Category Archive : Health

Spotting The 15 Signs Of An Anxiety Attack

Spotting The 15 Signs Of An Anxiety Attack: A Quick Guide

Anxiety attacks are a cause of enormous stress, discomfort, and sometimes embarrassment for some people. It is neither something to be ashamed of nor something to hide from, because it is a problem that can be addressed. That being said, it is important to be able to recognise the signs of an anxiety attack before it happens, so that you can take steps to manage it. In this article, we will look at 15 tell-tale signs of anxiety attack, so you can spot them easily.

1: Difficulty Breathing

One of the most common signs to look out for is difficulty breathing. Signs of an anxiety attack can include anything from a feeling of breathlessness to tightness in the chest, or having difficulty taking deep breaths. The difficulties here can result in a fear of passing out, which further exacerbates the feelings of panic and worry. Therefore, it is important to be aware of this sign.

Difficulty Breathing

2: Palpitations

Anxiety attacks can cause your heart to beat uncontrollably fast and hard, a symptom medically termed as palpitations. A racing heart is a physical sign of extreme stress, panic, and anxiety- the body perceiving a dangerous situation, despite none present. There may also be tightness in the chest, and a feeling of a heaviness.


3: Tensing of Muscles

Anxiety attacks also induce tensing of the muscles. This can be anything from a slight tremor to an intense, involuntary contraction of muscles. The tensing of the muscles is an involuntary way of the body responding to a dangerous situation, preparing to fight or take flight, thought to be a primitive response.

Tensing of Muscles

4: Sweating

Excessive sweating is often a sign of an anxiety attack, especially when the source of panic is invisible. Sweating is the body’s way of cooling itself in response to terror or fear, and while the physiological systems of the body may not be functioning normally such as breathing and muscles, an increase in body temperature due to anxiety can lead to sweating.


5: Nausea

Nausea is another classic sign of an anxiety attack. It can manifest itself in a variety of ways, including queasiness, vomiting, dizziness, stomach aches, or a loss of appetite. When the body perceives something as a danger, it shuts down other systems, such as digestion, to focus all its efforts on dealing with the perilous situation.


6: Muscle Cramps

Muscle cramps can also be a sign of anxiety attack. Anxiety can cause the body to tense up, and lead to persistent muscle pains and cramps. Such pains can be particularly acute as you find yourself unable to move as a result of the cramps, further intensifying the anxious state.

Muscle Cramps

7: Hot Flushes

A hot flush, medically known as a ‘hot flash’, is another common sign of an anxiety attack. It is an intense feeling of warmth across your body, often accompanied by sweating. Hot flushes come in waves, and can vary in intensity. One minute, the body may be comfortable, and the next, the face and body may flush incredibly quickly.

Hot Flushes

8: Uncontrollable Shaking

Anxiety attacks can lead to trembling, shaking, and twitching of muscles, especially in the limbs. While the tremor can be very intense, it manifest differently for different individuals. For instance, one individual could experience tremors in the hands and arms, while another could experience it in the legs and feet.

Uncontrollable Shaking

9: Vertigo

Vertigo is a sense of disorientation to place and time, as if everything is suddenly spinning. The cause of vertigo can be psychological thoughts or physical, however in the case of anxiety attacks, it is a result of racing thoughts that confusion the body. This can cause spinning sensations, a fear of the ground moving, or walking on a moving surface.


10: Foggy Thinking

Anxiety can cause the mind to feel cloudy, making it difficult to think, even if it is short term. Anxiety can make it difficult to think rationally and concentrate on the task at hand, especially if the situation is a stressful one. As a result, anxiety can make it difficult to have meaningful interactions, and can cause individuals to feel panicky and overwhelmed.


11: Hot Ears

Hot ears are an indication of the body entering panic state, during an anxiety attack. This happens due to the adrenaline coursing through the body during an anxiety attack, which increases the metabolism and causes more blood to flow. As a result, the body’s temperature increases and the skin may feel hot or tingly.

Hot Ears

12: Being Overly Aware Of Surroundings

When your body perceives imminent danger, it’s natural to want to be aware of your surroundings, almost as if to look out for signs of escape or threat. The same can be true when experiencing an anxiety attack, when everything in the environment starts to feel strangely intense and magnified.

Being Overly Aware Of Surroundings

13: Gastrointestinal Problems

Gastrointestinal problems, such as diarrhea can also be a symptom of anxiety attacks. This is because the digestive system and nervous system are closely tied, and during phases of heightened anxiety, the body will have an increased reaction to the food consumed.

Gastrointestinal Problems

14: Panic

The sudden urgency of handing a situation can be a sign of an anxiety attack. This is because the body perceives the situation a more frightening then it actually is, resulting in a feeling of suffocation or intense panic when there is no actual danger.


15: Hyperventilating

Hyperventilation is a common symptom of an anxiety attack. This is a result of the sudden rise in panic, difficulty taking in oxygen, and fear of an oncoming attack. People often are not aware they are hyperventilating until they regain their breath and composure.



Anxiety attacks can come without warning, and cause individuals a great deal of distress. That being said, it is important to be aware of the signs of an anxiety attack, so that one can take measures to reduce the chances of them occurring. What’s more, it is equally important to take the help you need, such as therapy or medication, to deal with the consequences of an attack.


Q. What is an anxiety attack?

A. An anxiety attack is a sense of heightened fear and unease triggered by a perceived danger. It is usually accompanied by physical symptoms such as sweating and dizziness, as the body’s physical systems react to the situation.

Q. How can I cope with an anxiety attack?

A. Coping mechanisms for an anxiety attack can be varied. Commonly, it is recommended to practice deep breathing to reduce the intensity of the physical symptoms. Moreover, if the anxiety is more complex, medication, therapy, and support groups can be sought for long-term relief.

Q. What are 5 warning signs of anxiety?

A: Certainly! Here are five warning signs of anxiety:

  1. Excessive Worrying: This is one of the most common signs of anxiety. It involves worrying excessively about everyday events, such as work, school, or relationships.
  2. Restlessness: Anxiety can also manifest as restlessness or feeling on edge. People with anxiety may struggle to sit still or relax, and may experience physical symptoms such as shaking or trembling.
  3. Fatigue: Chronic fatigue is another common symptom of anxiety. People with anxiety may feel constantly tired, even if they have had enough rest.
  4. Difficulty Concentrating: Anxiety can affect a person’s ability to concentrate. People with anxiety may find it challenging to focus on tasks or remember important details, which can impact their work or academic performance.
  5. Irritability: Anxiety can cause irritability, which can lead to mood swings, anger, or frustration. People with anxiety may feel on edge and easily irritated by minor things that would not typically bother them.

It’s important to note that anxiety can manifest in many different ways, and people may experience different symptoms. If you’re experiencing symptoms of anxiety that are impacting your daily life, it’s important to seek help from a mental health professional.

Q. How to reduce anxiety?

A. There are several ways to reduce anxiety, including:

  1. Therapy: Talking to a mental health professional can be helpful in reducing anxiety. Cognitive-behavioral therapy (CBT) is a common type of therapy that can help people learn coping skills and strategies to manage their anxiety.
  2. Medication: Medications, such as antidepressants or anti-anxiety medications, can be helpful in managing symptoms of anxiety. It’s important to work with a healthcare provider to find the right medication and dosage for you.
  3. Exercise: Regular exercise has been shown to be an effective way to reduce symptoms of anxiety. Exercise releases endorphins, which can improve mood and reduce stress.
  4. Relaxation techniques: Techniques such as deep breathing, meditation, and progressive muscle relaxation can help reduce anxiety. These techniques help to calm the mind and body and reduce feelings of stress.
  5. Lifestyle changes: Certain lifestyle changes can also help reduce anxiety. Getting enough sleep, eating a healthy diet, avoiding caffeine and alcohol, and reducing stress can all be helpful.

It’s important to note that what works for one person may not work for another, so it’s important to find the strategies that work best for you. If you’re struggling with anxiety, it’s important to seek help from a mental health professional who can provide personalized guidance and support.

Evolent Wellbeing inks offer to purchase IPG for $375M

Evolent Wellbeing inks offer to purchase IPG for $375M


Evolent Health this week declared an settlement to acquire IPG, which develops technological innovation and surgical management solutions for musculoskeletal ailments.

WHY IT Matters
The deal phone calls for Evolent to spend TPG Development, the development equity platform of option asset agency TPG, $375 million for the company – additionally a opportunity further thing to consider of up to $87 million, relying on sure benchmarks.

The acquisition is intended to develop Evolent’s benefit-based treatment portfolio – boosting its specialty choices, adding new customers and diversifying its commercial insurance policies income combine.

It broadens Evolent’s concentration to consist of surgical expense management concentrating on MSDs. By including to its specialty portfolio tof oncology, cardiology and finish-of-existence care organizing, the firm – which expects the deal to be immediately accretive to altered EBITDA margins and funds flow – suggests it will empower improved support of the price-based mostly needs of Evolent’s payer and possibility-bearing provider purchasers.

“IPG is a chief in surgical value administration alternatives with a target on musculoskeletal value and good quality and adds unique medical value and an improved fiscal profile to assist our mission for our sufferers, companies, payers and shareholders,” stated Evolent Overall health CEO Seth Blackley in a assertion.

THE More substantial Trend
The deal will come at a pivotal minute for price-primarily based care – which appears to be to be attaining some traction immediately after some many years of, arguably, a disappointing deficiency of progress.

Some new stories have witnessed the imperatives of danger-centered reimbursement ushering a new era of interoperability as payers are introduced much more into the combine thanks to new information trade prerequisites from the Facilities for Medicare and Medicaid Expert services. Some others are urging providers to spend additional in the IT and staffing wanted to satisfy the obligations of accountable care.

In the meantime, CMS announced this 7 days that it is designating a new service provider style – Rural Emergency Hospitals – with companies who satisfy conditions of participation eligible to get payment for services furnished on or just after January 1, 2023. (Pay attention to a the latest HIMSSCast episode on the future of rural care.)

ON THE History
“IPG will add useful interactions with national and regional professional overall health plans throughout the place, as well as hundreds of partnerships with ambulatory surgical procedure facilities nationally,” reported John Johnson, Evolent’s chief economic officer, in a statement.

“We are enthusiastic to turn into aspect of a foremost value-primarily based specialty care alternatives organization,” included Vince Coppola, CEO of IPG. “We glance ahead to operating intently with the Evolent crew to more accelerate our development and innovation. This partnership results in important possibilities for our organization, our customers and our group.”

Twitter: @MikeMiliardHITN
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Healthcare IT News is a HIMSS publication.

2022 Player Field: Murray, Kyrgios, Norrie, de Minaur, Tiafoe, Korda  Nishikori Returns

2022 Player Field: Murray, Kyrgios, Norrie, de Minaur, Tiafoe, Korda Nishikori Returns


posted: Jul. 01, 2022.

2022 Atlanta Open: Coco Gauff Adds Monday Match vs. Sofia Kenin 

2022 Player Field: Murray, Kyrgios, Norrie, de Minaur, Tiafoe, Korda

Nishikori Returns

June 28, 2022 – With just over a month away from the first balls being struck at the 2022 Atlanta Open at Atlantic Station, media, partners and special guests gathered on Atlantic Green at Atlantic Station for 2022 Atlanta Open Media Day. This year’s ATP 250 event will run from July 23-31, in Midtown, Atlanta as the U.S. Open Series kicks off on the North American hardcourts.

As previously announced by Atlanta Open Tournament Director, Eddie Gonzalez, Coco Gauff will face off with the Canadian star, Leylah Fernandez on Sunday Night, July 24 in the annual Sunday Showdown delivered by UPS.

With a smile on his face, Gonzalez surprised attendees by announcing that Coco has decided to stick around for another night and has added a July 25, Monday Night exhibition against fellow American, Sofia Kenin.

Kenin, now 23, earned her career-high No. 4 ranking and the Australian Open singles title in 2020. Now living in Pembroke Pines, Fla., Kenin has won five WTA singles titles since turning pro in 2017 and won two WTA doubles titles, including the 2019 China Open at the Premier Mandatory level with Bethanie Mattek-Sands. She was a finalist at Roland Garros in 2020 and in 2019 won the WTA’s “Most Improved Player” award.

“Our stadium will sell out for these exciting women’s matchups so get your tickets now before its too late,” added Gonzalez.

Coco Gauff is currently ranked No. 13 in singles and No. 5 in doubles.

Gonzalez announced this year’s Atlanta Open player field. Previously released were six-time champ, John Isner, Taylor Fritz and Reilly Opelka. The field features the top 11 Americans in the world rankings, three former Atlanta Open singles champions and a three-time major champ and former world No. 1.

Joining the fun for the first time in Atlanta will be former world No. 1 and two-time Wimbledon, US Open and Olympic singles champion Andy Murray.

Sir Andy Murray turned professional in 2005 with expectations high. In 2012, he won a gold medal at the London Olympics and claimed his first Grand Slam title with a stellar run at the U.S. Open. In 2013, Murray outlasted the field at Wimbledon to become the tournament’s first British men’s singles champion since 1936. In 2016, he won both his second Wimbledon title and second Olympic gold medal.

He is the youngest British player to compete in the Davis Cup,In 2007, Murray claimed a second straight SAP Open and also won the St. Petersburg Open to break into the ATP top 10. He defeated Rafael Nadal to reach the finals of the 2008 U.S. Open, before losing to Federer. He ascended to No. 2 in the world in 2009, and finished runner-up at the Australian Open in both 2010 and 2011. He reached No. 1 in the world in November of 2016. He has won over 700 ATP Tour matches and 46 titles around the world.

Also joining the world class field this summer, is Kei Nishikori. The best Japanese player of all-time has won 12 singles titles and was runner-up at the 2014 US Open, making him the first male player representing an Asian country to reach a Grand Slam singles final. He also became the first man from Asia to qualify for the ATP World Tour Finals. Nishikori last played in Atlanta in 2012.

Young Americans, Frances Tiafoe, Tommy Paul and 2016 champion, Nick Kyrgios also return.

2022 will mark the Atlanta debut of Sebastian Korda. In 2021, Korda reached his first ATP final at the Delray Beach Open, losing to Hubert Hurkacz in straight sets. He did not drop a set en route to the 2021 Parma championship on clay. He reached his first Masters 1000 quarterfinal, earning his first top 10 win against Diego Schwartzman in three sets. He achieved a career-high ranking of No. 30 after avenging a loss to Carlos Alcaraz in the 2021 Intesa Sanpaolo Next Gen ATP Finals championship match. For the biggest win of this season, he defeated Alcaraz to reach the third round at the 2022 Monte-Carlo Masters. He also reached the semifinals at the 2022 Estoril Open, defeating World. No. 10 Felix-Auger-Aliassimine.

2022 Atlanta Open Player Field and Ranking

Cameron Norrie GBR (12)

Taylor Fritz USA (14)

Reilly Opelka USA (18)

John Isner USA (24)

Alex de Minaur AUS (27)

Frances Tiafoe USA (28)

Miomir Kecmanovic SRB (30)

Tommy Paul USA (32

Jenson Brooksby USA (34)

Nick Kyrgios AUS (40)

Ilya Ivashka (44)

Maxime Cressy USA (45)

Sebastian Korda USA (46)

Andy Murray GBR (52)

Mackenzie McDonald USA 55

Brandon Nakashima USA 56

Marcos Giron USA 65

Benoit Paire FRA 73

James Duckworth AUS 74

WC Kei Nishikori (JPN)

WC Andres Martin (USA) – College Night

Tickets are on sale now at

College Night 2022 is setting up to be one of the biggest yet. Georgia Tech men’s tennis team member, Andres Martin has been awarded the main draw singles wildcard this year.

Opening the night session of Tuesday, July 26, Martin will face an ATP pro in the featured singles match.

Of special note is a new partner for the Inner Circle Lounge this year. Real Azul is an Atlanta-based tequila and the presenting sponsor of the Inner Circle Lounge along with the charity, The Giving Kitchen. The Giving Kitchen will againbe bringing some of Atlanta’s top chefs to the Real Azul Inner Circle Lounge during tournament week.

About the Atlanta Open

The Atlanta Open is held each year in July in Atlantic Station and is one of the summer tournaments in the US Open Series. The tournament features men’s top world tennis players in singles and doubles competition. Approximately 40,000 fans attend the tournament and bring an estimated economic impact of $10.3 million to Atlanta. John Isner won the 2021 title along with the 2018, 2017, 2015, 2014 and 2013 titles. Andy Roddick won his last ATP World Tour title when he defeated Gilles Muller at the 2012 BB&T Atlanta Open. Mardy Fish holds the title for 2011 and 2010. The tournament website is

About SeatGeek

SeatGeek is the leading mobile-focused ticket platform that enables fans to buy and sell tickets for sports, concert, and theater events. With industry-leading mobile ticketing apps, a fan-friendly user experience and its proprietary Deal Score™ technology that helps fans identify the best ticket values for a given event, SeatGeek is transforming the way that fans buy and sell tickets to their favorite events. SeatGeek Enterprise – the company’s primary ticketing platform – is used by 25 percent of the Premier League clubs, as well as the Dallas Cowboys and New Orleans Saints and Pelicans. Headquartered in New York, SeatGeek also has international offices in the U.K., Israel, Netherlands, and Italy.

About U.S. Open Series

Now in its 18th season, the world’s best players on the WTA and ATP Tour are coming together for the US Open Series. Linking seven summer WTA and ATP Tour tournaments to the US Open, the US Open Series serves as a true “regular season” of hardcourt tennis. Featuring a cohesive schedule, the Series centralizes the way tennis is viewed in North America, across multiple television and digital platforms. Fans will see today’s top champions go head-to-head with tomorrow’s emerging stars, as storylines develop throughout the summer season. Each tournament also engages its local community with a variety of outreach initiatives, including grass-roots youth tennis clinics and activities.

About GF Sports and Entertainment

GF Sports and Entertainment is a live events and sports media entertainment company created by New York-based private equity firm GF Capital Management & Advisors, LLC. Formed in July 2015, GF Sports and Entertainment owns two of the ATP World Tour’s longest running American tournaments, the Dallas Open and the Atlanta Open, as well as the New York National Lacrosse League team the New York Riptide. GF Sports also incubates new and emerging sport concepts utilizing its global expertise and network to help develop niche sports. Such concepts include Wolf Pack Ninjas, which operates ninja-focused events globally.

About The ATP

As a global governing body of men’s professional tennis, the ATP’s mission is to serve tennis. We entertain a billion global fans, showcase the world’s greatest players at the most prestigious tournaments, and inspire the next generation of fans and players. From the ATP Cup in Australia, to Europe, the Americas and Asia, the stars of the game battle for titles and Pepperstone ATP Rankings points at ATP Masters 1000, 500 and 250 events, and Grand Slams. All roads lead towards the Nitto ATP Finals, the prestigious season finale held in Turin, Italy. Featuring only the world’s top 8 qualified singles players and doubles teams, the tournament also sees the official crowning of the year-end ATP World No. 1, presented by Pepperstone, the ultimate achievement in tennis. For more information, please visit

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Rick Limpert

Media and Communications Manager, Atlanta Open

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HIV speeds up body’s growing older processes shortly after an infection, review shows: Improvements at the DNA amount can accelerate growing old by virtually 5 yrs, exploration demonstrates

HIV speeds up body’s growing older processes shortly after an infection, review shows: Improvements at the DNA amount can accelerate growing old by virtually 5 yrs, exploration demonstrates


HIV has an “early and significant” affect on getting old in contaminated folks, accelerating biological improvements in the system affiliated with normal aging in just two to a few years of an infection, in accordance to a examine by UCLA researchers and colleagues.

The results advise that new HIV an infection may possibly promptly minimize virtually five decades off an individual’s everyday living span relative to an uninfected human being.

“Our do the job demonstrates that even in the early months and years of dwelling with HIV, the virus has presently established into motion an accelerated growing old approach at the DNA amount,” claimed guide author Elizabeth Crabb Breen, a professor emerita at UCLA’s Cousins Centre for Psychoneuroimmunology and of psychiatry and biobehavioral sciences at the David Geffen School of Drugs at UCLA. “This emphasizes the essential significance of early HIV prognosis and an recognition of growing old-related challenges, as nicely as the price of protecting against HIV an infection in the first put.”

The analyze is revealed currently in the peer-reviewed journal iScience.

Earlier investigation has suggested that HIV and antiretroviral therapies used to hold the infection underneath management are related with an previously onset of age-associated disorders ordinarily involved with growing older, these as coronary heart and kidney illness, frailty, and cognitive troubles.

The analysis staff analyzed saved blood samples from 102 adult men collected six months or much less in advance of they turned infected with HIV and once more two to 3 decades following an infection. They in comparison these with matching samples from 102 non-contaminated guys of the identical age taken over the exact same time period of time. The authors say this analyze is the initially to match infected and non-infected persons in this way. All the gentlemen ended up members in the Multicenter AIDS Cohort Analyze, an ongoing nationwide review initiated in 1984.

The researchers centered on how HIV influences epigenetic DNA methylation, a approach cells use to transform genes on or off in the study course of ordinary physiological changes. Epigeneticchanges are those built in reaction to the affect of atmosphere, people’s behaviors or other exterior variables — such as ailment — that have an impact on how genes behave without having shifting the genes by themselves.

The team examined 5 epigenetic steps of growing old. Four of them are what are acknowledged as epigenetic “clocks,” every single of which works by using a a little distinctive solution to estimate biological age acceleration in a long time, relative to chronologic age. The fifth evaluate assessed the length of telomeres, the protective cap-like finishes of chromosomes that grow to be progressively shorter with age as cells divide, right up until they turn out to be so short that division is no for a longer period feasible.

HIV-contaminated individuals showed major age acceleration in every of the four epigenetic clock measurements — ranging from 1.9 to 4.8 several years — as well as telomere shortening in excess of the interval commencing just prior to infection and ending two to 3 years right after, in the absence of extremely lively antiretroviral remedy. Comparable age acceleration was not seen in the non-contaminated contributors about the identical time interval.

“Our obtain to unusual, perfectly-characterized samples permitted us to design this research in a way that leaves very little question about the position of HIV in eliciting biological signatures of early growing older,” reported senior writer Beth Jamieson, a professor in the division of hematology and oncology at the Geffen College. “Our very long-expression goal is to determine no matter whether we can use any of these signatures to predict whether an unique is at amplified hazard for unique getting older-associated condition outcomes, therefore exposing new targets for intervention therapeutics.”

The scientists observed some limitations to the analyze. It involved only guys, so benefits may well not be applicable to women of all ages. In addition, the quantity of non-white contributors was modest, and the sample dimensions was inadequate to get into consideration afterwards consequences of highly active antiretroviral cure or to forecast scientific results.

There is nevertheless no consensus on what constitutes ordinary aging or how to define it, the researchers wrote.

The Multicenter AIDS Cohort Examine, or MACS, is a big-scale study job that works by using demographic aspects, routines, condition historical past and sexual heritage amid males who have sex with gentlemen to examine the organic and addressed record of HIV an infection and AIDS. It is one of the handful of cohort scientific studies in the earth to have organic samples obtainable both ahead of and right after documented HIV infection in the similar persons. In 2019, MACS was blended with the Women’s Interagency HIV Study to type the MACS/WIHS Combined Cohort Review, or MWCCS.

This perform was supported by grants from the Nationwide Institutes of Well being Countrywide Institute on Getting old (R01 AG052340, R01 AG030327) and National Heart, Lung and Blood Institute (U01-HL146333), and the Susan G. Komen Occupation Catalyst Award (CCR16380478).

More review co-authors are Dr. Mary Sehl, Roger Shih, Peter Langfelder, Steve Horvath, Otoniel Martínez-Maza and Christina Ramirez of UCLA Ruibin Wang, Jay Bream and Priya Duggal of Johns Hopkins University Jeremy Martinson of the University of Pittsburgh and Dr. Steven Wolinsky of Northwestern College.

Machine-discovering algorithms can assist well being treatment personnel appropriately diagnose alcoholic beverages-associated hepatitis, acute cholangitis

Machine-discovering algorithms can assist well being treatment personnel appropriately diagnose alcoholic beverages-associated hepatitis, acute cholangitis


Acute cholangitis is a likely lifestyle-threatening bacterial an infection that frequently is connected with gallstones. Indications include fever, jaundice, ideal upper quadrant ache, and elevated liver enzymes.

While these may appear like unique, telltale symptoms, however, they are related to those people of a significantly diverse condition: alcoholic beverages-associated hepatitis. This problems emergency section staff and other wellness care specialists who require to diagnose and handle clients with liver enzyme abnormalities and systemic inflammatory responses.

New Mayo Clinic investigate finds that equipment-mastering algorithms can enable overall health care team distinguish the two problems. In an post posted in Mayo Clinic Proceedings, researchers show how algorithms may perhaps be powerful predictive instruments employing a couple basic variables and routinely out there structured clinical facts.

“This examine was enthusiastic by observing quite a few health-related suppliers in the emergency department or ICU battle to distinguish acute cholangitis and alcoholic beverages-linked hepatitis, which are pretty various situations that can present equally,” suggests Joseph Ahn, M.D., a 3rd-calendar year gastroenterology and hepatology fellow at Mayo Clinic in Rochester. Dr. Ahn is 1st creator of the analyze.

“We created and trained equipment-mastering algorithms to distinguish the two problems using some of the routinely out there lab values that all of these sufferers should really have,” Dr. Ahn claims. “The equipment-mastering algorithms shown fantastic performances for discriminating the two disorders, with in excess of 93% precision.”

The researchers analyzed digital wellness records of 459 sufferers older than age 18 who were admitted to Mayo Clinic in Rochester among Jan. 1, 2010, and Dec. 31, 2019. The sufferers were being identified with acute cholangitis or alcoholic beverages-related hepatitis.

Ten routinely obtainable laboratory values were gathered at the time of admission. Just after removing of individuals whose details have been incomplete, 260 sufferers with alcoholic beverages-associated hepatitis and 194 with acute cholangitis remained. These facts were being applied to prepare 8 machine-mastering algorithms.

The researchers also externally validated the success making use of a cohort of ICU people who were witnessed at Beth Israel Deaconess Professional medical Middle in Boston in between 2001 and 2012. The algorithms also outperformed physicians who participated in an on the web study, which is explained in the short article.

“The analyze highlights the probable for device-studying algorithms to help in medical choice-generating in instances of uncertainty,” states Dr. Ahn. “There are many situations of gastroenterologists obtaining consults for urgent endoscopic retrograde cholangiopancreatography in people who originally deny a history of alcoholic beverages use but later on convert out to have liquor-related hepatitis. In some cases, the incapacity to obtain a trustworthy record from sufferers with altered psychological standing or lack of accessibility to imaging modalities in underserved spots may well drive companies to make the dedication dependent on a constrained sum of aim knowledge.”

If the equipment-studying algorithms can be manufactured very easily obtainable with an on line calculator or smartphone app, they may possibly assist overall health treatment staff who are urgently offered with an acutely sick client with abnormal liver enzymes, in accordance to the review.

“For individuals, this would direct to enhanced diagnostic accuracy and reduce the number of further assessments or inappropriate purchasing of invasive strategies, which may perhaps hold off the accurate diagnosis or issue sufferers to the hazard of unnecessary difficulties,” Dr. Ahn states.

The authors are from the Division of Gastroenterology and Hepatology and the Division of Inside Medicine at Mayo Clinic in Rochester, and from the Office of Pc Science at Hanyang College in Seoul, South Korea. Co-author Yung-Kyun Noh was supported in this exploration by Samsung Research Funding and Incubation Heart of Samsung Electronics. The authors report no competing passions.

Tale Resource:

Elements delivered by Mayo Clinic. Original prepared by Jay Furst. Observe: Information may possibly be edited for design and style and duration.

Monkeypox unfold is presently an crisis: African officers

Monkeypox unfold is presently an crisis: African officers


Overall health authorities in Africa have referred to as on abundant nations around the world to share the world’s confined provide of vaccines

Overall health authorities in Africa have identified as on abundant nations to share the world’s limited source of vaccines

Health authorities in Africa say they are treating the increasing monkeypox outbreak there as an emergency and are contacting on abundant nations around the world to share the world’s confined source of vaccines in an exertion to stay clear of the obvious fairness problems witnessed all through the COVID-19 pandemic.

Monkeypox has been sickening persons in pieces of central and west Africa for many years, but the lack of laboratory diagnosis and weak surveillance suggests quite a few circumstances are going undetected throughout the continent. To date, nations around the world in Africa have described far more than 1,800 suspected cases so much this yr which includes extra than 70 deaths, but only 109 have been lab-confirmed.

“This individual outbreak for us indicates an unexpected emergency,” explained Ahmed Ogwell, the performing director of the Africa Facilities for Condition Command. “We want to be able to deal with monkeypox as an emergency now so that it does not bring about far more ache and struggling,” he stated.

Last 7 days, WHO explained its unexpected emergency committee concluded that the growing monkeypox outbreak was stressing, but did not still warrant currently being declared a world wide wellness unexpected emergency. The U.N. overall health agency stated it would reconsider its conclusion if the sickness continued spreading throughout a lot more borders, confirmed signals of greater severity, or began infecting vulnerable teams like expecting women and small children.

Globally, more than 5,000 scenarios of monkeypox have been documented in 51 nations around the world, according to the U.S. Facilities for Ailment Manage and Prevention. The majority of individuals instances are in Europe. No fatalities beyond Africa have been reported.

Within Africa, WHO said monkeypox has unfold to nations wherever it has not beforehand been viewed, such as South Africa, Ghana and Morocco. But extra than 90% of the continent’s infections are in Congo and Nigeria, in accordance to WHO’s Africa director, Dr. Moeti Matshidiso.

She said that offered the limited world wide materials of vaccines to battle monkeypox, WHO was in talks with suppliers and nations with stockpiles to see if they might be shared. The vaccines have predominantly been made to cease smallpox, a related disorder — and most are not licensed for use against monkeypox in Africa. Vaccines have not formerly been made use of to consider to stamp out monkeypox epidemics in Africa officials have relied typically on actions like call tracing and isolation.

“We would like to see the world wide spotlight on monkeypox act as a catalyst to beat this sickness the moment and for all in Africa,” she mentioned at a press briefing Thursday.

WHO pointed out that very similar to the scramble final 12 months for COVID-19 vaccines, international locations with supplies of vaccines to prevent monkeypox are not still sharing them with African nations.

“We do not have any donations that have been provided to (poorer) countries,” said Fiona Braka, who heads WHO’s unexpected emergency response team in Africa. “We know that individuals international locations that have some shares, they are primarily reserving them for their very own populations.”

WHO explained previous month it was doing the job to make a mechanism to share vaccines with countries with the most important outbreaks, which some anxiety could see vaccines go to prosperous nations like Britain, Germany and France, some of the agency’s most important donors and who now have their possess materials.

Even though monkeypox cases in Europe and North The us have been largely determined in men who are gay, bisexual or sleep with other guys, that is not the scenario in Africa.

WHO’s Tieble Traore explained that in accordance to in-depth facts from Ghana, the quantities of monkeypox situations had been virtually evenly split among gentlemen and females.

“We have not however viewed spread amongst adult men who have intercourse with adult men,” he mentioned.

Between monkeypox circumstances in Britain, which has the largest outbreak over and above Africa, the extensive greater part of instances are in men and officers have pointed out it is spreading only in just “defined sexual networks of homosexual, bisexual, or guys who have intercourse with gentlemen.”

Researchers warn that anyone is at danger of catching monkeypox if they come into close, actual physical speak to with an contaminated affected individual or their clothes or bedsheets.

In Africa, monkeypox has mainly been distribute to persons from infected wild animals like rodents or primates. It has not normally induced prevalent outbreaks or speedy spread among individuals.

HIMSSCast: Henry Ford director of virtual care talks telehealth

HIMSSCast: Henry Ford director of virtual care talks telehealth


What are some of the most crucial subject areas in telehealth these days?

  • Standardizing and optimizing telehealth integration into care pathways
  • Conducting complete exams during online video visits
  • Electronic and telehealth literacy
  • Telehealth sustainability and federal government advocacy

That’s according to this podcast’s quite specific visitor, Courtney Stevens, director of virtual care at Henry Ford Health Technique, dependent in Detroit.

Established in 1915 by Henry Ford himself, Henry Ford Wellbeing Process is a non-gain, built-in wellness technique fully commited to improving people’s lives by means of excellence in the science and art of healthcare and healing. Henry Ford Health Process features Henry Ford Professional medical Team, with much more than 1,900 medical professionals and researchers working towards in much more than 50 specialties at locations all through Southeast and Central Michigan, and five acute care hospitals.

Like what you hear? Subscribe to the podcast on Apple Podcasts, Spotify or Google Engage in!

Speaking factors:

  • Standardizing and optimizing telehealth integration into treatment pathways
  • Improved adoption and results
  • Progressive purposes of virtual treatment
  • Resources and systems that can be utilized to execute a in depth assessment with telemedicine
  • Asynchronous modes of telehealth
  • Digital and telehealth literacy
  • Client training and support
  • Telehealth sustainability and government advocacy
  • Can the healthcare market maintain the momentum of telehealth developed by the pandemic

Additional about this episode:

How distant affected individual checking increases treatment, saves money for continual treatment

Strengthening rural care and health fairness with telemedicine

Telehealth with a technician in the home reduces invest by 22% for Scottsdale Medical doctor Team

How telehealth can enable inpatient care, and what a hybrid potential seems like

The troubles of telemental overall health, and how they can be get over

Twitter: @SiwickiHealthIT
Electronic mail the author:
Health care IT News is a HIMSS Media publication.

Research: Telemental healthcare connected with elevated outpatient make contact with, hospitalization stick to-ups

Research: Telemental healthcare connected with elevated outpatient make contact with, hospitalization stick to-ups


The use of telehealth to supply solutions for people with significant mental health issues (SMI) demonstrates assure, but does not automatically make improvements to rates of consumption for treatment. It stays unclear whether an expansion of these providers would increase high quality of care.

These have been amongst the success of a cohort research published in JAMA Network Open up on June 27 that included 118,670 sufferers with schizophrenia or related psychotic disorders, and/or bipolar I problem in non-metropolitan counties.

The analyze observed the use of telehealth expert services enhanced the premiums of affected person observe-up with healthcare gurus right after hospitalization, along with a “modest increase” in speak to with outpatient specialty psychological healthcare professionals.

“However, no substantive changes in treatment adherence were being mentioned and an increase in hospitalizations was observed,” the report mentioned.

The maximize in hospitalizations does not always necessarily mean that the use of the telehealth resulted in poorer treatment, and ending with a healthcare facility take a look at, the report cautioned, but somewhat the use of telehealth authorized health care experts to effectively recognize and stabilize patients owning an acute disaster.

WHY THIS Matters

As treatment delivery becomes a lot more dispersed, patients have a lot more choices to seek out care exterior of conventional health programs.

Even so, this access to numerous care channels has developed a new issue: the digital fragmentation of health care. Group well being facilities have turned to telehealth to strengthen their solutions.

While use of telehealth or telemedicine systems has been rapidly evolving, supplied a force ahead owing to the pandemic, research is minimal about the deployment of specialty psychological healthcare and medicine adherence by way of telehealth engineering.

In rural places, entry to specialty care remains a obstacle for individuals with severe mental disorders, the report mentioned. There is currently an lively discussion in numerous states relating to no matter if to lengthen pandemic-related non permanent expansions of telemedicine for psychological sickness care.

Other electronic services, which includes the use of tablets, have served carry mental wellness applications to patients in rural locations.

According to yet another review revealed in JAMA Network Open, furnishing a video clip-enabled tablet to veterans dwelling in rural spots lessened unexpected emergency office visits and suicidal behaviors.

THE Bigger Trend

Research compiled in 2018 experienced previously described the feasibility of making use of telemedicine in the procedure of schizophrenia and psychotic disorders.

In accordance to Trilliant Health’s developments analysis, which centered on U.S. telehealth use amongst March 2020 and November 2021, about a quarter of Us residents used telehealth in the course of COVID-19.

Even so, other researchers have uncovered therapists engaging with a greater proportion of purchasers from decreased socioeconomic position groups, people on Medicaid and households ended up significantly less most likely to retain applying telehealth following the pandemic.

Use of telehealth for behavioral health and fitness is also on the rise, in accordance to the report. However, new electronic wellbeing instruments presented by shops, which includes Amazon and Walmart, as very well as product choices from Apple, Google and a slew of startups could guide to much more advanced and efficacious telehealth offers across a wide spectrum of care.

Monkeypox conditions triple in Europe, WHO states, Africa concerned

Monkeypox conditions triple in Europe, WHO states, Africa concerned


LONDON (AP) — The Planet Health Organization’s Europe chief warned Friday that monkeypox scenarios in the region have tripled in the last two weeks and urged countries to do extra to make sure the beforehand exceptional disease does not turn into entrenched on the continent.

And African health and fitness authorities claimed they are treating the increasing monkeypox outbreak as an crisis, calling on abundant nations around the world to share minimal supplies of vaccines to stay away from equity troubles found throughout the COVID-19 pandemic.

WHO Europe chief Dr. Hans Kluge reported in a assertion that amplified efforts were being essential despite the U.N. wellness agency’s conclusion final week that the escalating outbreak did not but warrant getting declared a international well being unexpected emergency.

“Urgent and coordinated motion is vital if we are to flip a corner in the race to reverse the ongoing unfold of this disease,” Kluge stated.

To date, much more than 5,000 monkeypox instances have been reported from 51 nations around the world that really don’t generally report the ailment, according to the U.S. Facilities for Sickness Manage and Prevention. Kluge explained the range of infections in Europe signifies about 90% of the world wide full, with 31 nations in the WHO’s European location possessing determined circumstances.

Kluge stated data noted to the WHO exhibit that 99% of circumstances have been in gentlemen — the majority in males that have intercourse with guys. But he claimed there had been now “small numbers” of cases amid residence contacts, such as youngsters. Most individuals reported indications like a rash, fever, tiredness, muscle mass ache, vomiting and chills.

Scientists alert anybody who is in near actual physical make contact with with anyone who has monkeypox or their clothing or bedsheets is at hazard of an infection. Vulnerable populations like youngsters and expecting girls are considered extra most likely to put up with significant condition.

About 10% of individuals have been hospitalized for procedure or to be isolated, and 1 human being was admitted to an intensive treatment unit. No deaths have been documented.

Kluge mentioned the challenge of stigmatization in some nations may well make some men and women cautious of seeking health care and reported the WHO was operating with associates which includes organizers of gay satisfaction events.

In the U.K., which has the greatest monkeypox outbreak past Africa, officers have mentioned the disorder is spreading in “defined sexual networks of homosexual, bisexual, or adult males who have intercourse with adult males.” British wellbeing authorities said there ended up no indicators suggesting sustained transmission over and above those populations.

A major WHO adviser reported in May well that the spike in cases in Europe was likely tied to sexual action by gentlemen at two rave functions in Spain and Belgium.

Ahead of gay satisfaction functions in the U.K. this weekend, London’s leading general public health medical professional requested men and women with symptoms of monkeypox, like swollen glands or blisters, to remain household.

Yet in Africa the WHO claims that in accordance to detailed facts from Ghana monkeypox cases were just about evenly split between males and women of all ages, and no distribute has been detected amongst males who have intercourse with gentlemen.

WHO Europe director Kluge also claimed the procurement of vaccines “must apply the rules of fairness.”

The principal vaccine remaining employed versus monkeypox was at first formulated for smallpox and the European Medicines Company reported this week it was commencing to examine whether it must be approved for monkeypox. The WHO has claimed provides of the vaccine, produced by Bavarian Nordic, are incredibly confined.

International locations such as the U.K. and Germany have currently started vaccinating men and women at large threat of monkeypox the U.K. not long ago widened its immunization method to largely homosexual and bisexual males who have numerous sexual partners and are believed to be most vulnerable.

Right until May possibly, monkeypox experienced under no circumstances been acknowledged to trigger substantial outbreaks past components of central and west Africa, exactly where it is been sickening men and women for decades, is endemic in numerous nations around the world and generally brings about limited outbreaks when it jumps to men and women from contaminated wild animals.

To date, there have been about 1,800 suspected monkeypox situations in Africa, which includes a lot more than 70 fatalities, but only 109 have been lab-confirmed. The lack of laboratory diagnosis and weak surveillance usually means lots of circumstances are going undetected.

“This unique outbreak for us means an crisis,” claimed Ahmed Ogwell, the acting director of the Africa Centers for Disorder Control.

The WHO claims monkeypox has unfold to African nations exactly where it hasn’t previously been noticed, which includes South Africa, Ghana and Morocco. But extra than 90% of the continent’s bacterial infections are in Congo and Nigeria, according to WHO Africa director, Dr. Moeti Matshidiso.

Vaccines have under no circumstances been applied to cease monkeypox outbreaks in Africa officers have relied largely on call tracing and isolation.

The WHO pointed out that equivalent to the scramble last calendar year for COVID-19 vaccines, countries with provides of vaccines for monkeypox are not yet sharing them with Africa.

“We do not have any donations that have been offered to (poorer) countries,” reported Fiona Braka, who heads the WHO emergency reaction workforce in Africa. “We know that people nations that have some shares, they are primarily reserving them for their have populations.”

Matshidiso stated the WHO was in talks with brands and countries with stockpiles to see if they could possibly be shared.

“We would like to see the worldwide spotlight on monkeypox act as a catalyst to beat this condition at the time and for all in Africa,” she reported Thursday.


Mutsaka noted from Harare, Zimbabwe.

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The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19

The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19


posted: Jul. 01, 2022.

The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19 

Citation: Miranda-Massari, J.R.; Toro, A.P.; Loh, D.; Rodriguez, J.R.; Borges, R.M.; Marcial-Vega, V.; Olalde, J.; Berdiel, M.J.; Riordan, N.H.; Martinez, J.M.; et al. The Effects of Vitamin C on the Multiple
Pathophysiological Stages of COVID-19. Life 2021, 11, x.

Academic Editor(s): Jeanne A Drisko and Qi Chen

Received: 4 November 2021

Accepted: 28 November 2021

Published: date

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Copyright: © 2021 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (

The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19

Jorge R. Miranda-Massari 1,2, Alondra P. Toro 3, Doris Loh 4, Jose R. Rodriguez 2,5, Raul Morales Borges 6,
Victor Marcial-Vega 7, Jose Olalde 8, Miguel J. Berdiel 9, Neil H. Riordan 10, Juan Manuel Martinez 11, Armando Gil 12, and Michael J. Gonzalez 2,3,13,*

1    Medical Sciences Campus, School of Pharmacy, University of Puerto Rico, San Juan 00936, PR, USA;
[email protected]

2    Program of Naturopathic Sciences, DP University, San Juan 00918, PR, USA; [email protected]

3    Medical Sciences Campus, School of Public Health, University of Puerto Rico, , San Juan 00936, PR, USA; [email protected]

4    Independent Researcher, TX, USA; [email protected]

5    PhD Clinical Psychology Program, San Juan Campus, Carlos Albizu University, San Juan 00901, PR, USA;
[email protected]

6    Ashford Institute of Hematology & Oncology, Integrative Optimal Health of Puerto Rico, San Juan 00907, PR, USA; [email protected]

7    School of Medicine, Universidad Central del Caribe, Bayamon 00960, PR, USA; [email protected]

8    Centro Médico Regenerativo, Caguas 00918, PR, USA; [email protected]

9    Berdiel Clinic, Ponce 00717, PR, USA; [email protected]

10   Medistem Panama, Technology Park (City of Knowledge), Panama 91767, CA, USA; [email protected]

11   Ortho-Regenerative Medicine, Chía 250001, Colombia; [email protected]

12   Gil Pharmaceutical, Ponce 00730, PR, USA; [email protected]

13   School of Chiropractic, Universidad Central del Caribe, Bayamon 00960, PR, USA

*    Correspondence: [email protected]

Abstract: Currently available anti-viral drugs may be useful in reducing the viral load but are not providing the necessary physiological effects to reduce the SARS-CoV-2 complications efficiently. Treatments that provide better clinical outcomes are urgently needed. 

Vitamin C (ascorbic acid, AA) is an essential nutrient with many biological roles that have been proven to play an important part in immune function; it serves as an antioxidant, an anti-viral, and exerts anti-thrombotic effects among many other physiological benefits.

Research has proven that AA at pharmacological doses can be beneficial to patients with acute respiratory distress syndrome (ARDS) and other respiratory illnesses, including sepsis. In addition, High-Dose Intravenous Vitamin C (HDIVC) has proven to be effective in patients with different viral diseases, such as influenza, chikungunya, Zika, and dengue. Moreover, HDIVC has been demonstrated to be very safe. Regarding COVID-19, vitamin C can suppress the cytokine storm, reduce thrombotic complications, and diminish alveolar and vascular damage, among other benefits. Due to these reasons, the use of HDIVC should be seriously considered in complicated COVID-19 patients. In this article, we will emphasize vitamin C’s multiple roles in the most prominent pathophysiological processes presented by the COVID-19 disease.

Keywords: COVID-19; ascorbic acid; intravenous vitamin C; pathophysiology of COVID-19;

1. Introduction

More than 100 million COVID-19 cases have been reported worldwide. This novel virus has caused a global health crisis. SARS-CoV-2 has three problematic characteristics. First, it seems to infect with a relative smaller viral load compared to other viruses, which makes it very contagious. Second, SARS-CoV-2 mutates fast, which can make available emergency vaccines less effective against new emerging strains, such as the Delta variant, which is characterized for manifesting more severe symptoms and being even more contagious than the original strain. Third, this virus causes a dangerous inflammation response that generates numerous free radicals and inflammatory molecules that can be highly cytotoxic and damaging. 

Meanwhile, hospitals have been treating infected patients with anti-viral drugs, such as remdesivir, hydroxychloroquine, and lopinavir. A recent study concluded that these drugs appeared to have little or no effect on hospitalized COVID-19 patients [1]. These and other reasons should ignite our interest to keep searching for treatments that can activate efficiently systemic defenses in order to generate better clinical outcomes for complicated COVID-19 patients.

One of the most important aspects to combat the SARS-CoV-2 is to have an optimized immune system that works properly and efficiently. In order for this system to function well, it needs a wide range of specific cofactors. One of these cofactors is vitamin C, also known as ascorbic acid. This powerful, water-soluble antioxidant is involved in many biological processes of the immune response [2]. Furthermore, this vitamin has shown potent anti-viral and anti-inflammatory activities in a variety of different viral infections [3,4]. Although oral vitamin C produces adequate concentrations to produce physiologic effects, pharmacologic concentrations require high intravenous doses that may be able to produce therapeutic benefits to COVID-19 patients.

Vitamin C is part of a comprehensive strategy to COVID-19. An ambulatory early management protocol of COVID-19 from an international consensus of experienced clinicians [5] proposed a multifaceted highly targeted sequential multidrug treatment that include vitamins, minerals, antimicrobials, steroids, colchicine, and possibly antithrombotic agents to assist the body deal with the viral load and the possible inflammatory and complications. A study in patients following this protocol demonstrated that early ambulatory treatment resulted in 87.6% reduction in hospitalization and 74.9% reduction in deaths [6].

Intravenous vitamin C has been successfully used in the hospitalized COVID-19 protocols [7]. It has been suggested that since vitamin C has both anti-inflammatory and antiviral effects, its use may help reduce drug dosing and toxicity [8]. Vitamin C, when given in high doses, is even extremely safe [9], and it can be easily excreted through the urine.

In this article, we will emphasize how vitamin C can attenuate many of the pathophysiological stages presented by the SARS-CoV-2 infection. Additionally, based on this information, we suggest that the administration of adequate dose of intravenous vitamin C combined with proven conventional supportive medications could provide COVID-19 patients with better clinical outcomes due to the multiple beneficial physiological properties it can exert. Moreover, AA is relatively non-toxic, and side effects are minimal.

Although oral intake of vitamin C does have a role in health maintenance, risk reduction and prevention, and prevention of infections, this article is focused on the more potent effects that can be achieved with pharmacologic concentrations.

2. High-Dose Intravenous Vitamin C (HDIVVC): Its Relevance

There are multiple ways vitamin C can be administered. It can be given either orally or intravenously. However, both methods have different physiological effects. In particular, there are studies that established differences between oral and IV vitamin C [10]. It was demonstrated that blood levels of vitamin C in patients were much higher by IV vitamin C than oral dosing. Because IV vitamin C is 100% bioavailable, it has the capacity to replenish tissues more efficiently and rapidly. Oral vitamin C at single doses of 200 mg is complete, and Cmax is about 60 min. However, it must be noted that under normal conditions in a healthy subject, bioavailability is reduced, which means that, for example, only about 33% a dose of 1250 mg or 412.5 mg will be absorbed when using a regular vitamin C formulation [11,12]. The decreased bioavailability of the larger oral doses is caused by saturation of the absorption mechanisms [13]. The oral dose must be absorbed by the small intestine, while IV vitamin C bypasses this route and is more readily available. Therefore, it is important to state that, to have better physiological effects that may lead to better clinical outcomes, IV vitamin C is the most potent method to attain higher blood concentrations. 

Another important aspect to highlight is that the effect of vitamin C will depend on frequency of application and quantity given. Multiple reports providing higher doses of IV vitamin C in a range from 30 to 150 g showed beneficial effects in cancer patients [14]. Moreover, in addition to all the benefits that high-dose IV vitamin C exerts, it is important to point out that it is very safe and non-toxic. Recently, there was a study published using high-dose IV vitamin C on COVID-19 patients [15], and results showed multiple improvements but, most importantly, no adverse effects.

Although there is no consensus about how to classify the doses in terms of magnitude, for the purpose of this article, we will refer to intravenous vitamin C in the context of a pharmacological effect and therefore will consider a low intravenous total daily dose to be 6–12 g, moderate intravenous total daily dose to be 13–24 g, and high dose intravenous total daily dose to exceed 25 gm daily.

In conclusion, high-dose IV vitamin C will provide better physiological effects leading to improved clinical outcomes due to higher concentrations while being safe and non-toxic.

3. Anti-Viral Mechanisms of Vitamin C

As mentioned previously, vitamin C is an essential nutrient for the body with several beneficial properties that help support proper functioning of the immune system, of great interest being its anti-viral capacity. Vitamin C has direct and indirect mechanisms that can exert these anti-viral properties. It has been shown that vitamin C can inactivate in vitro a wide range of viruses [16]. Virus inactivation was shown to be dependent on oxygen and was concluded to be mediated through oxidation to viral nucleic acids [17]. There is a possibility that ascorbate may damage viral capsids and even inhibit viral replication when provided in large doses. An in-vitro study showed that pharmacological ascorbate killed influenza virus in cultured human bronchial epithelial cells [18].

On the other hand, an indirect mechanism was proven by multiple studies in which vitamin C exerts powerful antiviral activity [19]. In a clinical study of 178 patients with Epstein Barr viral (EBV) infection treated with high doses of intravenous vitamin C, an inverse correlation was found between EBV viral capsid antigen (VCA), IgM, and vitamin C in plasma in patients with mononucleosis and chronic fatigue syndrome. Patients with high levels of vitamin C had lower levels of antigens in the acute state of disease [20].

Vitamin C can promote the production of anti-viral proteins, such as interferon. In an in-vitro study, there was evidence that, in the presence of ascorbic acid plus glutathione, interferon was produced [21]. These proteins play a role in immune protection and interfere with viral replication by binding to the cell surface. Moreover, a study analyzed in a mice model the multiple effects model of high-dose oral vitamin C supplementation the initial stage of influenza A virus (H3N2) [22]. They concluded that ascorbic acid could exert anti-viral activity by increasing the production of interferon-α/β. In addition, an animal study supports additional antiviral mechanisms of vitamin C. The administration of high doses of vitamin C caused virus attenuation of H1N1 virus. This study also showed that the intervention produced decreased expression of susceptibility genes and increased production of NF-κΒ, leading to the production of type I interferon (IFNs) [23]. Additionally, ascorbic acid enhanced the interferon levels produced by human embryo skin and human embryo lung fibroblasts induced by Newcastle disease virus [24].

4. Clinical Reports

4.1. Non-COVID Viral Infections

There are several studies reporting good clinical outcomes employing IV vitamin C on patients infected with different types of viruses. In example, there was a case report of a 54-year-old patient with chikungunya (CHIKV) fever with severe joint pain and inflammation [25]. The infected patient was treated with high doses of IV vitamin C for two days. Symptoms resolved promptly without any side effects during or after the infusions. In another case report, a 25-year-old patient tested positive for influenza virus [26]. Supplementation of IV vitamin C was given, resulting in fast improvement and returning to normal on day four. Therefore, these cases highlighted the effectiveness of IV vitamin C against combating viral infections.

Vitamin C has demonstrated that it can inhibit manifestations of viral ARDS. A case report showed how high doses of IV vitamin C can help stabilize a patient and help with decreasing the recovery time [27].

Later, there was a trial with patients suffering from sepsis and ARDS [28], in which vitamin C infusions were administered. Interestingly, results showed that vitamin C decreased mortality and length of stay for infected patients. In addition, there was a case report of a woman suffering with ARDS and other complications, in which the patient was intubated, presented hypoxemia, and chest imaging revealed opacities. Despite various approaches, the patient remained critical. Once IV vitamin C was initiated, the patient’s chest imaging and oxygenation began to improve. Rapidly, the woman became stable [29].

Some recent studies suggest that the use of ascorbic acid as part of a protective protocol against SARS-CoV-2 can reduce mortality in patients hospitalized in intensive care units with sepsis. This ascorbic acid protocol can significantly reduce mortality from sepsis [30], reduce ICU stay length, and significantly reduce the time to resolution of shock [31]. The use of ascorbic acid injections also improved the ventricular function (EF) 72 h after surgery and reduced the length of ICU stay in patients undergoing coronary artery bypass surgery.

4.2. COVID Viral Infections

The proven ability of vitamin C against other types of viruses may very well be equally as effective in SARS-CoV-2. The following cases support this this premise:

A case report of a COVID-19 patient with early use of high-dose intravenous vitamin C (HDIVC) showed positive outcomes [32]. The patient presented with chest X-ray opacities and infiltrations, body pain, dry cough, and other symptomatology. As she tested positive for SARS-CoV-2, 25 g of vitamin C was administered once a day for three consecutive days. The following day of the first infusion, the patient noted a dramatic improvement. Her body pain and headache were gone. Additionally, the most important aspect to highlight is that the infusions did not cause any adverse effects to the infected patient.

In an unusual early recovery case of a critical COVID-19 patient given vitamin C [33], a 74-year-old woman presented with fever, cough, and shortness of breath, oxygen saturation of 87%, and bilateral rhonchi. Chest radiography was suspicious for pneumonia and test was positive for SARS-CoV2. The patient was initially started on oral hydroxychloroquine and azithromycin. On day six, she developed ARDS and septic shock, for which mechanical ventilation and pressor support were started, along with infusion of high-dose IV vitamin C (11 g/d). 

The patient improved clinically and was able to be taken off mechanical ventilation within five days. This report emphasizes the potential benefits of high-dose IV vitamin C in critically ill COVID-19 patients in terms of speedy recovery and reduced length of mechanical ventilation and ICU stay. In this case, ascorbate seems to attenuate lung injury produced by the viral infection. It has been seen that even though a COVID-19 patient had already presented complications and developed critical conditions, such as acute respiratory syndrome ARDS or DAD, high doses of vitamin C can help stabilize, improve patient condition, and even shorten the length of the disease caused by the SARS-CoV-2 virus.

A case series of 17 high-risk patients with advanced age and multiple comorbidities who tested positive for COVID-19 and had moderate to severe disease were treated with IV vitamin C (1 g every 8 h for 3 days) in addition to standard treatment for COVID-19 [34]. Results showed a significant decrease in inflammatory markers, including ferritin and D-dimer, and a trend to decreasing FiO2 requirements. This case series presents a 17.6% rate of need for mechanical ventilation, which is comparable to a recent study, and 12% mortality rate, which is smaller [35]. Despite a relatively low dose of IVC, it produced comparable outcomes with some possible improvements.

In the case of a 77-year-old female with a history cardiovascular disease that presented with a five-day history, worsening symptoms received a variety of antimicrobials, anti-inflammatory agents, monoclonal antibodies, and IV vitamin C (6 g bid). She did not respond and eventually succumbed. This case illustrates the importance of early treatment to avoid the complications, such as cytokine storm, especially in patients with significant comorbidities. Once the cytokine storm manifests, even with aggressive and comprehensive treatments, it seems the body is unlikely to recover [36].

In this case report, two patients were confirmed with SARS-Cov2 pulmonary infection with respiratory distress at ages 57 and 58 years old, with 6–7 days of symptoms. Patient prior medical history was not reported and presumably had no risk factors. They were treated with oxygen in one case and mechanical ventilation in the other. Medications included hydroxychloroquine (600 mg/day), azithromycin, steroids, vitamin C (3 g/day), zinc, diuretics, and enoxaparin, which were equally used for the two patients. Both patients responded to treatment and recovered. The treatments described started on day 6–7 of symptoms but is unclear if patients had previous treatment before admission. In conclusion, this report is not helpful to assess the utility of the vitamin C in COVID-19 because the vitamin dose used were low. In addition, the route of administration is not specified as well as the presence of risk factors or previous therapy before hospitalization [37].

In a retrospective case series, twelve patients were enrolled, including six severe and six critical patients. All patients received high-dose intravenous vitamin C (average 163 mg/kg in severe patients), but on average, about a 10% higher dose was given to critical patients. Patients had significant improvements in CRP, lymphocyte count, and CD4. Improvements in oxygenation and SOF score were also observed. Greater improvements were observed in severe than critical patients after HDIVC. It was concluded that high-dose IVC (11 g per day average or more for a 70-kg person) could be beneficial in aspects of inflammatory response and immune and organ function for treatment of COVID-19 patients [38].

A retrospective case-matched clinical study compared the outcome and clinical courses of patients with moderate COVID-19 patients treated with an HDIVC protocol (100 mg/kg/day) for seven days from admission with a control group treated without the HDIVC. The HDIVC and control groups each comprised 55 patients. For the primary outcomes, there was a significant difference in the number of patients that evolved from moderate to severe type between the two groups. There was a significant reduction in the number of patients in the HDIVC that evolved from moderate to severe disease (p = 0.03). Additionally, compared to the control group, there was a shorter duration of systemic inflammatory response syndrome (SIRS, p = 0.0004) and lower SIRS occurrence (p = 0.0086) during the first week. It was concluded that in this population, a dose of 7 g for a 70-kg person may be of value in preventing progression from moderate to severe disease [39].

In an open-label, randomized, and controlled trial on patients with severe COVID-19 infection, the case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine, and the experimental group received IVC (6 g daily) added to the same regimen. The experimental group receiving IVC showed significant improvements in mean body temperature, which was significantly lower on the third day of hospitalization (p = 0.001) and peripheral capillary oxygen saturation (SpO2) (p = 0.014). However, the median length of hospitalization was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in the length of intensive care unit (ICU) stay and mortality between the two groups. It is noticeable that there were significant clinical differences in the initial response, and it seems that 6 g was not enough to change the clinical outcomes [40].

Finally, a recent placebo-controlled pilot study of high dose intravenous ascorbate in 56 critically ill COVID-19 patients showed significantly reduced mortality. The trial was conducted in two hospitals located in Wuhan, China, and used a daily dose of 24 g of ascorbate divided in two doses. The ICU mortality rate was 22% (6 out of 27) in the ascorbate group and 38% (11 out of 29) in the placebo. This difference did not reach statistical significance because of the small number of patients. However, in the most critically ill (SOFA > 3), the difference in hospital mortality was even bigger: 18.5% in the ascorbate group vs. 38% in placebo, achieving statistical significance (p = 0.04) [41].

In summary, when examining the existing literature for the use of intravenous vitamin C in COVID-19 patients, there is consistence in the evidence of improvements in outcomes, such as fever, inflammation, cell blood count, oxygenation, and even clotting markers. The case studies and small studies discussed provide some indication that the time to begin treatment, the dose of vitamin C, the presence of comorbidities, and the severity all play a role in response and mortality. However, it seems that better outcomes are associated with higher doses.

5. Vitamin C Suppresses Oxidative Stress

Oxidative stress is an imbalance of antioxidant molecules and free radicals species in the body. This can cause damage of DNA, membranes, proteins, and others, which can result in complications and diseases [42]. These free radicals are also referred to as oxygen reactive species (ROS). Exhibiting low concentrations of ROS and having an adequate homeostasis of them is beneficial for the body since they are needed in the immune system to fight pathogens, such as viruses. However, in high concentrations, these reactive molecules are toxic and may exert very damaging effects. It has been observed that when there is a viral infection, viruses can induce via multiple pathways severe oxidative stress [43]. Viruses are often associated with oxidative stress that can result in RedOx imbalances that can cause damage to cells. Regarding coronaviruses and SARS-CoV-2, increased levels of oxidative stress in infected patients seems to have a detrimental effect in cells and organs [8].

Some studies have proposed that a precise disulfide-thiol balance is crucial for viral entry and fusion into the host cell and that oxidative stress generated from free radicals can affect this balance. It seems possible that oxidation of thiols to disulfides, under a mechanism of oxidative stress, would improve the affinity of SARS-CoV-2 S proteins for the ACE2 receptor and consequently increase the severity of COVID-19 infection [44]. Oxidative stress refers to the harmful effects from excessive free radicals or prooxidants in a biological system. Advanced age is a risk factor for COVID-19 morbidity and mortality. Age-related decline GSH systems and the impaired control of the thiol to disulfide balance alters RedOx balance of all tissues. Using a specialized computational system for molecular dynamics simulation and for binding energy calculations, it was determined that the binding affinity was significantly impaired when all the disulfide bonds of both ACE2 and SARS-CoV/CoV-2 spike proteins were reduced to thiol groups. If this was the case, providing the body with increased glutathione precursors and cofactors, as well as electron donors like vitamin C, which regenerates reduced glutathione, would result in decreased entrance of the virus, reduced viral load, and consequently reduced severity of the COVID-19 infection [45,46].

In addition, an association of oxidative stress in COVID-19 and the amplification and perpetuation of the cytokine storm, coagulopathy, cell hypoxia, and mitochondrial dysfunction has been shown, suggesting a possible therapeutic role of antioxidants and other agents to reduce oxidative stress [47].

There was a study on COVID-19 patients evaluating levels of antioxidants and oxidative stress markers that concluded that infected patients had significantly lower levels of antioxidants [48]. Moreover, they stated that severe COVID-19 patients are at higher risk of oxidative stress.

Although COVID infection is the likely cause of depleted antioxidant cofactors, that study was not designed to determine cause and effect.

The NHANEs has established that there is a significant proportion of the USA population deficient in nutrients, including vitamin C (46%), vitamin A (45%), vitamin E (84%), and Vitamin D (95%) [49]. In a study with five hospitalized patients with COVID-19, researchers observed a deficiency of vitamin D in 76% and of selenium in 42% of the patients [50]. Although vitamin D is not considered and antioxidant vitamin, vitamin D reduces renin-angiotensin-aldosterone system activation and consequently decreases ROS.

Activation of the renin-angiotensin-aldosterone system and consequent increase in angiotensin II and aldosterone, as seen in cardiometabolic syndrome, participates in altering insulin/IGF-1 signaling pathways and reactive oxygen species formation to induce endothelial dysfunction and cardiovascular disease [51].The mechanisms involved in these inhibitory effects of ANG II include the generation of ROS [52].

An animal study in a model of hyperoxia-induced acute lung injury (HALI) found that 50 mg/kg of parenteral vitamin C produces a significant decrease in the levels of airway HMGB1 in hyperoxia control (p p [53]. This study, while not related to a viral infection, demonstrated the role of high-dose vitamin C in reducing damage from oxidative stress, inflammation, and lung integrity, which are pathophysiologic processes relevant to COVID.

Since COVID-19 patients commonly have lower levels of vitamin C due to the physiological stress of the viral infection [54], replacement of this vitamin in the optimal amounts to control oxidative stress as well to other benefits for COVID-19 patients should be considered. While low vitamin C status is associated with severe COVID, we do not yet know if patients with low vitamin C levels (pre-infection) are at greater risk of developing severe COVID or if severe COVID infections cause people to lose vitamin C more quickly. While both are likely, knowing this could assist in promoting preventive and health promotion measures.

6. Vitamin C Inhibits the Cytokine Storm Due to Its Antioxidant Capacity

The severity of being infected by SARS-CoV-2 is related to the cytokine storm, which can occur in many tissues. In the lungs, and in particular the alveoli, it can cause a proinflammatory response that leads to pneumonia, ARDS, diffuse alveolar damage (DAD), multiorgan failure, and other complications. Studies in Wuhan, China, showed that patients with severe COVID-19 symptoms had higher levels of IL-6 and other inflammatory cytokines in their blood samples [55]. It is normal for the body to increment the secondary (humoral) immune response after a high viral load exposure, which subsequently causes the release of these inflammatory cytokines that attack foreign proteins, such as those presented by SARS-CoV-2. However, it is expected that the body itself will gradually lower the immune response. In COVID-19 patients, the immune response does not seem to lower, causing detrimental and fatal effects to many organs. Due to this, the role of the cytokine storm rampage seen in COVID-19 has generated interest from the medical-scientific community as a potential target for combating the SARS-CoV-2 complications that may lead to death.

Furthermore, the alveolus is a structure that is very much affected by the cytokine storm. A common finding of post-mortem autopsies from COVID-19 patients reveals a trend of patients with highly damaged alveolar structures. A study noted that all of the seven COVID-19 lung specimens observed had diffuse alveolar damage (DAD) [56]. Another study observing pathogenesis of two severely infected COVID-19 patients found that the DAD seen in acute respiratory distress syndrome (ARDS) was not unique to COVID-19 patients but occurs in both SARS and MERS infections as well [57], which indicates that ARDS may be responsible for the DAD observed in COVID-19 cases. Furthermore, a third study stated that the development and progression of ARDS seen in COVID-19 is closely related to the inflammatory cytokine storm [58]. Outlining this information, suppression of the cytokine storm is of particular interest because it can prevent further complications, such as DAD and ARDS. Moreover, if a treatment can decrease the possibilities of the generation and/or progression of the cytokine storm, it could greatly decrease the possibilities of mortality in COVID-19 patients since they are highly correlated [59].

Vitamin C can inhibit the cytokine storm in COVID-19 patients based on its antioxidant properties. The main concern of the cytokine storm is the inflammatory response it produces, and one of the principal functions of this vitamin in addition to its great antioxidant capacity is that it exerts anti-inflammatory properties. It has already been observed in human and animal models that high doses of vitamin C may decrease several inflammatory parameters, such as inflammatory cytokine release and activity. For example, it was discovered that when a high dose of IV vitamin C was given to critically ill COVID-19 patients, their levels of interleukin-6 (IL-6) were lower than the placebo group (Jing et al. 2020). In addition, there is evidence that vitamin C inhibits a variety of cytokines [60], A group of 12 cancer patients receiving 25–125 gm of intravenous vitamin C and achieving 5–18 mM of ascorbate plasma concentration experienced normalization of many of the cytokine levels measured. Cytokines that were most consistently elevated prior to treatments included M-CSF-R, leptin, EGF, FGF-6, TNF-α, β, TARC, MCP-1,4, MIP, IL-4, 10, IL-4, and TGF-β. Cytokine levels tended to decrease during the course of treatment.

The intense proinflammatory response to the SARS-CoV-2 infection can lead to the development of a life-threatening cytokine release syndrome (CRS), which can lead to acute respiratory syndrome (ARDS), leading to a high mortality rate in elderly subjects and other at-risk populations. Furthermore, vitamin C supplementation can generate stable, antigen-specific regulatory T cells in animal models of autoimmune or acute graft versus-host diseases. Vitamins may shift the proinflammatory T-helper lymphocytes (Th17)-mediated immune response arising in autoimmune diseases towards a T-cell regulatory phenotype [61,62].

On the other hand, some reviews postulate that vitamin C can help remove alveolar fluid caused by distress of the inflammatory response [63]. Parenteral vitamin C infusion protected mice from the harmful consequences of sepsis by several mechanisms, including attenuation of the proinflammatory response, enhancement of epithelial barrier function, increasing alveolar fluid clearance, and prevention of sepsis-associated coagulation abnormalities [64]. An in-vitro study found that vitamin C acts at multiple levels to exert its antiviral and protective functions in the lungs. significant upregulation of several metabolic pathways and interferon-stimulated genes (ISGs) along with a downregulation of pathways involved in lung injury and inflammation [65].

Therefore, AA is promising for preventing and treating the cytokine storm itself.

7. Vitamin C Lessens Alveolar Damage and Lung Complications

One area that SARS-CoV-2 is likely to invade is the lung tissue, and a correlation has been observed between the virus and alveolar damage. It is very common for infected patients to develop ARDS, which is associated with large amounts of inflammation and damage on the alveolar-capillary barrier. Additionally, infected COVID-19 patients suffer further complications, resulting in permanent alveolar damage. When an infected patient has developed complications, such as ARDS and DAD, there is higher chance of mortality, and prognosis may seem to worsen. For instance, it has been established that ARDS is one of the principal causes of high mortality in patients with COVID-19 [66]. In order to reduce mortality rates and provide the patient with better clinical outcomes, it is important to identify better treatment that can directly manage these complications.

A brief research letter reported that vitamin C levels were undetectable in more than 90% of COVID-19 patients suffering with ARDS [67]. In addition, an epidemiological study reported that up to 82% of critically ill COVID-19 adult patients with ARDS had low vitamin C values [68].

This is consistent with low plasma levels of vitamin C reported in critically ill patients and many other conditions. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response [69,70]. Low vitamin C levels are also observed in patients with infections [68], trauma patients [72], cancer patients [73], and diabetes patients [74]. Patients with these complications have low plasma levels and benefit from high quantities of vitamin C to efficiently compensate from its excessive utilization by their immune system due to an increased physiological stress. Therefore, the supplementation of IV vitamin C can be beneficial to help maintain optimal protective levels in these patients and consequently maintain cellular homeostasis.

Although more research needs to be done in order to fully validate the effect IV vitamin C has on ARDS, current information seems very promising and appears to exert many beneficial properties on patients with ARDS. Some of the cases were discussed previously in Section 4.

8. Vitamin C Suppresses Thrombosis and Prevents Vascular Tissue Damage

Current research has been stating that SARS-CoV-2 may predispose infected patients to thrombotic diseases causing alteration in the coagulation cascade and leading to a worse prognosis [75,76]. Thrombotic complications could also significantly contribute to mortality. Furthermore, the COVID-19 disease can have a prothrombic state, and it can be seen in multiple organs, such as lungs, spleen, and gut [77]. This dangerous complication is due to the excessive performance of the immune system trying to combat the virus, which generates significant amounts of clotting substances in the blood. It can be said that inflammation and coagulation are interrelated when we speak about SARS-CoV-2. Currently, one of the typical ways to treat these thrombotic complications on COVID-19 patients are blood thinners. However, these medications do not always prevent clotting in infected patients, and there are minimal studies proving reliability [78]. In addition, a study highlighted that despite administration of anticoagulation medication, COVID-19 patients continued to have thrombotic complications [79]. This coagulopathy described in COVID-19 is characterized by an increase in procoagulant factors, such as fibrinogen and D-dimers, which have been associated with higher mortality.

Moreover, another structure that seems damaged by this virus are the endothelial cells found in the blood vessels. Studies show that particles from SARS-CoV-2 and inflammatory cells were detected in endothelial cells of infected patients [80]. This could be directly correlated to the thrombotic complications since blood vessels require healthy endothelial cells in order to inhibit the formation of clots. Moreover, when a virus is present, it can provoke the phagocytosis of important proteins from cells such as endothelial cells, causing loss of vascular integrity, cessation of important anti-clotting reactions, and leading to severe complications.

One of the many properties of vitamin C is that it exerts an antithrombotic action. It could be beneficial for COVID-19 patients to receive IV vitamin C to prevent or decrease thrombotic complications. Moreover, a study concluded that providing vitamin C during early stages of the disease prevented coagulopathy and the formation of microthrombi, which are common complications of COVID-19 [81]. Another important research to highlight is IV vitamin C and evaluation of D-dimer levels. The D-dimer test is a blood test used to detect presence of blood clots. Clinicians constantly order this test since it has been proven to be the best laboratory diagnostic marker for COVID-19-associated hemostatic abnormalities and is directly related with mortality [82]. Recently, there was a study of 17 COVID-19 patients that were given IV vitamin C [34]. Results showed that not only did vitamin C decrease the mortality rate but some inflammatory markers, such as D-dimer levels, were also decreased.

Nearly 40% of the protein content in the body is composed of collagen [83]. Collagen is a molecule that plays an important role in the health of the vascular system. This protein strengthens and protects the integrity of blood vessels. Each blood vessel contains a layer of endothelial cells that contain and need collagen to work properly. Collagen polypeptide synthesis, posttranslational hydroxylations, and actions of the two hydroxylases are independently regulated by vitamin C [84]. Vitamin C also increases the synthesis and deposition of type IV collagen in the basement membrane, stimulating endothelial proliferation [85], promoting adhesion [86], inhibiting apoptosis [87], scavenging radical species, and sparing endothelial cell-derived nitric oxide to help modulate blood flow [88]. Since moderate and severe SARS-CoV2 infection produces high level of oxidative stress in many tissues, it therefore creates a higher demand for vitamin C Since vitamin C insufficiency among healthy people in USA is 45% [49], it must be presumed that the vast majority of COVID-19 patients are depleted; however, for optimal collagen synthesis, oral might be enough. Although it is unknown if collagen synthesis is a likely path to influence COVID response in the short term or in the long term, this mechanism is likely to have an impact in a matter of days.

In addition to those involved in collagen synthesis, there is increasing evidence that ascorbate is required for optimal function of many dioxygenase enzymes. Several of these enzymes modulate the transcription of proteins involved in endothelial function, proliferation, and survival, including hypoxia-inducible factor-1α and histone and DNA demethylases. Additionally, vitamin C has been found acutely able to tighten the endothelial permeability barrier [89] and thus may modulate access of ascorbate and other molecules into tissues and organs [90].

Moreover, functional endothelial cells have the capacity of exerting antithrombotic properties and also possess the ability to degrade clots, preventing thrombosis [91]. Therefore, having healthy functional blood vessels can contribute to prevent thrombotic complications in patients with COVID-19.

9. Vitamin C Protects Red Blood Cells and Averts Hemoglobinopathy and Iron Metabolism Dysregulation

The Fenton reaction results from hydrogen peroxide (H2O2) catalyzed by iron (II) (Fe2+) to form hydroxide (OH) and hydroxyl radical. Since the use of intravenous vitamin C at high doses promotes the formation of peroxide [92], the formation of hydroxyl radicals is increased. Human and mammal cells produce SOD, catalase, and peroxidases that can quickly reduce peroxide, therefore reducing damaging effects. Catalase is the most effective catalyst for the decomposition of H2O2 and is an abundant antioxidant enzyme commonly found in the liver, erythrocytes, and alveolar epithelial cells [93]. However, many cancer cells [94] and some bacteria and viruses lack this mechanism and are therefore vulnerable to the oxidative stress generated by this reaction. Obligate anaerobes usually lack all three enzymes. Oxidizing disinfectants, such as a 0.5% hydrogen peroxide solution, have been shown to be inactivate coronaviruses when used as a surface disinfectant [95]. An in-vitro study showed that catalase pathways are critically involved in intracellular ROS regulation, including the expression of the tumor suppressor gene p53 [96].

COVID-19 captures iron and generates reactive oxygen species to damage the human immune system. SARS-CoV-2 may also affect red blood cells and hemoglobin. Multiple proteins from SARS-CoV-2 can affect the hemoglobin pathway and cause dissociation of iron. In summary, the virus inhibited the immune system through by excessive ROS production [97]. SARS-CoV-2 proteins can interact with hemoglobin and cause denaturation of the molecule. These alterations could inhibit the ability of red blood cells to transport oxygen, leading to hypoxia. Moreover, the hemoglobin pathway can also be altered by the condition of ARDS, which is very common in COVID-19 patients. For example, it has been observed that patients with ARDS can have higher levels of cell-free hemoglobin (CFH) [98]. Having high levels of CFH can be detrimental since it can cause inflammation and alveolar injury [99]. In addition, cell-free hemoglobin has the unstable ferric form, and therefore, it can initiate a cascade of free radical chain reactions, causing more oxidative stress toxicity and tissue damage [100].

This hemoglobin pathway irruption caused by the virus or ARDS can worsen the respiratory condition in COVID-19 patients since the virus already compromises the respiratory system. In COVID-19 patients, if there is a decrease in functional hemoglobin, it can result in poor clinical outcomes [101]. Taking this into account, evaluations on how to decrease or inhibit the capacity of the virus to invade this pathway or affect the red blood cells in order to maintain better oxygenation levels and overall stability in patients should be considered.

Hemoglobin desaturation accompanied by iron metabolism dysregulation favors the following pathological pathways: hypoxemia and systemic hypoxia, reduction of nitric oxide, coagulation activation, ferroptosis with oxidative stress and lipid peroxidation, mitochondrial degeneration, and apoptosis [102]. This hemoglobin alteration can contribute to the oxygen-deprived multifaceted syndrome seen in many COVID-19 patients. Interestingly, the erythrocyte presents other SARS-CoV-2 receptors in addition to the ACE2, such as cyclophylins, furins, and TMPRSS2 [103].

Given the dynamics of hemoglobin during SARS-CoV-2 infection, it is important to mention that vitamin C is implicated in iron homeostasis. Vitamin C stimulates iron sequestration/removal from plasma and works with the haptoglobin system to limit the extent of damage after infection. Iron metabolism is modulated by ascorbate by stimulating ferritin synthesis, inhibiting degradation of lysosomal ferritin, and decreasing cellular iron efflux. Moreover, ascorbate cycling across the plasma membrane is the mechanism for ascorbate-stimulated iron uptake from low-molecular-weight iron-citrate complexes, which are important in the plasma of individuals with iron-overload disorders [104].

Silent hypoxia is described in COVID-19 patients, who show a progressive worsening hypoxia associated with normal CO2.This condition worsens in later stages, when CO2 increases. Finally, hyperferritinemia can increasingly affect alveolar/capillary cell membrane integrity/permeability, causing inflammation, edema, and lung necrosis and further complicating the pulmonary condition. Furthermore, hyperferritinemia may induce a series of injuries to many organs via autoimmunity, such as coagulopathies, macrophage activation syndrome, hemochromatosis like liver damage, and other ferroptosis-driven syndromes.

As for vitamin C, it is known that it can maintain hemoglobin iron complex in the ferrous state that allows binding of oxygen, and it can also improve heme iron/cell RedOx balance [102]. Vitamin C can indirectly decrease furin cleavage and reduce endothelial permeability to free heme [105]. Additionally, as mentioned earlier, vitamin C has antioxidant capacities that could help in managing the oxidative radicals produced by the cell-free hemoglobin. Lastly, the inflammation linked to high levels of CFH can be possibly managed by vitamin C due to its anti-inflammatory capacity. 

Vitamin C is required in high amounts in tissues to maintain vascular strength and integrity. The microvasculature, when depleted of vitamin C, loses its structural capacity, as shown in patients suffering scurvy. These derangements can further enhance coagulability issues and cause patients to be prone to both venous and arterial blood clots. Vitamin C improves the condition of critically ill complicated COVID-19 patients by its multiple beneficial physiological effects, which include attenuation of lipid peroxidation, reduction of vascular permeability, lessening microvascular dysfunction, preserving the endothelial function and microcirculatory flow, improving endogenous vasopressor synthesis, and increasing vasopressor sensitivity and hemodynamic stability, which ultimately leads to reduced organ injury and dysfunction that may save lives among the critically ill [106].

10. Vitamin C Protective Role on SARS-CoV-2 Multiple Organ Manifestations

It is known that lung tissue is the initial and primary target of invasion by the SARS-CoV-2 virus. However, is not uncommon for SARS-CoV-2 to invade other organs. It will all depend on the quantity and origin of receptors that each infected patient possesses. Increased research reveals that COVID-19 patients commonly exhibit multiorgan manifestations. For example, there have been reported cases of patients presenting kidney injury, gastrointestinal symptoms, cardiovascular issues, liver problems, and other complications [107]. In this sense, COVID-19 can be considered as a systemic disease. Additionally, research highlighted and observed via data analyses shows that multiple organs and tissues were vulnerable to SARS-CoV-2 virus and not only the lungs [108].

The renal system seems to be one of the most frequently targeted areas for SARS-CoV-2; in addition, autopsies have demonstrated that there is a percentage of COVID-19 patients that suffered from renal tropism [109]. This includes patients with or without kidney diseases. The study also highlighted that the presence of SARS-CoV-2 RNA in the kidney was associated with increased risk of premature death. Taking this into account, prevention and reduction of kidney injury or complications in order to decrease disease severity and provide better clinical outcomes in COVID-19 patients must be evaluated. Vitamin C has been observed to provide potential benefits against development of kidney disease. For example, vitamin C can help in controlling anemia in patients with chronic kidney disease, and it can have reno-protective effects since it improves the levels of urea, MDA, and catalase [110].

The brain consumes a large amount of glucose and oxygen, which indicates rapid metabolism with increased oxidative stress. Therefore, ascorbate is abundant in the brain tissue. Ascorbate accumulates in choroid plexus cells (CP) and then passes through the CSF into the brain [111]. More specifically, ascorbate enters CNS through SVCT2 present in CP on the basal side [112] of the CP and also probably through GLUT1[113]. The brain steady-state ascorbate concentrations are remarkably high, and in addition, it also has exceptional retention of vitamin C in its tissues during states of deficiency. To this time, it unknown what the brain concentrations are as plasma ascorbate rises to pharmacological levels.

Regarding the nervous system, SARS-CoV-2 can have the capacity to cross the blood-brain barrier and cause multiple symptomatology in infected patients. Recent studies discovered that brain autopsies from COVID-19 patients had cortical neurons with viral load of SARS-CoV-2 [114]. Moreover, possible infection and minimal immune cell infiltrates were noted, providing evidence for SARS-CoV-2 neuroinvasive capacities. Regarding how vitamin C could play a role in the different manifestations of the nervous system, it has been seen that ascorbate can help in neuronal repair, myelination, and function [11[M1] [JM2] 5]. Additionally, the review stated that vitamin C is an important antioxidant for the CNS since it scavenges ROS molecules, causing suppression of oxidative stress in the nervous system.

On the other hand, it has been deduced that one of the possibilities of neurological manifestations on COVID-19 patients is due to the excessive immune response and the cytokine storm [107]. Therefore, as established previously, it seems that the suppression or inhibition of the cytokine storm could help in preventing neuronal complications in addition to multiple organ manifestations in COVID-19 patients. As mentioned before, this could be done by providing HDIVVC since various studies have proven the different mechanisms of action this vitamin cofactor exerts regarding the cytokine storm.

 11. Conclusions

Despite its favorable physiologic effects of ascorbate, which are both potent and multiple, it should not be considered as a sole treatment for SARS-CoV-2, but it does provide the immune system the necessary boost to combat the virus more efficiently, shorten the length of the disease, and prevent fatal complications. This important vitamin cofactor plays many roles in suppressing the pathological processes exerted by SARS-CoV-2. Vitamin C has immuno-supportive, anti-viral, anti-inflammatory, antioxidant, anti-thrombotic, and many other beneficial properties. Because it has all these capacities, it can be concluded that vitamin C, especially HDIVVC, can be seen as an important component in the treatment for SARS-CoV-2. What is also important to highlight is that in practically all of the pathophysiological stages of SARS-CoV-2, vitamin C can have a potential role in diminishing its detrimental effects. This is due to the pleiotropic physiological effects that ascorbate exhibits, such as inhibiting the cytokine storm, reducing oxidative stress, decreasing inflammation, and preventing thrombotic complications, among others. Moreover, vitamin C has the capacity to reduce mortality in COVID-19 patients while providing better clinical outcomes that do not include harsh side effects to the body. Furthermore, by supplementing vitamin C to COVID-19 patients, research states that it can reduce the high doses of medications, like corticosteroids. Vitamin C is a safe and low-cost option that should be contemplated as part of the treatment of COVID-19 patients.

On the other hand, vitamin C has been used as a treatment for many diseases, such as cancer, colds, inflammatory disorders, and others. Additionally, ascorbic acid is an important water-soluble molecule that is excreted very easily through urine. However, it can exert multiple beneficial physiological effects. COVID-19 patients usually possess low levels of vitamin C due to the stress imposed by SARS-CoV-2 infection. As a result, higher quantities of this vitamin cofactor are needed in order for the immune system to function properly during a viral attack. There is no doubt that the use of HDIVVC will be beneficial to virally infected patients. More research needs to be done to provide better clinical outcomes to COVID-19 patients. It is necessary to search for other available treatments that are less invasive yet capable of optimizing immune responses in infected COVID-19 patients. Vitamin C seems to be this additional component needed for a better treatment of COVID-19 patients.

Author Contributions: Conceptualization, writing, review and editing, M.J.G. and J.R.M.-M.; Writing, review and editing, A.P.T., D.L., J.R.R., R.M.B., V.M.-V., J.O., M.J.B., N.H.R., J.M.M., A.G. All authors have read and agreed to the published version of the manuscript.

Funding: This research received no external funding

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Not applicable.

Data Availability Statement: Not applicable

Acknowledgments: No contribution or funding or donations to declare.

Conflicts of Interest: The authors declare no conflict of interest.


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[M1]Please cite ref 113, 114 and 115 in the main text. Please notice references need to be cited in numberial order.



[JM2]They were correctly displayed in the manuscripts I send. I used the same document called proof ref only numbers to correct this document.



[M3]Please cite ref 113-115 in the main text.

Master the Fundamental Principles of Poker and Some of Its Variants – Ideal Facts Globe

Master the Fundamental Principles of Poker and Some of Its Variants – Ideal Facts Globe



A simple expertise of poker can aid you gain income in the poker activity. This post will assist you master the Fundamental Policies of Poker and some of its versions, which include the Betting intervals. This post also involves some tips on how to earn at poker. By the time you’re finished reading, you are going to be equipped to perform poker like the professional. But 1st, let’s take a closer seem at how poker video games work. How are the chips and money placed in the pot decided?

Procedures of poker

Poker procedures can differ significantly from sort to type, but the intention is often the exact – to have the ideal 5-card hand in a recreation of poker. This requires that all opponents fold just before the very last betting spherical. Each and every variant has its own established of principles – Straight Flush is a hand of five playing cards of the identical match, 4 of a Sort is 4 of a sort furthermore one random card, and Full Household is 3 of the very same rank and two playing cards of a reduced rank.

Fundamental procedures

Poker is a card game that has a whole lot of distinct guidelines and versions. For case in point, in a standard poker video game, the player who built the past intense motion need to exhibit their cards 1st. This implies that if you wager on the river, you have to display your playing cards before your opponent. This simple rule exists to prevent unneeded dialogue and moi battles. In addition, exhibiting your most effective hand is not regarded unethical.


There are numerous varieties of poker online games, but most of them follow the exact simple principles. The games are comparable in terms of the rankings of poker palms, and they all stick to the same typical play pattern. While lots of gamers stick to their favored on the net poker video game, many others like to experiment with different types of versions to obtain out which ones they enjoy the most. Texas Hold’Em poker is 1 of the most well-known variations, and there are a great number of variants available on the website.

Betting intervals

The length of the betting intervals may differ among the the different poker game titles. The initial participant to act should location a bet, and the gamers to his still left must elevate in proportion to the whole contribution of the participant just before them. If no other participant acts, the sport ends. The first spherical of betting entails placing a least wager, and afterwards rounds let the participant to elevate or look at. The ultimate spherical consists of a showdown, in which the winner is decided by the quantity of chips remaining in the pot after each round of betting.

Restrict games

Normally called a “sevens rule,” the sevens rule in restrict poker is the basis for determining the profitable opportunity of a hand. If a player’s initially card is increased than 7, it is known as a “burn card” and is discarded from the deck. Read through much more about this rule in Explanations. Also, in limit video games, a player can not check-increase. As with other poker variants, players have to identify their utmost time in a match prior to producing a closing final decision about betting.

Attribute of bluffing

Even though poker is a sport of probability, it can also be a game of ability and psychology. While you can understand standard procedures and techniques for profitable, there is no substitute for working experience. Irrespective of the skill degree, the important to profitable poker is to discover to mislead your opponents and acquire precise steps to get the laydown you want. Below are some suggestions to win poker palms:

We’re one of the world’s oldest democracies: Random facts to fill your heart with Canadian pride

We’re one of the world’s oldest democracies: Random facts to fill your heart with Canadian pride


Twice, Canadians have invented a medical cure so revolutionary it caused people to rise from their death beds

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Today is Canada’s 155th birthday, and the first Canada Day in three years that will feature the usual festivities of fireworks and public concerts. Before you head out to wave the maple leaf, bask in these random pieces of Canadiana and feel yourself filled with the spirit of our great dominion. 

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We’re one of the world’s oldest continuously operating democracies. There are plenty of older countries, of course, but the vast majority of them have been hit by some form of revolution, coup or invasion in the last 155 years. By some counts, we’re the world’s fourth oldest democracy (although the Americans obviously beat us on this point).

The UK Parliament was aggressively bored by the 1867 Act of Parliament that created Canada. The British North America Act was such tedious reading to the House of Lords that the parliamentary record contains multiple instances of the Colonial Secretary of the time apologizing that it was taking so much time. “There are defects in it, no doubt,” reads one of his many slams of our founding document.  

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In the 1960s, some maniac thought that a giant eye would be an excellent Canadian flag and mailed this design to Ottawa. Fortunately, we ignored him and went with a stylized red maple leaf instead. Click here to see more rejected flag designs.
In the 1960s, some maniac thought that a giant eye would be an excellent Canadian flag and mailed this design to Ottawa. Fortunately, we ignored him and went with a stylized red maple leaf instead. Click here to see more rejected flag designs. Photo by University of Saskatchewan Archives and Special Collections

Would you believe that a Canadian farm helped to smash communism? In 1983, Mikhail Gorbachev was just a young and unknown member of the Soviet politburo when – during a state visit to Canada – he went to a friendly dinner at the Ontario farm of federal cabinet minister Eugene Whelan. While there, he struck up a conversation with Aleksandr Yakovlev, the Soviet Ambassador to Canada. Both men soon realized that they shared the same doubts about deep flaws in the Soviet system. The three hours of intense dialogue that followed would become the root of glasnost and perestroika, the reforms that Gorbachev would implement upon becoming Soviet leader – unwittingly setting in motion a series of events that would dissolve the Soviet Union within just eight years of the Ontario meeting.

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We’re one of the world’s most heterogenous countries. In 2013, a German researcher set out to rank countries by “cultural diversity” – basically, how many distinct types of ethnicities and languages could be counted within a population. Canada turned out to be the clear North American leader in the category, and one of the most culturally diverse countries overall. Representatives of literally every ethnic group around the world hold Canadian citizenship, and the same holds true for speakers of all but the most obscure world languages. And unlike many of the other countries that scored high on cultural diversity, we haven’t descended into any serious internecine warfare in recent decades.

George H.W. Bush had once planned to become a Canadian. The patriarch of one of the most successful political dynasties in the United States (and a U.S. president himself), Bush had been seriously considering crossing the border to join the Royal Canadian Air Force in 1941. At that time, the U.S. was still neutral in the Second World War, so any American looking to fight the Axis had to join a Canadian unit. But then Pearl Harbor happened, the United States was plunged into war with both Germany and Japan, and Bush was able to get his wish to see combat by enlisting with the U.S. military.  

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Stan Rogers sings Northwest Passage, a song often called Canada’s “unofficial national anthem.” Rogers was killed in a 1983 fire aboard an Air Canada flight, and he remains one of the last people ever killed in an Air Canada accident; the airline has had no fatal mishaps in the 39 years since. Click here to see the song performed live in the memorial documentary One Warm Line.
Stan Rogers sings Northwest Passage, a song often called Canada’s “unofficial national anthem.” Rogers was killed in a 1983 fire aboard an Air Canada flight, and he remains one of the last people ever killed in an Air Canada accident; the airline has had no fatal mishaps in the 39 years since. Click here to see the song performed live in the memorial documentary One Warm Line. Photo by YouTube

Twice in history, Canadians have invented a medical innovation so revolutionary that it literally caused people to rise from their deathbeds. The first was the 1921 discovery of insulin by Frederick Banting. Until then, childhood diabetes was terminal; the only treatment was to slowly starve the patient to death. But with insulin, diabetic wards around the world were soon reporting “resurrections” of emaciated, comatose children. And then we did it again in the 1990s. It was a Canadian doctor, Julio Montaner, who discovered the “drug cocktail” that transformed AIDS from a guaranteed death sentence into a manageable chronic condition. Once again, wards around the world reported a “Lazarus effect” as patients on the edge of death suddenly faced the prospect of growing old.

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Canada became a nation in part because the IRA kept invading us. The idea of merging a bunch of British colonies into a centralized country came about largely as a security measure. The United States had just finished pounding the hell out of the secessionist Confederacy in the American Civil War, and Canadians of the time feared that Washington could just as easily turns their cannons north. But it was an invasion by a completely unexpected power that sealed the deal: Starting in 1866 – just a year before Confederation – parts of colonial Canada started getting attacked by ragtag Irish armies angry at the British.  

An atomic bomb has never been set off on Canadian soil – which is somewhat unexpected given that we were a key contributor to the Manhattan Project and have plenty of empty space that we could a-bomb if we wanted to. But there was a period of time when Canadians had The Bomb. From 1964 to 1984, U.S.-made nuclear weapons were in the arsenal of the Canadian Armed Forces – and that’s in addition to all the nuclear weapons that the Americans secretly kept at their Canadian bases.



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COVID-19 cases up by more than 30% in Britain previous 7 days

COVID-19 cases up by more than 30% in Britain previous 7 days


The hottest surge will come soon after an earlier boost of about 40% previous month, adhering to the big road functions, concerts and festivities held to mark 70 several years of Queen Elizabeth II’s reign.

The hottest surge comes soon after an previously boost of about 40% past month, subsequent the massive street events, concert events and festivities held to mark 70 a long time of Queen Elizabeth II’s reign.

The amount of new coronavirus cases across Britain has surged by much more than 30% in the final 7 days, new details showed on Friday, with conditions largely driven by the tremendous infectious omicron variants.

Information produced by Britain’s Office environment for Countrywide Data confirmed that far more than 3 million persons in the U.K. had COVID-19 very last 7 days, though there has not been an equal spike in hospitalizations. The quantity of COVID-19 fatalities also fell marginally in the last week.

“COVID-19 has not absent absent,” stated Dr. Mary Ramsay, of the Overall health Security Agency. “It is also sensible to use a experience covering in crowded, enclosed spaces,” she explained. Britain dropped just about all its coronavirus steps, including mask-donning and social distancing months ago and masks are not often noticed on community transportation.

The most recent bounce in Covid scenarios will come after an before maximize of about 40% final thirty day period, next the big road get-togethers, concerts and festivities held to mark the platinum jubilee celebrations marking 70 yrs of Queen Elizabeth II’s reign.

British officers claimed the hottest wave of COVID-19 bacterial infections were most likely brought about by omicron subvariants BA.4. and BA.5. Omicron has tended to cause a milder ailment than preceding variants like alpha or delta, but experts warn its capability to evade the immune technique usually means that men and women might be extra susceptible to staying reinfected, such as just after vaccination.

“The frequent bombardment of waves we are looking at does cause medical influence that is not to be underestimated,” claimed Dr. Stephen Griffin, an associate professor of medication at the University of Leeds, describing that any infection can direct to lengthy COVID.

Irrespective of widespread immunization throughout Britain, the defense from vaccines is possible fading and omicron and its subvariants have progressed to develop into much more infectious. Britain’s Health Safety Agency reported they had been viewing additional outbreaks in care homes for older persons and a increase in admissions to intense treatment models of people above 65.

Dr. Jonathan Van-Tam, a previous deputy main professional medical officer for the U.K., instructed the BBC that COVID-19 is now “much, a great deal, a great deal closer to seasonal flu” than when it 1st emerged. Still, he stated specialists should really be vigilant for any symptoms the virus was triggering a lot more severe sickness.

Germany’s Robert Koch Institute also claimed a identical rise in the coronavirus, with situations raising in particular amongst older folks, kids and adolescents. France has witnessed a leap in the COVID-19 hospitalization price and officers not long ago proposed that people get started donning masks once again on public transport.

Globally, the Globe Wellbeing Business stated this week that COVID-19 is expanding in much more than 100 nations around the world throughout the world. The U.N. wellbeing company warned that comfortable screening and surveillance steps signify it may perhaps be extra complicated to capture emerging variants before they unfold more commonly.

Mike Magee’s Guidance to the AMA on Reversal of Roe vs. Wade

Mike Magee’s Guidance to the AMA on Reversal of Roe vs. Wade



Steady, civic societies are built on human believe in and self confidence. If you were forced to rebuild a modern society, leveled by warfare and devastation, in which would you start? This is the dilemma the U.S. Military faced at the shut of WW II, particularly when it came to rebuilding Germany and Japan, with any luck , into steady democracies. The Marshall Strategy answered the problem higher than, and its achievements in choosing health and fitness providers as a starting place was effectively documented by a lot of in the many years to appear, like the RAND Company. Their summary in 2007 reported in component, “Country-constructing attempts simply cannot be thriving unless of course satisfactory interest is paid out to the wellness of the populace.” 

They commenced with services for gals and children, the very place that a splinter of politicians and Supreme Court Justices has focused, replacing entrusted doctors with partisan bureaucrats in an method so clearly flawed that it forced a training course correction a 50 percent-century in the past in the form of Roe v. Wade.

The follow of Drugs is elaborate. Ideally it demands awareness, abilities, supportive infrastructure, proximity and presence. But most of all, it calls for trust, particularly in moments of urgency, with lives at stake, when an particular person, and family, and neighborhood are all on higher inform. When time is of the essence, and specially if one particular or far more folks are striving to make the right conclusion for two, instead than a single lifestyle, selections are impossibly personal and intricate.

This was extensively recognized by most medical professionals, such as those most devout and conservative nationwide in the troubling several years leading up to Roe v. Wade. As lately as 1968, the membership of the Christian Health-related Society refused to endorse a proclamation that labeled abortion as sinful. In 1971, America’s main conservative religious organization, the Southern Baptist Convention, went on history as encouraging its members “to work for legislation that would allow for the chance of abortion underneath these types of disorders as rape, incest, crystal clear evidence of severe fetal deformity, and thoroughly ascertained evidence of the chance of problems to the emotional, mental, and actual physical health of the mom.” In 1973, the two the Southern Baptist Convention and the Christian Professional medical Society chose not to actively oppose the Supreme Courtroom ruling versus a Texas legislation prohibiting abortion recognised as Roe v. Wade, and reaffirmed that posture in 1974 and 1976.

What they recognized was that the nation’s social capital, its political steadiness and safety, relied intensely on the compassion, being familiar with and partnership engendered in the patient-doctor connection. As most medical practitioners noticed it, what achievable good could appear from placing politicians in the center of these types of difficult, emotion-ridden, and remarkably private selections?

The American Health care Association’s ready reaction to the June 24, 2022, reversal to Roe v. Wade was immediate and speedy. They labeled the decision “an egregious allowance of federal government intrusion into the healthcare examination home, a immediate attack on the follow of drugs and the client-health practitioner relationship…” Their president, Jack Resneck Jr. M.D. went even further to say, “…the AMA condemns the high courtrooms interpretation in this circumstance. We will often have medical professionalsbacks and protect the observe of drugs, we will struggle to protect the affected person-medical professional romance..” But what specifically does that suggest?

Approaching 75, and a lifelong member of the American Clinical Affiliation, I expect I know the AMA, its history as well as its strengths and weaknesses, as properly as anyone. Aside from owning deep own associations with quite a few of the Board of Trustees above the years (some of whom quietly keep on to call me for information), I have analyzed the evolution of the patient-medical professional marriage in six countries over a span of forty many years.

People who know me properly, and who have pushed back against my critique of the group, know that my intentions are honorable and that the alarms that I audio reflect my belief that, for our profession to endure as noble, self-governing, and dedicated earlier mentioned all to the clients who let us to care for them, we need to have a nationwide organization with arrive at into each American town and city, and formal representation in just about every condition, and just about every specialty.

My problem today, irrespective of the sturdy messaging from Chicago, is that the AMA and its customers have not thoroughly absorbed that this is a “mission-critical” minute in the organization’s background. It is also an option to purposefully flex its muscle groups, expand its membership, and strengthen its priorities. The sturdy words, without actions to back them up, I believe that, will permanently seal the AMA’s fate, and obstacle Medicine’s standing as a “profession.”

Listed here are five actions that I think the AMA should consider instantly to make it apparent that physicians stand united with our people, in partnership with nurses and other well being experts, and that the actions of final week can not and will not stand.

  1. The AMA should really pull all economic assistance for all Republican candidates through the 2022 elections.
  2. The AMA need to actively motivate doctor “civil disobedience” wherever acceptable to safeguard the well being and nicely getting of all women of all ages, no matter of age, race, sexual identity, faith, or financial status.
  3. The AMA really should convene, less than the auspices of its’ Basic Counsel, Andra K. Heller, a formal tactic assembly with the lawful counsels of all condition and specialty healthcare societies to formulate an aggressive legal tactic to decrease the injury of the the latest Supreme Court docket motion.
  4. The AMA ought to actively market AMA volunteers to enable offer a whole assortment of women’s wellbeing treatment providers at federal institutions and on federal land, and stand up data web pages that coordinate vacation and costs must inter-point out journey be demanded for treatment access.
  5. The AMA must immediately make crystal clear that any restriction of prescribing authority of medicines in guidance of women’s health and fitness care, together with contraceptive medications and gadgets, and Plan B therapies will consequence in a coordinated nationwide disruption of wellness companies.

Mike Magee MD is a Professional medical Historian and the writer of “CODE BLUE: Within the Health care-Industrial Complicated.”

Trainers have dropped their edge – slip on some loafers if you want to slice it this summertime | Jess Cartner-Morley

Trainers have dropped their edge – slip on some loafers if you want to slice it this summertime | Jess Cartner-Morley


Life utilized to be so uncomplicated. Loafers were wise and trainers have been not. Loafers had been for work or for extravagant trainers were being for days off and anything that involved running just after a ball. But modern lifetime has a habit of getting much more and more sophisticated, and footwear is no exception. The old procedures no extended use.

This seems like superior news than it truly is, due to the fact it was practical when trainers had been shorthand for peaceful dressing. There was no debate about what to wear at the weekend, simply because trainers were the only shoe in city. And if you desired to put on a fit without sporting A Go well with, all you had to do was include trainers for an prompt subversive twist. Furthermore, if you were being donning a really gown on vacation but preferred to search a tiny little bit neat, not like you have been off on a sightseeing tour of historic monuments – not that there’s everything mistaken with historic monuments, but you know what I imply – you wore trainers. Converse, Stan Smiths, then Nike Air Power Types.

Inevitably, the wear-it-with-trainers trick received worn out by overuse. Bella Hadid wears Hugo Boss trainers, but so does Keir Starmer. Alexa Chung wears Superga, but see also the Duchess of Cambridge. Trainers have been comprehensively mainstreamed and while sporting trainers with anything, anywhere, has been handy – and cozy – it indicates trainers no extended have any sort of frisson.

Meanwhile, loafers, at the time the ultimate establishment shoe, have located their edge. This begun on the catwalk, where by loafers morphed into backless mules (challenging to dress in, so really trend) and then sprouted furry linings (impractical, which is also really trend). The regular-yet-subtle gold horsebit chain was supersized into a chunk of bling, the old-university slender define beefed up with chunky punk-style lug soles.

My all-time favorite loafers will generally be my common black Gucci kinds – the very low-critical, non-jazzy kind that are never ever in the store window any more, but nonetheless do good business enterprise – a true expense get which I have experienced for years and which are nevertheless as fantastic as new. But in the past several summers, I have uncovered the everyday living-shifting magic of a pair of white loafers.

You are not the white loafer form, I know – but nor was I. A contact way too P Diddy. A bit much too pristine for real lifetime. But then, reader, I bought a pair and, frankly, if I could marry my white loafers at this level, I would. Which is how considerably I enjoy them. They have a vaguely Panama-hat-adjacent air of summer time formality that brings a strike of the surprising with no being remotely difficult to have on.

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A white shoe in summer season will make so many outfits do the job. Absolutely nothing kills the dreamy, solar-dazed vibe of light chinos or a floaty dress speedier than a black shoe. For most of the calendar year, my black loafers are excellent with a trench and excellent with a blazer and denims, but when the solar shines I want white shoes.

If you have nonetheless to be persuaded, start out with a two-tone design (brown and off-white is a vintage), mainly because at this level, trainers and loafers have practically swapped sites. Trainers have develop into the evident decision – which is why politicians and royals dress in them when they are trying to glance usual.

I still appreciate tremendous-very simple white trainers (currently partial to a pair of Keds) but loafers are a supremely handy substitute. They are just the proper sum of quirky, go with anything and are at ease enough to put on each and every day. Everyday living is nevertheless very very simple, when you have the suitable footwear.

We struggle all the time since our twins have been born. Should we get divorced? | Request Annalisa Barbieri

We struggle all the time since our twins have been born. Should we get divorced? | Request Annalisa Barbieri


I have been with my spouse for 10 years. Two several years in the past, immediately after fertility cure, I grew to become expecting with twins, now 18 months outdated. Whilst overjoyed, I feel our marriage has experienced.

We really like our young children dearly. But time and funds are very seriously impacting our relationship, to the extent that divorce has arrive up.

The childcare charges are so much, and we’ve both of those experienced to make massive sacrifices. I have had to lower a working day from my function 7 days – it doesn’t audio like substantially, but I’m an academic and have supplied up my one analysis day to consider treatment of the twins. I sense unfortunate and annoyed. I went into this job mainly to do investigate, not accurate unlimited essays and then devote the relaxation of the time with the little ones. I sense robbed, like I did a PhD for nothing.

All of my wages go to fork out for childcare, so I really feel trapped amongst scraping my pennies together, by no means getting enough function done, and feeling bitter that all my time/income is likely to the kids. Really do not get me improper – I know what is included in staying a parent, and I realize that sacrifice is component of it. I’m just still left with nothing at all in the engine.

My wife, in the meantime, gets to work her five-day-a-week task (her occupation is not as adaptable as mine), but she is fatigued as she has to do the job shifts. We struggle about cleansing, childcare time, what we do with our unique free of charge time, and revenue. She has reported she feels trapped in our relationship since we have the youngsters and the house.

I nevertheless adore her, she’s a wonderful mom and commonly a excellent man or woman, but I’m receiving to a stage exactly where I resent her. I never imagine she loves me any a lot more and question: should really we get divorced?

Not yet. It all seems incredibly tricky. You have the two experienced such a massive daily life transform. Fertility remedy can be gruelling, and when you do get expecting and have little ones the pressure to feel happy and grateful is immense.

You audio like you experienced a fulfilled (and ordered) existence in advance of you had small children, and the modify from autonomous grownup to parenthood can get time to get employed to. You say you “know what is involved” in currently being a dad or mum, but I’m not absolutely sure anyone really does until finally they get there. The continual alertness, getting readily available 24/7, staying interrupted all the time, the slumber deprivation, the aggressive tiredness with one’s associate. They can challenge a person’s sanity.

I ponder if your wife sees the small children as far more “your” duty – and that you sense this, as you gave beginning to them? I wished to know why the childcare appear out of your wages alone?

I consulted UKCP psychotherapist Fe Robinson: “When we’re below a ton of stress we shed that generosity of remaining equipped to see points from an additional person’s level of see.”

We equally imagine that’s occurring with you and your spouse. “Also,” claims Robinson, “when you are tired and overstretched, everything feels like a work – even the joyful stuff.”

Robinson puzzled what your assist network was. When we come to feel resentful, we frequently want our associates to recognise this and “save” us. This could possibly not materialize as you both of those sound exceptionally stretched.

It’s practical to bear in mind that this hyper-dependent phase – where childcare sucks all your finances – is not for ever. “Remember, from the expression following they turn a few you will get some cost-free childcare,” states Robinson. But ahead of you know it, they will be in college. Issues will change once more.

Robinson also sensed a “struggle with identity you’re an academic with a PhD – maybe you experience you’ve offered up who you are, still are not feeling rewarded in your practical experience of mothering”. Consider to try to remember: these things consider time.

Robinson proposed an training she does with couples: “I get them to picture different distinct futures, eg, ‘What would your everyday living be like if you continue to be as you are in 6 months/a 12 months/5 many years?’ and you then review that to other scenarios this sort of as ‘What would it be like if we break up?’”

You probably feel you just can’t afford couples treatment, but it can be transformative – and splitting up is pricey. Also, the childcare will not get a lot easier, just much more sophisticated. Divorcing will not make you richer either. Splitting up may well truly feel like the only response but, from what you have mentioned, your relationship is even now value preserving.

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Just about every 7 days Annalisa Barbieri addresses a relatives-similar difficulty sent in by a reader. If you would like information from Annalisa on a family members subject, make sure you send your problem to Annalisa regrets she are not able to enter into private correspondence. Submissions are issue to our phrases and ailments.

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Discussions With Annalisa Barbieri, series 2, is out there here.

Cristiano Ronaldo Seeks $626K From Woman’s Attorney In Vegas Rape Scenario

Cristiano Ronaldo Seeks $626K From Woman’s Attorney In Vegas Rape Scenario


Cristiano Ronaldo’s legal staff has knocked the US district court docket, trying to get $626,000 from the lawyers of the Nevada girl, whose rape demand from the soccer star was dismissed previously this calendar year. 

Browse A lot more: Ronaldo’s £1.7m Bugatti Veyron Associated In A Crash In Spain 

District Judge Jennifer Dorsey dismissed the lawsuit citing the lack of evidence. Dorsey concluded that the plaintiff’s law firm relied on stolen paperwork and fabricated data. Ronaldo’s lawyer Peter Christiansen has asked the judge to make the woman’s lawyer Leslie Mark Stovall pay the amount of money. 

“Given Stovall’s abuses and flagrant misconduct, Stovall really should be created personally accountable for ensuring Ronaldo is reimbursed for having to defend versus his vexatious and lousy religion perform,” Christiansen explained, as quoted by the Involved Press.

Ronaldo was accused of breaching the agreement after owning allegedly paid out $375,000 to the woman in 2010 to preserve the incident to herself. Ronaldo’s authorized workforce by no means disputed that his consumer met the female, but generally taken care of the sexual intercourse was consensual. Meanwhile, Stovall argued that the lady was in no situation to refuse such a significant sum that Ronaldo compensated to drop the legal cost.

All through the last hearing last month, decide Dorsey slammed Stovall for flouting the court’s rules and rules, and also closed her solution to reopen the situation.

“I locate that the procurement and ongoing use of these documents was poor faith, and just disqualifying Stovall will not heal the prejudice to Ronaldo since the misappropriated documents and their private contents have been woven into the very cloth of plaintiff claims,” the ruling reported. 

Ronaldo at present plies his trade for Manchester United, in which he will enter the ultimate season of his agreement this season. He is a crucial cog of the aspect beneath transition, and the club has manufactured it very clear that he is not up for sale. 

Showcased Graphic Credit rating: @Cristiano/Instagram