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Saturday, September 30, 2023

COVID-19 Virus Infects Coronary Vasculature

A new study finds SARS-CoV-2 directly infects the coronary vasculature and causes plaque inflammation, which could help explain why people with COVID-19 have an increased risk for ischemic cardiovascular complications up to 1 year after infection.

METHODOLOGY:

Researchers obtained 27 coronary autopsy specimens from eight patients who died from COVID-19, mean age 70 years and 75% male. All had coronary artery disease and most had cardiovascular risk factors such as hypertension, were overweight or obese, and had hyperlipidemia and type 2 diabetes.
All but one patient, who was pronounced dead before hospital admission, were hospitalized for an average of 17.6 days.
To identify SARS-CoV-2 viral RNA (vRNA) in the autoptic coronary vasculature, researchers performed RNA fluorescence in situ hybridization (RNA-FISH) analysis for the vRNA encoding the spike (S) protein; they also probed the antisense strand of the S gene (S antisense), which is only produced during viral replication.

TAKEAWAY:

The study found evidence of SARS-CoV-2 replication in all analyzed human autopsy coronaries regardless of their pathological classification, although viral replication was highest in early-stage lesions that progress to more advanced atherosclerotic plaques.
Findings indicated that more than 79% of macrophages (white blood cells that help remove lipids) and over 90% of foam cells (lipid-laden macrophages that are a hallmark of atherosclerosis at all stages of the disease) are S+, and more than 40% of both cell types are S antisense+, indicating SARS-CoV-2 can infect macrophages at a high rate.
SARS-CoV-2 induced a strong inflammatory response as evidenced by release of cytokines (including interleukin-1 beta and interluekin-6 that are linked to myocardial infarction) in both macrophages and foam cells, which may contribute to the ischemic cardiovascular complications in patients with COVID-19.

IN PRACTICE:

"Our data conclusively demonstrate that SARS-CoV-2 is capable of infecting and replicating in macrophages within the coronary vasculature of patients with COVID-19," write the authors, adding that SARS-CoV-2 preferentially replicates in foam cells compared to other macrophages, suggesting these cells "might act as a reservoir of SARS-CoV-2 viral debris in the atherosclerotic plaque."

SOURCE:

The study was led by Natalia Eberhardt, PhD, postdoctoral fellow, Department of Medicine, Division of Cardiology, New York University, New York City, and colleagues. It was published online September 28 in Nature Cardiovascular Research.

LIMITATIONS:

Findings are relevant only to the original strains of SARS-CoV-2 that circulated in New York City between May 2020 and May 2021, and are not generalizable to patients younger and healthier than those from whom samples were obtained for the study.

DISCLOSURES:

The study received support from the National Institutes of Health (NIH). The authors report no relevant financial relationships.

https://www.medscape.com/viewarticle/996964

Residential Move After a Heart Attack Raises Risk for Death

Moving from one residence to another after an acute myocardial infarction (AMI) significantly increases the risk for death or transition to a long-term care facility as an end-of-life measure, data suggest.

In a prospective study that followed more than 3000 patients with AMI over two decades, each residential move was associated with a 12% higher rate of death.

Dr David Alter

"This study determined that residential mobility was more important than any other social factor that we studied," investigator David Alter, MD, PhD, chair of cardiovascular and metabolic research at the University Health Network–Toronto Rehabilitation Institute and associate professor of medicine at the University of Toronto, told Medscape Medical News.

The results were published online September 17 in the Canadian Journal of Cardiology.

Moving and Mortality

"There's been very little work, surprisingly, on what happens when individuals move from community to community," said Alter. "It is that movement from community to community that is a factor within the social context that needs to be explored better. To the best of our knowledge, up until our study, it has been studied very briefly in the literature."

The prospective cohort study sample included 3369 patients who had an AMI between December 1, 1999, and March 30, 2023. The investigators followed participants until death or the last available follow-up date of March 30, 2020. They defined a residential move as a relocation from one postal code region to another.

The investigators drew data from multiple sources, including the prospective, observational Socio-Economic Status and Acute Myocardial Infarction study, which encompassed more than 35,000 patient life-years following hospitalization for a first heart attack in Ontario. Mortality data were collected from the Ontario Registered Persons Data Base. Other sources included Statistics Canada for information on neighborhood income, the Canadian Institutes for Health Information for patients' clinical factors and comorbidities, and the Ontario Health Insurance Plan (OHIP) database for physician visits. Information on long-term care admissions came from the Continuous Care Reporting System-Long Term Care, OHIP, and the Ontario Drugs Benefit databases, the latter of which also provided information on medication prescriptions for individuals aged 65 years and older.

Patients' ages ranged from 19 to 101 years (median age, 65 years). Sixty-nine percent of patients were men. Of the study population, 1828 patients (54.3%) had at least one residential move during the study period. Approximately 87% died in the community or moved from home into a long-term care facility as an end-of-life destination. Overall, 84.8% of patients who were admitted to long-term care facilities died.

The study also tracked the socioeconomic status of persons living in the postal code regions from and to which patients moved. About 32% of patients moved to a neighborhood with a lower socioeconomic status, and 30.5% moved to an area with a higher socioeconomic status.

Each residential move was associated with a 12% higher rate of death and a 26% higher rate of long-term institutionalization for end-of-life care. In unadjusted analyses, the rate of death was almost double for those who moved more frequently: 44.3% for those who moved two or more times, vs 24.8% for those who moved once in 10 years.

Accounting for a multitude of variables, such as the socioeconomic status of areas that patients moved between, is a strength of the study, said Alter. But the study lacked information about why people moved.

"Where this study has a huge amount of strength is that it was designed specifically to really understand a patient's clinical and psychosocial profile at the start of their journey, their first AMI. But the fact that we took it from heart attack onward is also a strength because it characterizes and anchors a clinical context in which we were following patients out," said Alter.

"An Important Marker"

Commenting on the findings for Medscape, Paul Oh, MD, medical director of the cardiovascular disease prevention and rehabilitation program at University Health Network, said, "This is a very well-designed study and analysis from a cohort that has provided important insights about the role of socioeconomic factors and long-term outcomes post MI [myocardial infarction] over many years." Oh did not participate in the study.

Dr Paul Oh

"A few covariates that could impact on outcomes, like institutionalization, were not available to include in adjusted analyses — eg, functional status, frailty, mild cognitive changes, and availability of social supports in the home," he said.

The findings add another variable that cardiologists who care for post-MI patients need to be aware of, Oh added. "Clinicians need better awareness that the need to change residence is an important marker of changing health status and may portend end-of-life events in the near future. The need to change residence can signal an important change in physical, cognitive, and social circumstances that needs to be further explored during clinical encounters, with the goal of identifying and addressing any potentially reversible issues and identifying additional supports that may help that individual continue to live independently in their own home."

The study was supported by ICES, which receives funding from the Ontario Ministry of Health. The investigators have disclosed no relevant financial relationships. Oh serves on research boards for Lilly and Novartis and receives research funding from Apple.

Can J Cardiol. Published September 17, 2023. Abstract

https://www.medscape.com/viewarticle/996952

TikTok promotes illegal steroids to teens who want to look like Captain America, nonprofit warns

TikTok has become a key marketing channel for promoting steroids and other bodybuilding drugs to millions of the video-sharing site’s users, according to a damning report.

The study by the nonprofit Center for Countering Digital Hate says popular videos encouraging the use of the products for aesthetic or athletic gain are being posted by influencers who often downplay the risks associated with them.

“They’re being marketed to young men by influencers who are deliberately saying, ‘If you want to be like Captain America, you’ve got to take these drugs’,” CCDH founder and CEO Imran Ahmed said after the study was released Thursday.

The Chinese-owned app — which has 87 million users in the US, many of them under age — has been accused of promoting a “toxic” diet culture, encouraging frivolous spending, and pushing Chinese propaganda.

The nonprofit’s study focused on TikTok videos which promoted a class of steroid-like drugs (SLDs) that include anabolic-androgenic steroids (AAS), peptides, and Selective Androgen Receptor Modulators (SARMs).

“Videos with hashtags promoting SLDs were viewed by US users up to 587 million times in the last three years, including up to 420 million views from US users aged under 24,” according to the CCDH.

TikTok spokesperson Ben Rathe criticized the report, saying the group’s methodology doesn’t distinguish between harmful videos and positive content that talks about recovery from steroids or their side effects. It’s not possible for the CCDH to know that based on the type of data they’re presenting and the sheer volume of videos that are on TikTok, he said.

One video of a man working out displayed text that read: “Hear me out. Everyone always hating on steroids bro. You know who took steroids? Captain America. Bro literally is a morally grounded character and he injected super soldier serum.”

Another showed a young man deadlifting with text that said his mother asked: “First protein powder, now creatine. What’s next…steroids?” The clip then cuts to a clip of bodybuilder Ronnie Coleman saying “Yeah buddy!”

Adolescents who use protein powder supplements may have as much as a “five-fold higher risk of new use of steroids and other muscle-building products,” CCDH claimed.

One TikTok nodded to the link between protein powder and steroid use, showing a man discovering a vile of drugs in his whey protein powder container. “I found something in the whey,” the post said in a play on words.

A slew of comments called out that the mysterious bottle of drugs is “something called roids.”

And in a particularly disturbing post that has garnered over 2.4 million views, a teen who said he was 13 years old documented his “30-day steroids transformation” where a slideshow of images showed him becoming increasingly muscular.

Among the SARMs gaining popularity on the ByteDance-owned app is MK-2866. Though it’s an SLD that’s banned from being sold or purchased for humans, MK-2866 is still being sold for recreational use by third-party supplement companies.

@tomasobeid
Lightweight! #ronniecoleman #yeahbuddy #fyp #gymtok #steroids #protein #foryou #creatine #tren #motivation #relatable
♬ Part of me hardstyle remix – Raskal

Videos using the hashtag #MK-2866 have amassed nearly 3 million views on TikTok, and one popular post with 42,000-plus views promotes the supplement as a pill that can increase lean muscle, improve strength and endurance, and reduce recovery time.

Another SARM making its way into the limelight: Trenbolone, or simply “tren,” which is popular among bodybuilders, but has become even more sought after by non-weightlifters thanks to its promotion on TikTok, CCDH claims.

One account that posts under the username @teach_me_roids claims that the unnamed user’s workout and supplement-taking tips can help young boys bio-hack their body through puberty “in order to suppress their estrogen levels, which he claims will increase their height and genital size.”

The account holder also boasts a 10% discount code for Swiss Chems — a site that claims to be “a trusted source for high-quality research chemicals” — in their TikTok bio.

On Swiss Chems’ website, there’s an entire section dedicated to SARMs.

The hashtag #Tren was among the 30 tags that the CCDH found featured videos relating to the abuse or sale of SLDs, “contributing to a culture where abusing the drugs to alter body shape and size is normalized.”

For reference, 19.8 billion videos use the hashtag #Tren.

The CCDH report follows a warning issued by the Food and Drug Administration in April about performance-enhancing drugs being marketed to teenagers and young adults on social media platforms

The CCDH urged policymakers at the end of its report to “close loopholes through which sites selling SLDs can operate online.”

They’re also calling on TikTok to better enforce its ban on content that promotes the use of recreational drugs.

Rathe, the TikTok spokesperson, said content that sells or depicts SARMS will be removed by the company when it’s detected.

https://nypost.com/2023/09/29/tiktok-promotes-illegal-steroids-to-teens-nonprofit-warns/

How colleges brazenly get around Supreme Court’s affirmative action ruling

Now that race-based affirmative action in college admissions has been overturned in a landmark Supreme Court decision, colleges, and universities are scrambling to diversify their student bodies without running afoul of civil rights law.

Several top-ranked schools are rolling out a slew of new essay prompts that fish for demographic information with leading questions — and some are going so far as to directly ask about prospective students’ race.

Johns Hopkins University in Baltimore asks students to “tell us about an aspect of your identity (e.g. race, gender, sexuality, religion, community, etc.) or a life experience that has shaped you as an individual…”

Meanwhile, Rice University in Houston asks applicants: “What perspectives shaped by your background, experiences, upbringing, and/or racial identity inspire you to join our community of change agents at Rice?”

And every single Ivy League school has added an application question about students’ backgrounds, according to college admission expert and Ivy Coach managing partner Brian Taylor.

It’s a clever loophole: ask about race … without expressly requiring students to write about their race.

And some schools aren’t even remotely subtle about their motivations.

Sarah Lawrence College in Bronxville, New York, even cites the Supreme Court’s decision in its essay prompt.

“In the syllabus of a 2023 majority decision of the Supreme Court written by Chief Justice John Roberts, the author notes: ‘Nothing prohibits universities from considering an applicant’s discussion of how race affected the applicant’s life, so long as that discussion is concretely tied to a quality of character or unique ability that the particular applicant can contribute to the university,’” the Sarah Lawrence application reads.

“Drawing upon examples from your life, a quality of your character, and/or a unique ability you possess, describe how you believe your goals for a college education might be impacted, influenced, or affected by the Court’s decision.”

These schools are pushing the envelope as far as possible — and the federal government seems to be egging them on.

The Biden Administration’s Department of Education is even weighing in, giving colleges tips on how to “enhance racial diversity” in higher education without running afoul of the Supreme Court ruling.

In a report released Thursday, the administration urged schools to increase targeted outreach to non-white communities and give “meaningful consideration in admissions to the adversity students have faced … including racial discrimination.”

Taylor says these new essay prompts leave many students grasping at straws: “They’re often confused because they think to themselves, ‘If I’m not an underrepresented minority if I’m not a member of the LGBTQ community, how do I answer this question?’”

Schools are right that diversity is important. We don’t want colleges filled only with ultra-privileged students who could afford the best SAT tutors — or whose families forked over a massive donation.

However, implicitly asking about race makes students feel pressured to write about their ethnicity rather than their character to help their admissions prospects.

“A number of students are disappointed that they feel they have to write about their race in their essay prompt. And they’re correct to think so,” Taylor said, referring to increasing their admissions odds. “They need to let it be known that they are Black or Latino or Native American, and they need to let it be known how that shaped who they are.”

Bunmi Omisore, a 19-year-old Duke freshman, told The Post she’s glad she was in the last class to apply before the ruling for this very reason.

“I wrote about things like my family, ‘The Bachelor’ and biking in my application essays,” Omisore said. “But if I were applying now, I think I would have to forfeit writing about some of those parts of my personality and opt for writing about things that I don’t really like thinking about, like my experiences with racism or my racial trauma.

“You’re going to be having a lot of minority students basically telling a single story, and it’s not fair because that takes away from the uniqueness of the applicant,” she added.

Not only is this tactic a brazen abuse of a legal loophole — it also reduces students to their immutable characteristics and incentivizes them to performatively boil themselves down to their race. That’s the opposite of progress.

Abolishing legacy admissions — which disproportionately favor white applicants — and implementing socioeconomic affirmative action, which would boost disadvantaged students of all backgrounds, are two better ways to promote diversity

Colleges need to figure out how to do this without indulging in race essentialism.

https://nypost.com/2023/09/30/how-colleges-are-skirting-supreme-couts-affirmative-action-ruling/

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