initial damage and rush of inflammatory cells, but the damage is so extensive that the body’s immune response is completely overwhelmed — which causes even more immune response, more immune cells and more damage,” said Matthew Frieman, a virologist at the University of Maryland School of Medicine.

PMC U.S. National Library of Medicine/National Institutes of Health states, “Inflammation is a biological response of the immune system that can be triggered by a variety of factors, including pathogens, damaged cells and toxic compounds. These factors may induce acute and/or chronic inflammatory responses in the heart, pancreas, liver, kidney, lung, brain, intestinal tract and reproductive system, potentially leading to tissue damage or disease.

With infection, the virus probably begins to multiply inside cells lining the airway, which are fringed with hairlike structures. Coronaviruses that cause common colds are excellent at infecting the upper airway, while SARS tended to go deeper in the lungs. As the coronavirus gains strength, Frieman said, dead cells are sloughed off and collect in the airway, making breathing difficult.

Inflammation is the immune system’s response to harmful stimuli, such as pathogens, damaged cells, toxic compounds, or irradiation [], and acts by removing injurious stimuli and initiating the healing process []. Inflammation is therefore a defense mechanism that is vital to health []. Usually, during acute inflammatory responses, cellular and molecular events and interactions efficiently minimize impending injury or infection. This mitigation process contributes to restoration of tissue homeostasis and resolution of the acute inflammation. However, uncontrolled acute inflammation may become chronic, contributing to a variety of chronic inflammatory diseases [].

At the tissue level, inflammation is characterized by redness, swelling, heat, pain, and loss of tissue function, which result from local immune, vascular and inflammatory cell responses to infection or injury []. Important microcirculatory events that occur during the inflammatory process include vascular permeability changes, leukocyte recruitment and accumulation, and inflammatory mediator release [, ].

Various pathogenic factors, such as infection, tissue injury, or cardiac infarction, can induce inflammation by causing tissue damage. The etiologies of inflammation can be infectious or non-infectious (Table (Table1).1). In response to tissue injury, the body initiates a chemical signaling cascade that stimulates responses aimed at healing affected tissues. These signals activate leukocyte chemotaxis from the general circulation to sites of damage. These activated leukocytes produce cytokines that induce inflammatory responses [].

The inflammatory response is the coordinate activation of signaling pathways that regulate inflammatory mediator levels in resident tissue cells and inflammatory cells recruited from the blood []. Inflammation is a common pathogenesis of many chronic diseases, including cardiovascular and bowel diseases, diabetes, arthritis, and cancer []. Although inflammatory response processes depend on the precise nature of the initial stimulus and its location in the body, they all share a common mechanism, which can be summarized as follows: 1) cell surface pattern receptors recognize detrimental stimuli; 2) inflammatory pathways are activated; 3) inflammatory markers are released; and 4) inflammatory cells are recruited.”

This is why you see constant commercials stating to stay home especially if you have lung disease, diabetes, low immunity, and heart disease/high B/P.  Including obesity.  homeless, and the older age (60 years old and up).  It’s like a car in that the longer you have the car the more wear and tear on the car well the same with the body for elderly and homeless.  The older the patient the harder it is to fight the disease.  So there are factors that involve bad turn outs for patients with Covid-19 virus that can go to lung damage to death.

Through worldometer.info as of this past Monday 976,176 cases of corona virus in the USA.  Close to one million cases and where is the worst cases NY being in NYC and NJ (there next door neighbor).  NY cases are 293,354 with total deaths 22,275

Through nyc.gov in NYC Total cases are 153,204, Hospitalized cases are  39, 635 Confirmed Deaths 11,460 Probable Deaths 5213

Through MSNBC/NBC/John’s Hopkins today at 1126 they show:

WORLDWIDE CASES OF CORONA CONFIRMED CASES:   2,989,493

Total America Confirmed Cases:  974,500

Worldwide with most confirmed cases:

United States:   974, 500   Spain:  226,629

Italy:  197, 675 France:  162, 220 Germany:  167, 770

Cases in America:

New York:  294, 491        New Jersey: 109, 038  

Massachusetts: 54, 938  Illinois:  43, 903   California: 43, 672

(source of counts is John Hopkins/NBC NEWS April 27th 2020)

New York City: cases 153, 204 as of 4/26/2020 (Source is https://projects.thecity.nyc/2020 at 1708)

New York City: cases 158, 000 (Source from 2hrs ago by wikipedia, time 4/27/ 2020 is 1130)

Why is NYC over 1/2 the cases of America as of today at 1100?

Size of NYC – of the 5 bureau cities only covers 321 square miles, over 205,000 acres.

Population The population of people in NYC are 8.399 million not including illegals .

Dirtiest City in America –  NYC

Sanctuary City –  Leaders of sanctuary cities say they want to reduce fear of deportation and possible family break-up among people who are in the city illegally, this can definitely put a city at a potential risk for disease.

Low income groups in the city.  This means that in New York City income of $68,720 for a family of four is considered to be low income.   (https://www.povertycenter.columbia.edu/poverty-disadvantage-in-new-york-city)

About 1.7 million New Yorkers lived below the poverty line in 2011-2015. This number is larger than the population of Philadelphia or Phoenix, and would be the country’s 7th largest city if ranked separately. The overall poverty rate in New York City has remained relatively steady since 1980, hovering at around 20%.

Homes – primarily apartments and small.

Subways & Buses – a major way of transportation in NYC.  Standing right next to each other.

Two international airports – J.F.K. and La Guardia.  Traveling in and out of America all over the world including China.  In Manhattan there’s China town as well.

Pollution in NYC – in 1oth place the worst pollution by Yahoo Finance (the 7 of the 9 before it where all in California).

See the pattern why NYC is highest with Covid19 virus? 

There are numerous factors putting NYC at risk for where they are in count of Covid19 unfortunately and hopefully both Governor Cuomo and Mayor Deblasio will follow what Governor Cuomo stated this morning between 1100 – 1130 on MSNBC that we need to look at this disaster and learn from it to allow us to be better prepared for when this type of a disaster occurs again since NYS, NYC and of course other states were not.  Governor Cuomo also pointed out examples in American history has gone through disasters before from Great Chicago Fire, Depression, and others which made our nation stronger.

 

 

 

 

QUOTE FOR TUESDAY:

A widowmaker heart attack occurs when the left anterior descending (LAD) artery, which supplies blood to the larger, front part of the heart, is blocked at its origin. “This artery delivers a major amount of blood to your heart,” Dr. Abdallah explains.”

Cleveland Clinic

What is the Black Widow?

When it comes to the heart, time is critical. Blood carries oxygen to the body. When blood flow is blocked, cells can die. The more time that passes before treatment, the bigger the risk of death.

A complete blockage in the main artery that feeds the front and side walls of the heart and the septum, a muscular boundary between the left and right chambers.

“That’s a big deal” ,says Dr. Todd Caulfield, the Providence interventional cardiologist who operates on patient’s like this. “People call this the widow maker.”, he states.  Nationwide about 300,000 people suffer cardiac arrest outside a hospital every year, according to the federal Centers for Disease Control and Prevention. Only 8 percent survive.

The heart pumps blood to the body and brain. The heart also needs blood so it pumps blood to itself, too. The heart’s blood supply is essentially three main arteries: one that goes to the front; the other that goes to the back; and the final artery that connects to the side of the heart. When one of those arteries is blocked, the heart doesn’t get enough blood and oxygen, causing a heart attack. This is simply due to the block that doesn’t allow oxygen to the heart tissue that that artery feeds oxygenated blood.  This causes ischemia (lack of oxygen perfusion to tissue).  It causes pain first (chest pain=angina) and if the block continues than it will lead to infarction meaning death of the tissue not receiving enough (partial block) or no oxygen (a complete block).  The exact same thing happens in the brain, which causes a stroke; or the foot causing first pain leading to blackish skin of the foot tissue=necrotic tissue which ends up being amputated (like in some patients with  diabetes or peripheral vascular disease).  So lack of oxygen to our tissue parts anywhere can cause death to the tissue and depending on the tissue area cause death (like with the heart, due to the heart being the engine of the human body).

Interventional Cardiologist Randy Goodroe says patients are getting treatment quicker for heart attacks, more now than ever before. So the once grim reality of suffering from “the widowmaker” – a heart attack that results in immediate death – has become somewhat of a misnomer.

It’s called a “widowmaker”, Dr. Goodroe added, because it would typically kill you if the artery doesn’t get opened fast enough.

There are two different kinds of heart attacks. One is called an ST-elevation myocardial infarction, or STEMI, where the artery is totally blocked (i.e. the widowmaker), and we are on the clock to get the artery opened as soon as possible. There’s also a non-ST-elevation myocardial infarction (NSTEMI) where an artery is partially or temporarily blocked, and is still urgent to get the artery cleared, but not emergent.

Common Risk Factors:

Age is definitely a risk factor. We start seeing coronary disease in people who are between 50 and 60-years-old, and obviously, the older the person, the older the arteries, the higher the risk. Diabetes is another one of the greatest risk factors. Smoking is the strongest modifiable risk factor, meaning it’s the worst thing people can do to themselves to accelerate the disease process. High blood pressure and family history are also risk factors for heart attacks.

How to detect it if in the ER with symptoms & than repair it:

If a patient enters the ER with heart attack symptoms, quickly performed is an electrocardiogram (EKG) including cardiac enzymes to and echocardiogram or stress test to detect a totally obstructed artery. The artery is like a pipe or a tube., so we put a tiny wire through the blockageThose patients are very quickly taken to the cardiac catheterization lab where an angiogram is done to detect if there is and how bad the blockage is, if present.  Than with an angioplasty (balloons) at the end of the angiogram catheter break up the blockage and stents inserted in the area of blockage to get the blood flowing to the heart again.  The balloon is taken out and a stent is slid over that also has a balloon on it and once the stent goes up, it props open the blockage.  Blockage is repaired.

 

 

 

 

 

 

 

 

QUOTE FOR MONDAY:

“You can become infected by coming into close contact (about 6 feet or twoarm lengths) with a person who has COVID-19. COVID-19 is primarily spreadfrom person to person.• You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks.• You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.”

cdc.gov

QUOTES FOR THE WEEKEND:

Coronaviruses are composed of enveloped virions that contain a positive strand RNA genome. Human coronaviruses may cause the common cold or severe respiratory illness. In 2002 the SARS coronavirus emerged in China and spread globally, infecting over 8000 individuals and killing more than 900.

“On Tuesday, January 21, the Centers for Disease Control & Prevention (CDC) confirmed the first U.S. case of a coronavirus (2019 Novel Coronavirus, or 2019-nCoV) that originated last month in the central Chinese city of Wuhan. The patient had returned to Washington State last week from a trip to Wuhan, where 300 confirmed infections and several deaths have occurred. Thailand, Japan, and South Korea have also reported a handful of cases, all connected to travel from Wuhan. [January 24 update: A second U.S. case has been confirmed in Chicago, Illinois, and three cases have been confirmed in France.].

On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern. On January 31, the U.S. Department of Health and Human Services (HHS) Secretary declared a U.S. public health emergency to respond to 2019-nCoV.§ Also on January 31, the president of the United States signed a “Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus,” which limits entry into the United States of persons who traveled to mainland China to U.S. citizens and lawful permanent residents and their families.” USA Citizen Protection

CDC Centers for Disease Control and Prevention

Reports suggest that 2019-nCoV was initially spread from animal-to-person. Currently, there are growing indications that there is limited person-to-person spread, though it is unclear how easily this may be happening.”

Hawaii.gov

 

QUOTE FOR FRIDAY:

“Both diseases may be treated with chemotherapy, radiation therapy and/or stem cell transplantation.  Immunotherapy drugs may also help treat non-Hodgkin lymphoma and other hematological malignancies, such as multiple myeloma. “The early data suggests immunotherapy will play a future role in the management of lymphomas,” says Dr. Maurie Markman, President of Medicine and Science for Cancer Treatment Centers of America® (CTCA).”

Cancer Treatment Centers of America