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Saturday, May 18, 2024

Ozempic dupe costs just $5 at your local gas station

 No need to shell out over $1000 a month for Ozempic — there’s a gas station dupe that’ll cost you just $5.

Zyn nicotine pouches are the trendy new weight loss hack favored by Gen Z users, who tout the doses of flavored powder as a poor man’s semiglutide shot — with some content creators claiming to have shed up to 30 pounds.

Nik Bando, who runs the popular golf fan account ThiccyFowler on Instagram, told fans he dropped the weight by “replacing Zyn with any hunger,” dubbing the phenomenon “O-Zyn-pic” in a video posted on social media earlier this year.

Content creators are drumming up buzz about the trendy nicotine pouches after sharing the unforeseen side effect that caused them to shed weight.Getty Images

“It works,” he promised.

Bando admitted he has become “addicted” to the $5 pouches, which are placed between the gum and lip to dissolve and be absorbed through the tissue.

Zyn has grown in popularity as an alternative to smoking or vaping. Nicotine is the major appetite suppressant component of tobacco, according to the National Institutes of Health (NIH).

Bando isn’t the only one touting the nicotine pouch method — TikToker TrippsAhoy is another content creator recently seen raving to viewers about dropping from 190 lbs. to 140 lbs., using Zyn and other brands.

On Reddit, a user who self-identified as an “overeater” asked if it was worth developing a nicotine addiction in order to curb appetite. Coming from a family addicted to cigarettes, the user said they’ve witnessed how difficult it would be to quit but found the idea of nicotine pouches “interesting.”

“Would it be the dumbest idea in the world to substitute overeating with a nic addiction?” the anonymous user inquired.

While the responses were divided between pro-Zyn and anti-addiction, University of Minnesota assistant profession Dr. Carolyn Bramante warned against introducing the nicotine pouches into your daily routine, telling Business Insider that there are better treatments for weight loss available that are approved by the Food and Drug Administration.

“It’s important to think about safety,” she noted.

Health experts are concerned over the TikTok-touted effects of Zyn, as professionals are unsure of the lasting effects of nicotine pouches in people with obesity.tiktok/@trippsahoy

While the pouches don’t require the user to smoke, the trendy product still comes with risks, such as gum damage and the consequences of ingesting nicotine, like an increased chance of cardiovascular disease or problems with the heart, lungs, stomach and more.

Zyn is said to contain more nicotine than a cigarette. Nicotine has long been touted as a viable option for appetite suppression despite. According to Insider, adverts promoting cigarettes for weight loss date back to the 1920s, when Lucky Strike darts were marketed as healthier than candy and could yield a slimmer waist.

However, Bramante warned the younger generation against falling into the same old patterns.

“We don’t fully understand how nicotine works to regulate appetite in people, specifically with obesity,” she said.

“This feels like a discreet way to lose weight,” said Hernández.Getty Images

“I would advise them to seek care for obesity treatment from their primary-care clinician and/or an obesity-medicine specialist, with the mindset that it’s a long-term relationship with follow-up and with multiple treatment options that we can now adjust to meet an individual’s needs,” she urged.

Philip Morris International, the owner of Zyn products, isn’t billing the pouches as a weight loss drug at all — it is users who are rediscovering the potential slimming effects of nicotine.

The company told Insider that the product is intended for consumers 21 years or older who already use nicotine and want to continue to using it.

Product analyst Andrea Hernández, author of the Snaxshot newsletter, referenced the youth-oriented marketing — which includes collecting points with every purchase, redeemable for must-haves like Apple AirPods — as one reason why Zyn has taken hold with younger people.

“It’s like… ‘This is something that I can literally buy in a gas station, that I’m still getting points on, that has this byproduct effect that it wasn’t intended for, but I’ve found it,” the expert said.

In a recent post, Hernández called Zyn “Ozempic for the masses,” due to its cheap price tag compared to that of the once weekly jab, which can cost up to $1,300 for some patients.

“People want to lose weight, but it’s something people can’t afford and don’t want to talk about,” Hernández said, referring to the Zyn craze. “This feels like a discreet way to lose weight.”

https://nypost.com/2024/05/18/lifestyle/affordable-ozempic-dupe-costs-just-5-at-your-local-gas-station/

Why Did The US Spend $320 Million On A Rube Goldberg Pier For Gaza?

 by Ann Wright via CommonDreams.org,

Instead of U.S. President Joe Biden marking a red line in the sand demanding that Israel allow aid into Gaza via ground transportation, his inept diplomatic team sent out a plea for help to the U.S. military.

While in the U.S. Army and Army Reserves for 29 years, I thought I had seen some pretty stupid things the military was told by politicians to do. It always begins with politicians deciding the easiest, most sensible solution to a problem would have too much political baggage and cost them votes in the next election. So, they look for a politically expedient solution, one that is invariably very expensive and convoluted.

Attempting a Military Solution for a Political or Diplomat Problem—AGAIN!!!

In this vein, all too often, politicians turn to the U.S. military for a solution to a non-military problem. Then some A-type personality in the military presents a hair-brained idea to the politicians, probably never thinking that the idea would be accepted. Then it is accepted to get the politicians out of a jam, and the next thing you know is that the Rube Goldberg, crazy idea is being funded.

This unbelievable scenario is what has happened with getting humanitarian aid into Gaza for the starving survivors of the Israeli genocide of Gaza. Instead of U.S. President Joe Biden marking a red line in the Israel/Gaza/Egypt sand demanding that Israel allow into Gaza the miles of tractor-trailer loads of food and medicine that have been stalled for months at the Rafah border crossing, Biden's inept diplomatic team sent out a plea for help to the U.S. military.

Palestinians in Gaza and citizens around the world will not forget that miles of supplies are just feet away from Gaza at the Rafah crossing and the U.S. will not use its pressure on Israel to open the gates at Rafah.

And the U.S. military, always looking for validation of its immense "capabilities," seized the opportunity to use one of its little-known assets—the Army's Joint Logistics Over the Shore, or JLOTS, system that provides bridging and water access capabilities—to help out the failed U.S. diplomatic efforts to get the U.S.'s "strongest ally in the Middle East" to end the starvation of hundreds of thousands of Palestinians in Gaza by letting the massive truck convoys filled with food and medicines into Gaza.

Normally used to move military equipment across rivers where bridges have been blown up—many times by the U.S. military itself—and sometimes to transfer military equipment from a ship onto shore, the U.S. Army's small navy swung into action and began sailing to the Mediterranean in U.S. Army ships filled with barges that can be locked together to form landing docks and causeways.

Rube Goldberg Complex of Construction and Transportation Ideas

In a Rube Goldberg complex of construction and transportation ideas, the U.S. military anchored to the sea floor three miles off the northern coast of Gaza a floating dock system onto which large cargo ships can dock.

Cargo ships will off-load pallets and possibly container loads of humanitarian assistance—long-life packaged food and medical supplies—on the three-mile off-shore dock. This cargo will have undergone inspection by Israeli authorities in the port of Larnaca, Cyprus, 200 miles from Gaza.

The inspection process involves Cypriot customs, Israeli teams, the U.S., and the United Nations Office for Project Services. The U.S. Agency for International Development has set up a coordination cell in Cyprus.

Two-thousand trucks to offload ONE ship driving 1,800 feet on a causeway that will be dangerously affected by tides, winds, and waves is a recipe for disaster.

From the cargo ships, food and medical supplies will be transferred into the backs of U.S. Army trucks (probably 2.5-ton trucks) that have arrived on the floating pier brought there by two types of smaller Army boats—Logistic Support Vessels, or LSVs, and Landing Craft Utility boats (LCUs). LSVs can hold 15 trucks each and the LCUs about five.

The loaded 2.5-ton trucks will be driven back onto the LSVs and motored three miles to the second floating pier system constructed by the U.S. military.

The trucks will then be driven off the LSVs onto the second pier and down a two-lane, 1,800-foot (six U.S. football fields long) causeway anchored onto Gaza land by the Israeli military. The causeway will be anchored onto Gaza shores by the Israeli military because the U.S. military is forbidden to have "boots on the ground" in Gaza.

The truckloads of food and medical supplies will then be driven somewhere... and supplies distributed by some organization... yet to be determined according to the latest news reports.

The empty trucks will then be driven back along the two-lane, 1,800-foot causeway to the floating pier where they will be driven into the small LSVs, and the LSVs then sailed back three miles to the larger off-shore pier and the process begun again. The long causeway should be a cause of alarm for drivers, as the winds and waves so dramatically affected the construction of the causeway that most of the causeway was put together in the calm waters of Ashdod, an Israeli harbor, after winds and waves made construction of the causeway in place off Gaza impossible. Parts of the causeway are now being towed 20 miles from Ashdod harbor to northern Gaza to be linked into place.

While Thousands of Truck Loads of Cargo Wait at the Rafah Border Crossing, It Will Take 2,000 Truck Loads to Empty Each 5,000 Ton Cargo Ship  

if a large cargo ship has 5,000 tons of food and medical supplies to be off-loaded, and if each truck can hold 2.5 tons of cargo, it will take 2,000 trucks to take the cargo from one ship. If there are 15 trucks on each LSV, then the LSVs will have to make 133 trips to get the trucks to the 1,800 foot causeway.

If the LCUs that hold only five trucks are mostly used, then it would take 400 trips to get the cargo to shore.

Two-thousand trucks to offload ONE ship driving 1,800 feet on a causeway that will be dangerously affected by tides, winds, and waves is a recipe for disaster.

A graphic, not to scale, showing how the aid delivery system will work. (Photo: Department of Defense)

Will Israel Bomb the Docks, Piers, and Causeway? Remember the USS Liberty!

The possibility of probability is high that Israeli military jets, drones, and artillery may "mistakenly" target the pier complex... or Hamas or other militant groups may decide that the U.S. complicity in the genocide of over 35,000 Palestinians in Gaza outweighs the meager food and medical supplies the U.S. is bringing into Gaza, which presents another aspect of the recipe for disaster for the U.S. Rube Goldberg pier.

U.S. military personnel should remember the Israeli attack on a U.S. military ship, the USS Liberty. In 1967, the Israeli military bombed and torpedoed a U.S. ship off Gaza, killing 34 and wounding 171, and almost sunk the ship. The U.S. cover-up for its ally Israel's brutal, lethal attack on a U.S. military ship continues to this day, as does the U.S. complicity in the Israeli genocide of Gaza.

The World Will Not Forget

Palestinians in Gaza and citizens around the world will not forget that miles of supplies are just feet away from Gaza at the Rafah crossing and the U.S. will not use its pressure on Israel to open the gates at Rafah, instead offering an expensive, idiotic solution to an easily solvable problem.

https://www.zerohedge.com/geopolitical/why-did-us-spend-320-million-rube-goldberg-pier-gaza

Billionaires Funding Protests Donate Millions To House Dems

 by Susan Crabtree via RealClearPolitics.com,

For President Biden and congressional Democrats, the fierce party division over the campus protests and the war in Gaza is full of warning signs during the 2024 election year. The unrest is unlikely to stop when universities break for the summer; protesters are pledging to disrupt the August Democratic National Convention planned to be held in Chicago. 

Most House Democrats have been reticent on the antisemitic protests and encampments roiling college graduations this month, while a handful have vocally defended or even celebrated the student protests as displays of protected free speech. 

Rep. Ilhan Omar, a Minnesota Democrat, said she was proud of her daughter, a Barnard College student who was suspended for participating in illegal protests and who was among 100 people arrested after demonstrations at Columbia University in April. Throughout the months of campus protests, members of the progressive “squad,” Reps. Rashida Tlaib of Michigan and Cori Bush of Missouri have applauded “courageous” anti-Israel student protestors while condemning efforts by university administrators and police to dismantle the encampments. 

A RealClearPolitics analysis of Federal Election Commission data shows one possible reason most Democrats are trying to avoid the campus fray: House Democrats’ reelection campaigns have accepted $6.5 million from three major political families, which have helped bankroll several student groups participating in the protests. The family members cut most of those checks over the last two years, although some of the donations to longstanding House members came over the last decade.

The names are well-known among Democratic funding circles: Soros, Rockefeller, and Pritzker. Yet before the anti-Jewish protests swept college campuses over the last few months, their financial ties to the student groups were not widely known. Illinois Gov. J.B. Pritzker, a member of the same wealthy Pritzker family, is not among the donors. 

Several investigative media reports over the last month have uncovered the extensive financial ties between these families and student groups involved in organizing anti-Israel protests and activism across the country predating the Oct. 7 Hamas terrorist attacks on Israel and in its aftermath and during Israel’s war against Hamas in Gaza. 

The donors to student groups include George Soros, a billionaire philanthropist and Democratic campaign contributor who helms the Open Society Foundation and his family members; the Pritzkers, the owners of Hyatt Hotels Corporation; and members of the famed Rockefeller family, including relatives of the wealthy American Banker and philanthropist David Rockefeller. The donations have either gone directly to student groups involved in campus demonstrations or to umbrella foundations and organizations, which have, in turn, channeled the funds to the protestors. 

The House Democratic Congressional Committee and the House Majority PAC, which was founded by former Speaker Nancy Pelosi and is directly affiliated with the House Democratic leadership, collected most of those funds, nearly $5.5 million by those two Democratic campaign entities alone, FEC records show. 

Meanwhile, 30 House Democrats, including Democratic Leader Hakeem Jeffries and other members of the leadership, received a combined total of $856,858 from the Soros, Pritzker, and Rockefeller families, while a dozen Democratic candidates in competitive races received a total of $139,000. RCP did not examine Senate recipients. 

The House members in competitive races who received funds from at least one of the three families include Reps. Mary Peltola of Alaska, Mike Levin of California, Yadira Caraveo of Colorado, Johana Hayes of Connecticut, Eric Sorensen of Illinois, Frank Mrvan of Indiana, Sharice Davids, Jared Golden, Hillary Scholten, Angie Craig of Minnesota, Don Davis, Chris Pappas of New Hampshire, Gabe Vasquez, of New Mexico, Susie Lee of Nevada, Steven Horsford of Nevada, Paty Ryan of New York, Marcy Kaptur of Ohio, Andrea Salinas of Oregon, Susan Wild of Pennsylvania, and Matt Cartwright of Pennsylvania. 

Craig’s campaigns have received the most of any other House member from the three families: $96,490 since 2018. Lee’s campaign received the second most: $75,000 since 2017. 

The Democratic candidates who accepted donations from at least one of the three families include Kirsten Engel in Arizona; Adam Gray, Rudy Salas, George Whitesides, and Will Rollins in California; Lanon Baccam in Iowa; Tony Vargas in Nebraska; Lauren Gillen, Mondaire Jones, and Josh Riley in New York; Ashley Ehasz in Pennsylvania; and Michelle Vallejo in Texas.

Neither the DCCC nor any of the House members and candidates responded to RealClearPolitics’ questions about whether they had any concerns about the financial ties between the Soros, Pritzker, and Rockefeller families to these student groups. 

Several organizations have played key roles in pro-Palestinian student activism and protests and have received donations from Soros, Pritzker, and Rockefeller family members. The U.S. Campaign for Palestinian Rights, a pro-Palestinian advocacy group, has received at least $700,000 in Open Society Foundation grants since 2018 and $355,000 from the Rockefeller Brothers since 2019. 

In 2023, the USCPR had three fellows – Nidaa Lafi, Craig Birckhead-Morton, and Malak Afaneh – all of whom have figured prominently in the nationwide protests, the New York Post reported in late April. The group provides up to $7,800 for its community-based fellows and between $2,880 and $3,660 for its campus-based fellows for spending at least eight hours a week organizing campaigns led by Palestinian organizations.

While all were involved in student protests over the last several months, the University of California at Berkeley’s Afanah, co-president of Law Students for Justice in Palestine, made the most headlines. Afanah commandeered a microphone during a graduation dinner at the law school dean’s home to speak out against Israel’s war in Gaza. She claimed a First Amendment right to disrupt the gathering and then accused the dean’s wife of assaulting her when she forcefully asked her to leave. 

The Open Society Foundations defended its funding of these groups and their right to “peacefully protest” in an April 26 X.com post. 

“We have a long history of fighting antisemitism, Islamophobia, and all forms of racism and hate, and have advocated for the rights of Palestinians and Israelis and for peaceful resolution to the conflict in Israel and the Occupied Palestinian Territories,” the Foundations said. 

“Our funding is a matter of public record, disclosed on our website, fully compliant with U.S. laws, and is part of our commitment to continuing open debate that is ultimately the only hope for peace in the region,” the organization asserted. 

Jewish Voice for Peace and IfNotNow are two additional organizations deeply involved in the student protests and backed by the Tides Foundations, which is Soros-funded. Jewish Voice for Peace, which openly describes itself as anti-Zionist, has also received $500,000 in funds from the Rockefeller Brothers Fund over the last five years. David Rockefeller Jr. sits on the Rockefeller Brothers’ board. The group has separately provided grants to both the Tides Foundation and the Tides Center, as Politico reported in early May

The Pritzkers founded the Libra Foundation, which seeds smaller nonprofits, many of which have participated in pro-Palestinian marches, according to the same Politico report. One of them is the Climate Justice Alliance, which has labeled President Biden “Genocide Joe” for his handling of Israel’s war against Hamas in Gaza. 

Others benefitting from Pritzker largesse include Black Organizing for Leadership and Dignity, which has helped promote anti-Israel protests, and the Immigrant Defense Project, which participated in a protest in D.C. earlier this year in which police arrested a number of participants. The Pritzkers also help financially support the Tides Foundation, which funds other small left-wing groups, including Adalah Justice Project, a prominent participant in the Columbia University protests and encampment, which police disbanded in early May. 

House Republicans have launched multiple investigations into the funding of the campus protests and encampments. Earlier this week, the chairs of two GOP-led House committees, the Education and the Workforce and the House Oversight and Accountability panels, sent Treasury Secretary Janet Yellen a letter requesting all suspicious activity reports, or SARs, connected to 20 organizations that have reportedly led, financed, and participated in the antisemitic protests on college campuses. SARs are documents that financial institutions and other professionals file with the Treasury’s Financial Crimes Enforcement Network to flag law enforcement to potential instances of money laundering or terrorist financing. 

“It’s no coincidence that the day after the October 7 Hamas terrorist attack, antisemitic mobs began springing up on college campuses across the country,” Rep. Virginia Foxx, who chairs the Education and the Workforce Committee, said in a statement.

 “These protests have been coordinated and well-organized, indicating that outside groups or influences may be at play. American education is under attack. It’s critical that Congress investigates how these groups, who are tearing apart our institutions, are being funded before it’s too late.” 

House Oversight Chairman James Comer pledged that his committee would follow the money trail and stressed that the antisemitism “thriving” on many college campuses “must not go unchecked.” 

Topping the list that Foxx and Comer sent Yellen is Students for Justice in Palestine, or SJP, which has close ties to several anti-Israel organizations. After the Oct. 7 attacks, Students for Justice in Palestine’s national steering committee distributed a “tool kit” for activists that proclaimed, “glory to our resistance” and included a template for an advertisement showing protesters beneath a Palestinian flag. The image contained a paraglider, an apparent tribute to Hamas’ use of paragliders who slaughtered 360 youthful concert-goers, raped others, and took 44 people hostage during the Oct. 7 attack. That tool kit drew criticism from the Anti-Defamation League, which accused it of “celebrating terrorism.” 

Students for Palestine has since been banned or suspended by Brandeis, Columbia, and George Washington University, among other colleges and universities. During his presidential campaign, Florida Gov. Ron DeSantis banned the group from state campuses, referring to their alleged ties to Hamas.

“We had a group of Students for Justice in Palestine,” DeSantis said. 

“They claimed solidarity with Hamas. We deactivated them. We were not going to use tax dollars to fund jihad.”

2016 report from the Cohen Center for Modern Jewish Studies at Brandeis stated that having a chapter on campus is “one of the strongest predictors of perceiving a hostile climate toward Israel and Jews.” 

The Foundation for Defense of Democracies’ Jonathan Schanzer, a former Treasury official responsible for designating numerous terrorist financiers, said his organization has been watching the financial network behind Students for Justice in Palestine for several years. The group, he said, has an umbrella organization known as Americans Muslims for Palestine, or AMP, a nonprofit that was previously based in Chicago but more recently moved to Falls Church, Virginia. For the last several years, AMP has been embroiled in litigation, accusing it of being an “alter-ego” or shell organization for the Islamic Association for Palestine, or IAP, a disbanded organization linked to Hamas. 

In 2023, Schanzer testified before the House Ways and Means Committee that IAP had received numerous checks and deposited them into Hamas’ bank account, information uncovered during the litigation. In some cases, the deposits included the memo line “for Palestinian martyrs only,” Schanzer noted. 

Hatem Bazian, AMP’s founder, was a frequent speaker at IAP forums, and Osama Abuirshaid, who edited IAP’s newspaper, is now AMP’s executive director, Schanzer said. In addition, Abuirshaid has published articles in English and Arabic praising Hamas, noting in them that he has communicated with Hamas leader Mousa Abu Marzook. 

AMP created Students for Justice in Palestine, which started with just a handful of schools and has now expanded to 200 U.S. campuses with chapters. The group is a loosely connected network of autonomous chapters with no named leader. The structure allows it to avoid registering as a nonprofit and filing tax documents. Bazian, who founded the first chapter 30 years ago at the University of California at Berkeley, has described the student organization as “a symbolic franchise without a franchise fee.” 

Bazian, who is now the chairman of American Muslims for Palestine’s board and a lecturer at Berkeley, has downplayed its ties to the student organization. He says AMP has only provided printed materials and offered grants for students to attend conferences or host speakers but has no supervisory role or control over the Students for Justice in Palestine. 

Schanzer, however, strongly disagrees. While he stresses that FDD has not produced any evidence of present criminal wrongdoing implicating AMP, he argues that AMP and its organizers deserve intense scrutiny from members of Congress. AMP, he said, has, over the last two decades, provided checks to students at Northwestern, DePaul, and Loyola universities, among others. 

Last year, Bazian curiously criticized CNN’s Jake Tapper’s “racist” coverage of Rep. Tlaib, arguing in a post from his own X.com account that, “As Jews who believe in human rights and justice, we demand you do better.” Schanzer notes that Bazian is Muslim, not Jewish, and the tweet has led to suspicion that Bazian thought he was logged into Jewish Voice for Peace’s account but mistakenly tweeted from his personal account. 

Nine Americans and Israeli survivors and victims of the Oct. 7 Hamas attacks are suing AMP and Students for Justice in Palestine, alleging that groups collaborated with Hamas to legitimize the Hamas attacks and provide public relations services for the terrorist organization. Meanwhile, the University of Florida chapter of Students for Justice in Palestine sued the state, challenging the Chancellor of the State University System’s order to state universities to deactivate the student group. 

https://www.zerohedge.com/political/billionaires-funding-protests-donate-millions-house-dems

Palpitations and PVCs: Why Worry?

 

Matthew F. Watto, MD: Welcome to The Curbsiders. I'm Dr Matthew Frank Watto, here with America's primary care physician, Dr Paul Nelson Williams. This was a classic podcast episode, where we talked about palpitations with Dr Josh Cooper. Tell me, Paul, what was your favorite take- home point from our conversation?

Paul N. Williams, MD: We talked about premature ventricular contractions (PVCs). We often think of PVCs as a symptom of a sick heart, and not as actually causing cardiac pathology. We see them on an EKG and we think, That's weird. So we check the patient's electrolytes to make sure we're not missing something, then we go on our merry way and assume that we've done the most that we can. Dr Cooper was sharing with us that a PVC burden > 10% can actually lead to cardiomyopathy. PVCs are often dismissed in the setting of normal electrolytes and a bare-bones workup, and not thought about further. But they probably warrant investigation by someone who deals with them all the time, whether we're talking ablation or medications or other options. Since our podcast, I've been taking PVCs more seriously than I had up to that point.

Watto: Me too. When I read a Holter report, I look at the PVC burden. If it's < 1%, it's not as worrisome as if it's 10%. Dr Cooper told us that the heart beats 100,000 times a day. So, 10% would be 10,000 PVCs a day, and that can be enough to cause cardiomyopathy, which is scary. 

Sinus tachycardia is another thing that people tend to write off: Oh, it's just sinus tachycardia. I'm terrified of sinus tachycardia. If I have a patient in clinic with a heart rate of 115 beats/min at rest, I'm worried. Why is their heart rate 115 at rest? Maybe it's because you walked in the room and you're America's primary care physician — just to be in your presence gives them tachycardia. But you need to figure that out. There are so many reasons for that. I don't know about you, Paul, but I do investigate. 

Williams: From time to time, I will ask a trainee about a patient's tachycardia, and they will say the patient is always tachycardic. That is the least reassuring thing you could say — it sounds really bad. So I agree with you. It's not unusual to be a little bit tachycardic when you're at the doctor's office or in the presence of greatness. But do your due diligence and make sure you aren't missing some underlying cause.

Watto: Dr Cooper mentioned the common things that can cause tachycardia: anxiety, pain, dehydration, or a medication the patient is taking. You might need to check a TSH to make sure it's not hyperthyroidism. I once diagnosed Graves disease before I even examined the patient because I walked in and the heart rate was 125 at rest and the patient was kind of tremulous. I thought, I bet this person has hyperthyroidism and it ended up being Graves disease.

There's also a diagnosis of exclusion — I don't know that I've ever made it — but it's basically idiopathic inappropriate sinus tachycardia. Depending on how long that goes on, if it's fast enough, it can lead to cardiomyopathy. So, I wouldn't just throw a beta-blocker at that. Investigate it, make sure you're confident about why this tachycardia is happening and is it happening outside your office? If so, it might be worth sending them to cardiology. 

Let's say you are working up a patient who came in with palpitations. If you find PVCs, that's probably what the patient is feeling. Or maybe you find sinus tachycardia. But what if you find nothing? What do we do then? 

Williams: I really liked Dr Cooper's framing of this. Their symptoms mean that something is going on. You can have a conversation saying that you've done a very thorough cardiac workup, and you are fairly certain that the symptoms are not coming from their heart, and that's good news. That means their heart, at least, is not going to kill them. 

But even if this is something like anxiety, anxiety is a medical condition that warrants evaluation and appropriate treatment. So rather than saying, Well, don't worry, this is nothing to worry about, we need to acknowledge that the symptoms are present, something is causing them, and we need to figure out what to do next. Dr Cooper then makes his best guess and connects them with whatever specialist that requires. He may even send them back to their primary care doctor, who might be best equipped to manage it. But rather than saying Don't worry, everything's fine (because that doesn't mean their symptoms are gone), we should tell the patient that their symptoms are probably not cardiac, and we will figure out what to do next to find out what is causing the symptoms. 

Watto: In my experience, a lot of patients who come in with palpitations are really looking for reassurance. They have a sense that it's probably nothing too serious, because in some cases it's been going on for years. It's kind of a fleeting feeling, and they have never passed out or anything — they can exercise. They just want you to say, Maybe this is nothing. And once you get that monitor data and you can correlate their symptoms with their rhythm and show them that it's just sinus rhythm, many patients are reassured by that, and I am too. But if it isn't, you can offer them anxiety treatment, like Dr Cooper said. Patients don't like it when you just blame everything on anxiety, so taking them through it and showing them that you are taking it seriously helps. You can still offer treatment even if you don't find a dangerous cardiac rhythm. 

If you want to hear more about palpitations, because we did discuss a lot more in our podcast with Dr Cooper, then click here

https://www.medscape.com/viewarticle/palpitations-and-pvcs-why-worry-2024a1000904

'Texas Team's Wastewater Surveillance Can Pick Up Concerning H5N1 Mutations'

 While the CDC's recently launched wastewater dashboard

opens in a new tab or window reports levels of influenza A, a team in Texas is getting far more granular in its wastewater monitoring.

The team at the Texas Epidemic Public Health Institute (TEPHI) in Houston can detect H5N1 specifically -- and it can even pick up potentially concerning genetic changes that could provide an early warning about adaptation to humans.

That kind of surveillance could sound an alarm well before standard symptomatic surveillance like emergency department visits or hospitalizations, which would only pick up an H5N1 outbreak after it's already spreading in people.

"This allows us to monitor over time for the emergence of new mutations or strains" of H5N1, said Eric Boerwinkle, PhD, director of TEPHI and dean of UTHealth Houston School of Public Health. "We can look for mutations that could increase virulence or increase transmission, even transmission to and among humans."

For instance, the team can look for the hallmark E627K mutationopens in a new tab or window in H5N1's polymerase basic protein 2 (PB2) gene, which has been identified in human cases of the disease -- including the dairy cattle worker in Texasopens in a new tab or window whose only symptom of infection was conjunctivitis.

"Going forward, a major concern will be looking at the different alleles and seeing if there's this hallmark mutation or potentially others," said Michael Tisza, PhD, of TEPHI and Baylor College of Medicine in Houston. "This technology would allow us to do that."

The E627K mutation hasn't turned up in their surveillance yet, but the team is keeping an eye out for it, they said.

Detecting an early signal like that would enable TEPHI to work with its public health partners who can then "direct other resources to look at things like syndromic surveillance to better assess what's going on in those locations as far as the sources go," said Blake Hanson, PhD, of TEPHI and UTHealth in Houston.

Hanson described wastewater monitoring as having varying levels of resolution. The widest resolution is detecting influenza A, which covers a wide range of viruses including H2N3, H1N1, and H5N1. That's what the CDC's dashboard monitors.

While the CDC's wastewater monitoring efforts may be helpful right now -- during the late spring and the summer when it would be unusual to have high levels of influenza A circulating -- it won't work as well during the regular flu season in fall and winter.

"When symptoms and our seasonal influenza levels are low, it's a reasonable proxy for other strains of influenza A circulating in wastewater," Hanson said.

The next level would be detecting the H5 gene using polymerase chain reaction (PCR). That's what a team from Verily Life Sciences, Emory University, and Stanford University recently did, as reported in a medRxiv preprintopens in a new tab or window. They detected influenza A at 59 wastewater treatment plants in the U.S. this spring. They then searched for -- and found -- the H5 gene using PCR at three wastewater treatment plants with a positive flu A signal. All three plants were in a state with confirmed outbreaks of H5N1 in dairy cattle, they reported.

"They can only confidently say that's H5, where our method has a third level of resolution where we can represent the entirety of the genome for the H5N1 strains," Hanson said.

TEPHI's virome sequencing would provide the most granular look, detecting H5N1 specifically, along with any potential mutations in its genome.

Tisza said they only need about a 50-mL sample of wastewater to detect sequences from any given viruses, as long as they're present at about 100 or more genome copies per mL.

The team captures viral genetic material from the sample, then runs it through a sequencer -- the Illumina NovaSeq machine in this case -- which generates a readout of those sequences.

They then use bioinformatics software to identify viruses from those genomes and genome fragments, also scanning for interesting mutations. With COVID, for instance, they're able to see new strains as they come to dominate, Tisza said.

The team recently detected H5N1 in wastewater in nine Texas cities during a sampling period of March 4 through April 25, and they published their findings as a preprint in medRxivopens in a new tab or window. For that paper, Tisza and Hanson both separately confirmed the sequences manually to be sure they were dealing with H5N1.

TEPHI has been conducting wastewater surveillance since May 2022, testing samples from plants across Texas on a weekly basis, and has detected more than 400 human and animal viruses to date.

The group's methodology is public, published in Nature Communicationsopens in a new tab or window in October 2023.

"All our methods are published, and we welcome others to adopt these techniques because we think they're incredibly powerful," Hanson said, particularly for H5N1 surveillance.

The team continues to observe H5N1 sequences in their wastewater sampling, Boerwinkle said. The point of the surveillance is to help keep public health prepared for a potential outbreak: "If we're prepared, we can keep the economy strong," he added.

Andrew Pekosz, PhD, of Johns Hopkins University in Baltimore, who isn't involved in TEPHI, said the team's work is "an important part of the 'pyramid' of analysis that we need to do with wastewater."

"First, you need easy rapid tests to identify the small percentage of systems that might have a signal for influenza," Pekosz told MedPage Today in an email. "You then need to take those samples and do an in-depth analysis by sequencing to clearly identify what kind of influenza ... is driving that positivity. If your sequencing is good enough, you can even identify the proportion of the sample that has important mutations like the PB2 mutation."

"It's all about using the various virus surveillance tools to maximize efficiency and minimize cost," he said.

https://www.medpagetoday.com/special-reports/exclusives/110169