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Review Article| Volume 14, ISSUE 1, P29-39, March 2022
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Armando Del Prete, MD
Armando Del Prete
Corresponding author. Division of Cardiology, Santa Maria Goretti Hospital, Via Guido Reni 1, Latina, Italy.
Division of Cardiology, Santa Maria Goretti Hospital, Via Guido Reni 1, 04100 Latina, Italy
Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
Francesca Conway, MD
Francesca Conway
London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
Domenico G. Della Rocca, MD, PhD
Domenico G. Della Rocca
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 000 N Interstate Hwy 35 Suite 720, Austin, TX 78705, USA
Giuseppe Biondi-Zoccai, MD, MStat
Giuseppe Biondi-Zoccai
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Corso della Repubblica 79, 04100 Latina, Italy
Mediterranea Cardiocentro, Via Ponte di Tappia 82, 80133 Naples, Italy
Francesco De Felice, MD
Francesco De Felice
Division of Cardiology, San Camillo Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy
Carmine Musto, MD, PhD
Carmine Musto
Marco Picichè, MD
Marco Picichè
Department of Cardiac Surgery, San Bortolo Hospital, Viale Ferdinando Rodolfi 37, 36100 Vicenza, Italy
Eugenio Martuscelli, MD, PhD
Eugenio Martuscelli
Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
Andrea Natale, MD
Interventional Electrophysiology, Scripps Clinic, 9898 Genesee Ave Fl 3, La Jolla, CA 92037, USA
Metro Health Medical Center, Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA
Francesco Versaci, MD
Published:October 30, 2021DOI:https://doi.org/10.1016/j.ccep.2021.10.004
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Myocardial injury
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily infects the respiratory tract but can broadly affect the cardiovascular system too.
SARS-CoV-2 can damage the myocardium by direct viral invasion or indirectly through inflammation, endothelial activation, and microvascular thrombosis.
Myocardial injury affects about one-quarter of patients with COVID-19, even those without prior cardiovascular disease.
Patients with COVID-19 who experience myocardial injury have higher hospital mortality rates and can present long-term complications.
The diagnosis of myocardial injury can be particularly challenging in the context of COVID-19, particularly in patients with advanced disease.
The new coronavirus-associated disease 2019 (COVID-19), due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents an unprecedented public health emergency that has been accompanied by a global health crisis. Although SARS-CoV-2 primarily infects the respiratory system, causing a variety of clinical presentations, from asymptomatic infection to interstitial pneumonia and severe acute respiratory distress syndrome (ARDS), the cardiovascular implications are also significant, especially in their contribution to disease morbidity and mortality.
When the cardiovascular system is affected, complications can include myocardial injury, acute myocardial infarction (MI), heart failure, myocarditis, dysrhythmias, and venous thromboembolic events.
Long B.
Brady W.J.
Koyfman A.
Cardiovascular complications in COVID-19.
Am J Emerg Med. 2020 Jul; 38: 1504-1507
Although various studies have demonstrated an association between preexisting cardiovascular disease and severe COVID-19 manifestations, it is possible that the viral infection itself may lead to cardiac complications or exacerbate preexisting cardiovascular conditions.
Huang C.
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
Guan W.J.
Ni Z.Y.
China medical treatment expert group for covid-19. Clinical characteristics of coronavirus disease 2019 in China.
N Engl J Med. 2020; 382: 1708-1720
Acute myocardial injury is not uncommon in patients with COVID-19 and correlates with disease severity.
Efros O.
Barda N.
Meisel E.
Myocardial injury in hospitalized patients with COVID-19 infection-Risk factors and outcomes.
PLoS One. 2021; 16: e0247800
In addition, patients with long-term coronary artery disease or risk factors for atherosclerotic disease are at heightened risk of acute coronary syndromes (ACS) if infected with SARS-CoV-2. Acute coronary events in patients with COVID-19 may be the result of the systemic inflammatory hyperactivity, triggered by the viral infection and mediated by circulating cytokines that interact with preexisting atherosclerotic plaques, potentially causing plaque instability and rupture, ultimately leading to a type 1 MI.
Sheth A.R.
Grewal U.S.
Patel H.P.
Possible mechanisms responsible for acute coronary events in COVID-19.
Med Hypotheses. 2020; 143: 110125
In patients who eventually overcome myocardial injury and SARS-CoV-2 infection, there is evidence of long-term cardiovascular complications, although the magnitude of these sequelae is still unclear.
Physiopathological involvement of the cardiovascular system
SARS-CoV-2 primarily infects cells in the respiratory tract, causing a wide spectrum of respiratory manifestations, from asymptomatic or mild infection to bilateral interstitial pneumonia and severe ARDS.
There is also evidence supporting the affinity of the virus for multiple tissues, suggesting that SARS-CoV-2 has an organotropism that extends beyond the respiratory system, involving the brain, the liver, the kidney, and the cardiovascular district.
Puelles V.G.
Lütgehetmann M.
Lindenmeyer M.T.
Multiorgan and renal tropism of SARS-CoV-2.
N Engl J Med. 2020; 383: 590-592
When the cardiovascular system is affected a vast range of complications can occur, from myocardial injury and acute MI to heart failure, myocarditis, dysrhythmias, and venous thromboembolic events.
Previously published reports have described increased incidence of myocardial injury among patients with COVID-19.
Gu Z.C.
Zhang C.
Kong L.C.
Incidence of myocardial injury in coronavirus disease 2019 (COVID-19): a pooled analysis of 7,679 patients from 53 studies.
Cardiovasc Diagn Ther. 2020; 10: 667-677
During SARS-COV-2 infection the myocardium may be damaged by the viral invasion of cardiac muscle cells, inflammation and production of free radicals and reactive oxygen species, microvascular thrombosis, and a disproportion between oxygen supply and demand.
Giustino G.
Croft L.B.
Stefanini G.G.
Characterization of myocardial injury in patients with COVID-19.
J Am Coll Cardiol. 2020; 76: 2043-2055
As a result, myocardial dysfunction, heart failure, myocardial injury, and both type 1 and type 2 MI may manifest, mediated by these one or more of these underlying mechanisms. Cardiac tissue tropism of SARS-CoV-2 is supported by the findings of an autopsy series of 20 patients: detectable viral SARS-CoV genome was found in 7 of the 20 heart samples, along with increased myocardial fibrosis and inflammation.
Oudit G.Y.
Kassiri Z.
Jiang C.
SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS.
Eur J Clin Invest. 2009; 39: 618-625
Direct viral invasion is not the only mechanism through which SARS-CoV-2 can damage the heart. A particularly interesting interaction has been described between SARS-CoV-2 and the renin angiotensin system (RAS).
Babapoor-Farrokhran S.
Gill D.
Walker J.
Myocardial injury and COVID-19: possible mechanisms.
Life Sci. 2020; 253: 117723
The main hypothesis is that the RAS may be involved in the pathophysiology of COVID-19 via activation of the classic pathway. The angiotensin-converting enzyme 2 (ACE2) serves as a master regulator of the RAS. By metabolizing the vasoconstricting and proinflammatory angiotensin II (Ang II), ACE2 generates Ang 1 to 7, which counteracts the proinflammatory and prooxidant effects of Ang II.
Laghlam D.
Jozwiak M.
Nguyen L.S.
Renin-angiotensin-aldosterone system and immunomodulation: a state-of-the-art review.
Cells. 2021; 10: 1767
Molecular studies have demonstrated that ACE2 is the SARS-CoV-2 cell entry receptor, through the activation of the viral outer membrane spike protein S by transmembrane protease serine 2 (TMPRSS2).
Hoffmann M.
Kleine-Weber H.
Schroeder S.
SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.
Cell. 2020; 181 (e8): 271-280
SARS-CoV-2 uses ACE2 as the port of entry by binding the extracellular domain of the host receptor through the S1/s2 subunits of the transmembrane spike glycoprotein.
Li W.
Moore M.J.
Vasllieva N.
Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus.
Huang Y.
Yang C.
Xu X.F.
Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19.
Acta Pharmacol Sin. 2020; 41: 1141-1149
Once a cell becomes infected with SARS-CoV-2, ACE2 is internalized, the virus can enter the cell and release its RNA to initiate replication and transcription of the viral genome. After synthesis and assembly of structural proteins, new virus is released from the cell by exocytosis, whereas host cells may be disabled or destroyed in the process.
Liu P.P.
Blet A.
Smyth D.
The science underlying COVID-19: implications for the cardio- vascular system.
Circulation. 2020; 142: 68-78
Beyond causing direct cell damage through viral infiltration, SARS-CoV-2 downregulates ACE 2 expression and Ang 1 to 7 production, leading to the loss of the RAS counterregulatory protective arm.
Sankrityayan H.
Kale A.
Sharma N.
Evidence for use or disuse of renin-angiotensin system modulators in patients having COVID-19 with an underlying cardiorenal disorder.
J Cardiovasc Pharmacol Ther. 2020; 25: 299-306
By hampering the expression of ACE2, the beneficial degradation of Ang II to the counterregulatory Ang
decreases, leading to unopposed Ang II effects, mediated by the receptor AT1. The AngII/AT1 activation yields several unfavorable effects, which include vasoconstrictive effects, but also host potentially detrimental effects on the endothelium, inflammation, and coagulation, ultimately increasing vascular permeability and promoting organ damage (Fig. 1).
Walls A.C.
Park Y.J.
Tortorici M.A.
Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein.
Cell. 2020; 181: 281-292.e6
Kuba K.
Imai Y.
Angiotensin-converting enzyme 2 in lung diseases.
Curr Opin Pharmacol. 2006; 6: 271-276
These findings are supported by the fact that COVID-19 patients often present with increased AngII levels.
Arentz M.
Yim E.
Klaff L.
Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
JAMA. 2020; 323: 1612-1614
Yang Y.
Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury.
Sci China Life Sci. 2020; 63: 364-374
ACE2 is widely expressed in the lung but can also be found in high concentrations in the circulatory system at the level of arterial and venous endothelium as well as largely expressed by myocardial pericytes.
Zhou F.
Yu T.
Du R.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
The Lancet. 2020; 395: 1054-1062
Chen L.
Chen M.
The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2.
Cardiovasc Res. 2020; 116: 1097-1100
Fig. 1SARS-CoV-2 entry in host cells (A, B) and downregulation of ACE2 expression (C).
Cardiovascular damage mediated by SARS-CoV-2 may therefore be the result of 3 different pathways:
Direct myocardial damage due to viral entry through ACE2, resulting in myocardial cell destruction and inflammation;
Indirect injury due to ACE2 downregulation following viral replication, with subsequent hyperactivation of the Ang II/AT1 system, responsible of vasoconstrictive, proinflammatory, and prooxidant effects
Indirect injury through the activation of B and T immune cells, leading to a systemic inflammatory response and increased cardiac stress due to hypoxemia.
Mehta P.
McAuley D.F.
Brown M.
HLH across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression.
Clerkin K.J.
Fried J.A.
Raikhelkar J.
COVID-19 and cardiovascular disease.
Circulation. 2020; 141: 1648-1655
The immune-mediated pathway can generate a cytokine storm with high circulating levels of interleukin-2 (IL-2), IL-7, IL-10, and tumor necrosis factor, as a result of alternate immune response. This mechanism has been observed in severe forms of COVID-19 and can mediate myocardial injury as well as lung injury (particularly diffuse alveolar damage), finally leading to multiorgan failure. Components of the systemic inflammatory response can exert a negative inotropic effect, promote cardiomyocyte apoptosis and fibrosis, and induce the release of procoagulant factors.
Moccia F.
Gerbino A.
Lionetti V.
COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches.
Geroscience. 2020; 42: 1021-1049
The high plasma levels of activated macrophages that usually accompany conditions of hypercytokinemia can lead to further release of cytokines, including IL-1β and IL-6, which promote the expression of adhesion molecules, inflammatory cell infiltration, and vascular inflammation, contributing to formation and propagation of microcirculatory lesions and endothelial dysfunction.
Tay M.Z.
Poh C.M.
Rénia L.
The trinity of COVID-19: immunity, inflammation and interven- tion.
Nat Rev Immunol. 2020; 20: 363-374
Macrophages can also release procoagulant factors, further accelerating inflammation and augmenting a prothrombotic condition and thrombotic microangiopathy.
Ramadan M.S.
Bertolino L.
Marrazzo T.
The Monaldi Hospital Cardiovascular Infection Study Group. Cardiac complications during the active phase of COVID-19: review of the current evidence.
Intern Emerg Med. 2021; : 1-11
High circulating levels of macrophages might also interact with preexisting atherosclerotic plaques, leading to rupture of the fibrous cap and possibly causing type 1 MI.
Nencioni A.
Trzeciak S.
Shapiro N.I.
The microcirculation as a diagnostic and therapeutic target in sepsis.
Intern Emerg Med. 2009; 4: 413-418
These pathways are not unique to SARS-CoV-2, as viral infections are known to determine adverse cardiovascular events by precipitating plaque rupture in the setting of inflammation and a prothrombotic state.
Xiong T.Y.
Redwood S.
Prendergast B.
Coronaviruses and the cardiovascular system: acute and long-term implications.
Eur Heart J. 2020; 41: 1798-1800
It is also possible that hyperinflammation may generate a supply-demand mismatch at the level of the myocardium. SARS-CoV-2 infection can therefore precipitate myocardial injury by determining an oxygen supply–demand imbalance, either with or without acute coronary plaque pathology (type 1 and 2 MI).
SARS-CoV-2 can attack the cardiovascular system through different strategies: through direct damage of myocytes mediated by the virus as well as indirect mechanisms due to RAS pathway dysregulation, hyperinflammation leading to endothelial disfunction in different districts, and activation of procoagulant factors with microvascular thrombosis and oxygen supply–demand imbalance (Fig. 2). These mechanisms can take place in the presence of preexisting cardiovascular conditions or in patients without a clinical history of cardiovascular disease (CVD). Nonetheless, individuals with cardiovascular comorbidities or diabetes are at greater risk of experiencing a more aggressive SARS-CoV2 infection and the related cardiovascular complications.
Perrotta F.
Corbi G.
Mazzeo G.
COVID-19 and the elderly: insights into pathogenesis and clinical decision-making.
Aging Clin Exp Res. 2020; 32: 1599-1608
Fig. 2Direct (A) and indirect (B) mechanisms of acute myocardial injury during SARS-CoV-2 infection and clinical outcomes.
Prevalence and clinical outcome of myocardial injury in COVID-19
The detection of least one elevated cardiac troponin value greater than the 99th percentile upper reference limit defines myocardial injury. Although MI represents a manifestation of myocardial injury, it requires clinical evidence of acute myocardial ischemia in order to perform the diagnosis. There are various subtypes of MI, the most common being type 1 infarction (characterized by plaque rupture, ulceration, erosion, or dissection resulting in coronary thrombosis) and type 2 infarction (secondary to myocardial oxygen supply–demand mismatch in the absence of coronary thrombosis).
Thygesen K.
Alpert J.S.
Jaffe A.S.
Executive group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American heart association (AHA)/World heart Federation (WHF) Task Force for the Universal definition of myocardial infarction. Fourth universal definition of myocardial infarction (2018).
Individuals infected with SARS-CoV-2 seem to be in a condition of increased susceptibility to various forms of myocardial injury.
Bonow R.O.
Fonarow G.C.
O'Gara P.T.
Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality.
JAMA Cardiol. 2020; 5: 751-753
A study conducted in Wuhan showed evidence of cardiac damage with high levels of circulating troponin in up to 28% of patients with SARS-CoV-2. Furthermore, patients with evidence of cardiac injury had higher mortality rates compared with those without (51.2% vs 4.55%, P < 0 .001). Complications such as acute respiratory syndrome distress, electrolyte alteration, and acute kidney injury were prevalent in patients with cardiac injury, suggesting how the cardiac involvement plays a detrimental effect in the prognosis of these patients
Shi S.
Qin M.
Shen B.
Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China [published online March 25, 2020].
A recently published review, composed of 26 studies including a total of 11,685 patients, estimated a lower prevalence of acute myocardial injury among SARS-CoV-2–infected patients, with around 20% showing evidence of myocardial injury (detected through the sample of troponin and/or creatine-kinase MB). In discussing the physiopathological mechanisms, the investigators also suggest a possible clinical role of cardiac biomarkers in the risk stratification of COVID-19.
Bavishi C.
Trivedi V.
Special article—acute myocardial injury in patients hospitalized with COVID-19 infection: a review.
Prog Cardio-vasc Dis. 2020; 63: 682-689
Nishiga M.
Wang D.W.
Han Y.
COVID- 19 and cardiovascular disease: from basic mechanisms to clinical perspectives.
Nat Rev Cardiol. 2020; 17: 543-558
A systematic review published in 2021 estimated the rate of new cardiac injury between 7.2% and 77%, respectively, in live and dead SARS-CoV-2–infected cases, reiterating the concept that cardiac injury is associated to worse outcomes and higher rates of mortality, predominantly driven by development of shock and malignant arrythmias. In fact, about 46.3% of patients with cardiac injury required mechanical ventilation, 58.5% experienced acute respiratory distress syndrome, and 15.9% suffered from electrolyte disturbance. In addition, the levels of troponin I seemed to be inversely correlated with the days of survival.
Moayed M.S.
Rahimi-Bashar F.
Vahedian-Azimi A.
Cardiac injury in COVID-19: a systematic review.
Adv Exp Med Biol. 2021; 1321: 325-333
In a multicenter retrospective cohort study including 2736 patients, 36% were found to have elevated troponin concentration. Even small increases in troponin I levels (ranging from 0.03 to 0.09 ng/mL), found in the 16% of the entire cohort of patients, were significantly associated with the death of the patients (adjusted hazard ratio: 1.75; 95% confidence interval [CI]: 1.37–2.24; P < .001). Patients with evidence of more robust damage to the myocardium may experience more than a 3-fold increase in the risk of mortality. Patients with preexisting CVD are more likely to experience myocardial injury compared with those without.
Lala A.
Johnson K.W.
Januzzi J.L.
Preva- lence and impact of myocardial injury in patients hospitalized with COVID-19 infection.
J Am Coll Cardiol. 2020; 76: 533-546
Principal imaging findings in patients with COVID-19 with myocardial injury
The clinical presentation of myocardial injury in patients with COVID-19 is usually atypical and therefore hard to diagnose. The cause of the increase in troponin levels in patients with COVID-19 has not been clearly defined. Cardiac damage can arise in patients with no previous history of CVD and in the absence of chest pain. Diagnosing pathologies such as myocarditis in patients with COVID-19 and increased levels of troponin is quite challenging, given the scarcity of studies that correlate the evidence from imaging techniques such as cardiac MRI or invasive methods such as endomyocardial biopsy to the clinical and echocardiographic findings in these patients. In addition, the latency between the onset of symptoms and the evidence of myocardial injury (about 14 days) raises doubts as to whether myocyte damage can be considered only as a marker of advanced disease severity or if it directly implies a greater risk of COVID-19 mortality.
Guo T.
Fan Y.
Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).
JAMA Cardiol. 2020; 27: 1-8
Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China.
JAMA Cardiol. 2020; 25: 802-810
Romero J.
Alviz I.
Parides M.
T-wave inversion as a manifestation of COVID-19 infection: a case series.
J Interv Card Electrophysiol. 2020; 59: 485-493
A recent study evaluating a total of 201 patients with COVID-19 with critical and noncritical clinical conditions and with myocardial injury, detected through an elevation of CK-MB and troponin I levels, reported 18.7% of cases showing evidence of echocardiographic abnormalities. The main abnormalities were right ventricular dilatation and dysfunction (prevalent in critical patients). The investigators were able to highlight the direct contribution of COVID-19 to the myocardial injury of these patients. In addition, 43.7% of patients had new changes at electrocardiography and 36.3% had signs of ST depression.
Liaqat A.
Ali-Khan R.S.
Asad M.
Evaluation of myocardial injury patterns and ST changes among critical and non-critical patients with coronavirus-19 disease.
Sci Rep. 2021; : 4828
Cardiac MRI (CMR) represents the hallmark of the morphologic definition and classification of myocardial tissue pathology, especially in patients with myocardial edema. In a systematic review by Ojha and colleagues including 199 patients from 34 studies, myocarditis was the most common diagnosis at cardiac MRI in patients with evidence of myocardial injury (40.2% of cases). Mapping abnormalities, edema, and late gadolinium enhancement (LGE) represented the most frequently detected myocardial findings.
Ojha V.
Verma M.
Pandey N.N.
Cardiac magnetic resonance imaging in coronavirus disease 2019 (COVID-19): a systematic review of cardiac magnetic resonance imaging findings in 199 patients.
J Thorac Imaging. 2021; 36: 73-83
In a prospective observational trial by Puntmann and colleagues including 100 recently recovered COVID-19 cases, abnormal findings at CMR were found in 78% of patients, of which 60% showed ongoing myocardial inflammation with an increased native T2 (in a minority of cases regional scar and pericardial enhancement were detected), regardless of preexisting conditions and COVID-19 severity, raising concerns on the long-term consequences of SARS-CoV-2.
Puntmann V.O.
Carerj M.L.
Wieters I.
Outcomes of cardiovascular magnetic resonance imaging in patients recently recov- ered from coronavirus disease 2019 (COVID-19).
JAMA Cardiol. 2020; 5: 1265-1273
Most of the patients experienced only mild forms of illness.
The prevalence of cardiac damage at CMR was quite lower in another recent multicenter trial involving 148 cases of severe COVID-19 recruited from 6 different facilities and with laboratory evidence of troponin elevation. The trial evaluated patients after discharge through CMR. The CMR protocol included adenosine stress perfusion (where clinically appropriate) and was performed at a median of 68 days postdischarge. Twenty-six percent of CMRs showed evidence of a myocarditis-like scar, 22% of infarction or ischemia, and 6% characterized by combination of both. Most of the myocarditis-like lesions involved 3 or less segments and was not accompanied by left ventricular dysfunction, although 30% of these patients had active myocarditis. Stress perfusion revealed inducible ischemia in 26% of cases and myocardial infarction findings in 19%. These findings suggest how even after discharge the rate of cardiac injury remains high. About a quarter of all patients included in the trial experienced ischemic heart disease (in the absence of previous CVD history in two-thirds of cases).
Kotecha T.
Knight D.S.
Razvi Y.
Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance European Heart.
Journal. 2021; 42: 1866-1878
The discrepancy in prevalence of cardiac abnormalities at CMR that emerges from the 2 previously cited studies can be explained by differences in the selection of study participants and in the definition of myocardial injury and inflammation using isolated or combined CMR parameters and, in addition, by the different latency periods between the acute phase of COVID-19 and the timing of CMR. Moreover, abnormal T1 sequences and LGE may overdiagnose myocardial inflammation if used alone. The studies did not investigate the possibility of underlying and silent pathologic cardiac conditions not directly related to COVID-19. Several limitations affected these studies, including the absence of a description of patients' symptoms and their correlation to imaging findings.
Friedrich M.G.
Cooper L.T.
What we (don't) know about myocardial injury after COVID-19.
A recent literature review examining 277 patients with COVID-19 undergoing autopsy showed that the true prevalence of myocarditis was lower than 2%. Cardiovascular histopathologic findings potentially related to COVID-19 infections were found in the 47.8% of cases. The findings included myocardial microvascular thrombi, inflammation, or intraluminal megakaryocytes The investigators specified that the wide differences in histology reports found in the studies may be a marker of observer bias.
Halushka M.K.
Vander Heide R.S.
Myocarditis is rare in COVID-19 autopsies: car- diovascular findings across 277 postmortem examinations.
Cardiovasc Pathol. 2021; 50: 107300
There are several ongoing studies with larger sample sizes, an accurate standard protocol of imaging assessment, and longer follow-up periods that aim to explore the mid- and long-term cardiac sequelae following COVID-19 and identify factors that could significantly affect the outcomes of these patients.
Myocardial infarction type 1, 2, and 3
This paragraph explores the challenges in the management of the different types of MI and the possible overlap of acute pathologies (whether myocardial, pulmonary, or systemic) that further nuance the diagnosis.
Solomon M.D.
McNulty E.J.
Rana J.S.
The COVID-19 pandemic and the incidence of acute myocardial infarction.
Tejada Meza H.
Lambea Gil Á.
Saldaña A.S.
Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain.
Int J Stroke. 2020; 15: 755-762
The largest study investigating COVID-19 and acute cardiovascular events is a Swedish study involving 86,742 patients diagnosed with COVID-19 and a matched population of controls (348,481 patients). The investigators calculated the incidence rate ratio (IRR) of acute MI following COVID-19. The IRR was calculated in 2 separate analyses: including the day of exposure to SARS-CoV-2 (day 0) and excluding day 0. Excluding day 0 from the analysis led to the estimation of the IRR of acute MI of 2.89 (95% CI 1.51–5.55) in the first week of infection and 2.53 (95% CI 1.29–4.94), and 1.60 (95% CI 0.84–3.04), respectively, in the second week and in the third and fourth weeks. The inclusion of day 0 in the analysis resulted in a significant increase in the IRR during the first week (IRR 8.44; 95% CI 5.45–13.08) followed by comparable rate ratios in the remaining weeks. The analysis that excludes the day of viral exposure ensures potential elimination of testing bias because there is a possibility of a higher likelihood of detecting even asymptomatic forms of SARS-COV-2 in patients who are admitted to the hospital for MI or ischemic stroke. On the other hand, the exclusion of the day of viral exposure may lead to an underestimation of the true risk of cardiovascular events.
Katsoularis I.
Fonseca-Rodriguez O.
Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study Lancet.
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These results seem to clash with the significant reduction in hospital admission rates for acute ischemic cardiovascular events (both acute coronary syndromes and ischemic strokes) that has been described during the initial phases of the pandemic.
Mafham M.M.
Spata E.
Goldacre R.
COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England.
D'Anna L.
Oishi S.
Impact of national lockdown on the hyperacute stroke care and rapid transient ischaemic attack outpatient service in a comprehensive tertiary stroke centre during the COVID-19 pandemic.
Front Neurol. 2021; 12: 627493
A possible explanation of this discrepancy is that particularly during the first wave of the pandemic several patients experiencing ACS and acute ischemic stroke did not seek timely medical attention for fear of exposure to SARS-CoV-2 at the hospital or to respect measures of physical distancing. Another possible explanation is related to the clinical instability of patients with COVID-19 and the rapid deterioration of the conditions of patients with severe forms, preventing a complete diagnostic evaluation.
Rudilosso S.
Laredo C.
Vera V.
Acute stroke care is at risk in the era of COVID-19: experience at a comprehensive stroke center in Barcelona.
Stroke. 2020; 51: 1991-1995
There are also certain characteristics of patients hospitalized for STEMI and affected by COVID-19 that have been recently described in the literature and that raise concern among providers. Specifically, a study including a nationwide registry of 1010 consecutive patients treated within 42 specific STEMI care networks investigated the clinical, procedural, and in-hospital prognostic features of COVID-19 patients affected by STEMI. This population showed a significant increase in stent thrombosis (3.3% vs 0.8%, P = .020), cardiogenic shock (9.9% vs 3.8%, P = .007), and in-hospital mortality compared with non-COVID-19 STEMI patients (23.1% vs 5.7%, P < .0001).
Rodriguez-Leor O.
Cid Alvarez A.B.
Pérez de Prado A.
In-hospital outcomes of COVID-19 ST-elevation myocardial infarction patients.
EuroIntervention. 2021; 16: 1426-1433
A single-center observational study of 115 consecutive patients with STEMI managed by primary percutaneous coronary intervention (PCI) showed a higher thrombus burden and higher rates of multivessel thrombosis (17.9% vs 0%, P = .003) and stent thrombosis (10.3% vs 1.2%, P = .04) in patients with COVID-19 compared with non-COVID patients. Although the thrombolysis in MI flow and thrombus grade were similar in the 2 groups, the modified thrombus grade after first device resulted higher in patients with COVID-STEMI (75% vs 31%; P = 1⁄4 0.0006). Of these cases of COVID-STEMI a high percentage (about 60% vs 9.2% P = .002) received a Gp IIb/IIIa and underwent thrombectomy (17.9% vs 1.3%) when compared with non-COVID patients. The patients in the COVID-19 group had higher proportions of hypertension, diabetes, dyslipidemia, and previous PCI. The myocardial blush grade (MBG) resulted significantly lower in the COVID-STEMI (MBG of 2–3 in 54% vs 93%, P < .0001); the postprocedural median left ventricular ejection fraction resulted lower in COVID-STEMI patients (42.5% vs 45.0%; P = .019) as well as higher peak plasma troponin levels. The higher thrombus burden found in the COVID-STEMI group may represent a requirement for a more aggressive antithrombotic therapy in selected cases, although the actual evidence supporting this conduct is still poor.
Choudry F.A.
Hamshere S.M.
Rathod K.S.
High thrombus burden in patients with COVID-19 presenting with ST-Segment elevation myocardial infarction.
Data investigating ACS and COVID-19 remain conflictual, and the association is still uncertain. A systematic review and meta-analysis including 50,123 patients from 10 studies revealed a nonstatistically significant difference in admission rates of patients with STEMI during the pandemic compared with the previous year (IRR = 0.789, 95% CI 0.730–0.852 P = .01) and no increases in mortality for STEMI patients treated during the pandemic (odds ratio [OR] = 1.178, 95% CI 0.926–1.498, P = .01). What emerged from this review is that door-to-balloon time was significantly prolonged in STEMIs treated during the pandemic. Although these results harbor uncertainty regarding the impact of the pandemic on STEMI admission rates or mortality, they shed light on the organizational strain that facilities faced in the midst of the pandemic response.
Rattka M.
Dreyhaupt J.
Winsauer C.
Effect of the COVID- 19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis.
Heart. 2020; 107: 482-487
Diagnosis and management in patients with type 2 MI and COVID-19 are challenging, with repercussions on time to coronary angiographic evaluation. Inaccurate diagnosis of type 1 MI instead of type 2 and difficulties with differential diagnosis between MI and myocarditis might lead to an overestimation of acute MI. In a study by Stefanini and colleagues conducted on 28 patients with a diagnosis of STEMI that were promptly referred to the catheterization laboratory for urgent coronary angiography, 60.7% had a culprit lesion requiring urgent percutaneous treatment, whereas 39.3% did not show any signs of coronary obstructive lesion at angiography.
Montorfano M.
Trabattoni D.
ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes.
Unfortunately the investigators did not investigate if the clinical presentation was attributable to a type 2 MI or to myocarditis or to SARS-CoV-2–related endothelial dysfunction. It is reasonable to hypothesize that a type 2 MI due to demand ischemia might be much more common in patients experiencing COVID-19. The condition of systemic inflammation triggered by viral infections, such as coronavirus and influenza virus,
Smeeth L.
Thomas S.L.
Hall A.J.
Risk of myocardial infarction and stroke after acute infection or vaccination.
may lead to oxygen supply–demand mismatch in the myocardium. It is also critical to highlight that it is clinically challenging to perform a correct differential diagnosis between non-STEMI ACS from other conditions that imply a form of myocardial injury such as hypoxemia, arrhythmias, sepsis, or myocarditis. To further complicate the matter, it is possible that these conditions may overlap, particularly in complex patients experiencing severe COVID-19. Sudden cardiac deaths or unexplained deaths have been reported in patients with SARS-CoV-2 infection and a previously diagnosed coronary artery disease. In this subset of patients it is possible to speculate a type 3 MI as the cause of the demise.
Ebinger J.E.
Shah P.K.
Declining admissions for acute cardiovascular illness: the Covid-19 paradox.
Metzler B.
Siostrzonek P.
Binder R.K.
Decline of acute coronary syn- drome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage.
De Rosa S.
Spaccarotella C.
Basso C.
Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era.
The Takotsubo syndrome (TTS) is another cardiomyopathy that may determine myocardial injury in patients with COVID-19. TTS consists in a transient acute myocardial dysfunction, often characterized by circumferential myocardial regional akinesia/hypokinesia, leading to clinical acute heart failure, and in some cases mimicking an acute MI. Although the definite physiopathology of TTS has not yet been totally clarified, it is known that the sympathetic stimulation (ie, catecholamine-induced microvascular impairment) driven by sudden stress represents a trigger, and other evidences suggest how ongoing inflammation, infections, and other clinical conditions such as respiratory failure may be involved in the etiology.
Medina de Chazal H.
Del Buono M.G.
Keyser-Marcus L.
Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review.
A case series of 118 consecutive patients with COVID-19 undergoing transthoracic evaluation found ultrasound features of TTS in 4.2%. These patients also had higher level of plasmatic troponin compared with patients without TTS myocardial injury and high rates of in-hospital complications and mortality.
Oates C.P.
Takotsubo cardiomyopathy in males with Covid-19.
These findings are in line with the findings of other investigators who reported high rates of severe respiratory and cardiac insufficiency eventually leading to greater oxygen requirements, use of vasopressors, and cardiac ventricular support devices in patients with TTS myocardial injury associated with COVID-19.
Roca E.
Lombardi C.
Campana M.
Takotsubo syndrome associated with COVID-19.
Eur J Case Rep Intern Med. 2020; 7: 001665
Park J.H.
Moon J.Y.
Sohn K.M.
Two fatal cases of stress-induced cardiomyopathy in COVID-19 patients.
J Cardio- Vasc Imaging. 2020; 28: 300-303
Nguyen D.
Nguyen T.
De Bels D.
A case of Takotsubo cardiomyopathy with COVID 19.
Eur Heart J Cardiovasc Imaging. 2020; 21: 1052
The available evidence on COVID-19 and myocardial injury highlights the necessity to perform an accurate evaluation of the troponin elevation (ie, of the myocardial injury), the patients' clinical features, and an appropriate risk stratification. Direct invasive testing should be reserved for patients with a high pretest probability of coronary artery disease (CAD), whereas computed tomography scan or CMR is the appropriate test for patients with an intermediate probability of CAD, in order to evaluate either epicardial arteries or coronary arteries and rule out myocarditis. Patients with a low risk of CAD should be referred to strict follow-up.
Patients with COVID-19 that in addition experience an STEMI or very high-risk NSTEMI should be referred to the catheterization laboratory within the timeframe suggested by the current guidelines. Fibrinolysis should be considered only in case of difficulties in patients' transfer to a hub center in order to perform timely PCIs.
Cameli M.
Pastore M.C.
Giulia Elena Mandoli et al COVID-19 and Acute Coronary Syndromes: current Data and Future Implications.
Front Cardiovasc Med. 2021; 7: 593496
Impact of COVID-19 pandemic on mechanical reperfusion for patients with STEMI. De Luca G, Verdoia M, Cerchek M et al.
Am Coll Cardiol. 2020; 76: 2321-2330
Multisystem inflammatory syndrome in children
Although COVID-19 usually represents a mild entity among children, with approximately 2% to 6% requiring intensive care, the infection should not be underestimated in the pediatric population.
Sperotto F.
Friedman K.
Son M.B.
Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach.
Eur J Pediatr. 2021; 180: 307-322
A multisystem inflammatory syndrome (MIS-C) caused by SARS-CoV-2 has been reported among the pediatric population from several countries. MIS-C can lead to a large spectrum of symptoms that mimic a Kawasaki-like disease. Clinical manifestations range from persistent pyrexia to polymorphic rash, conjunctivitis, mucosal abnormalities, and myocardial involvement (including acute myocardial dysfunction, arrythmias, and acute pericarditis).
Once again the cytokine storm plays a role in the pathogenesis of MIS-C. The condition of hyperinflammation can generate multiple consequences within the cardiac district. In severe cases there have been reports of coronary artery dilatation and aneurysm (8%–24% of patients), which may be due to the state of hyperinflammation with disruption of the arterial wall, as seen in Kawasaki disease (KD).
Alsaied T.
Tremoulet A.H.
Burns J.C.
Review of cardiac involvement in multisystem inflammatory syndrome in children.
Other clinical features described in children affected by MIS-C are acute myocardial dysfunction, hypotension requiring fluid resuscitation, and, in some cases, cardiogenic shock requiring cardiac inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation.
A key clinical difference between MIS-C and KD is represented by the fact that ventricular dysfunction and eventually shock are common presentations in MIS-C (50% of cases) and occur less frequently in children with KD (5%–10%).
Recent evidence suggests that the administration of immunomodulatory drugs during the acute phase of the illness, such as intravenous immunoglobulins and steroids, may reverse the dysregulated inflammatory response yielding to recovery within days or a few weeks. Anticoagulation therapy is also suggested in the pediatric patients presenting with severe ventricular dysfunction and in case of evidence of giant coronary aneurysm.
Although MIS-C is associated to low mortality, nothing is known of its mid- and long-term sequelae.
Based on the current literature on myocardial injury during COVID-19, it is possible to conclude that this association is not uncommon. Myocardial injury can be considered as a concerning complication of SARS-CoV-2 infection, which can eventually lead to a large spectrum of myocardial pathologies (ie, myocarditis, myocardial infarction, Takotsubo syndrome) through the interaction between the virus and myocardial and endothelial cells, mediated by direct viral invasion or indirect mechanisms such as the downregulation of ACE2 receptor expression. Immune-mediated overresponse, cytokine storm, and activation of prothrombotic pathways are further mechanisms of myocardial damage that contribute to the various forms of myocardial injury that have been described.
Della Rocca D.G.
Magnocavallo M.
Lavalle C.
Evidence of systemic endothelial injury and microthrombosis in hospitalized COVID-19 patients at different stages of the disease.
J Thromb Thrombolysis. 2021; 51: 571-576
Although a trend of reduction in the number of hospital admissions for MI has been described, particularly during the first wave of pandemic, it is necessary to interpret these findings with caution and to consider the weight of other factors such as patient's reluctance to seek medical attention due to fear of in-hospital SARS-CoV-2 exposure or the strain on the organizational capacity of facilities in building the response to the pandemic.
Versaci F.
Scappaticci M.
Calcagno S.
ST-elevation myocardial infarction in the COVID-19 era.
Minerva Cardiol Angiol. 2021; 69: 6-8
The direct impact of acute myocardial injury on the mortality of patients with COVID-19 has been described, whereas there is also evidence of long-term sequelae of myocardial injury (both inflammatory and ischemic) that are particularly concerning in older patients and in patients with cardiovascular comorbidities.
De Luca G.
Cercek M.
Jensen L.O.
Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry.
Cardiovasc Diabetol. 2020; 19: 215
There is therefore a pressing need to continue investigating these new and complex clinical entities in order to understand how to treat and manage these patients. It is possible to hypothesize the need for dedicated protocols that involve a strict cardiovascular follow-up through both clinical and sequential imaging evaluation, based on the patients' comorbidities and overall risk stratification.
Clinics care points
Myocardial injury during COVID-19 can manifest through a large spectrum of pathologies (myocarditis, myocardial infarction, Takostubo Syndrome and MIS-C).
Cardiac damage during SARS-CoV-2 infection can arise in patients with no previous hystory of heart disease or in the absence of symptoms and is therefore challenging to diagnose.
There is evidence of long-term effects in patients affected by myocardial injury during SARS-CoV-2 infection, although the impact and reversibility of these sequelae is still not fully understood.
Patients that experience myocardial injury during COVID-19 should undergo regular follow-up through clinical and imaging evaluation and dedicated protocols should be designed, based on their individual risk.
All the authors report no conflict of interest.
DOI: https://doi.org/10.1016/j.ccep.2021.10.004
© 2021 Elsevier Inc. All rights reserved.


text:
OMICRON IS THE MAIN PROBLEM WITH THE SURGE IN COVID CASES IN TOKYO
THE FAST-spreading variant of the Omicron coronavirus is the main problem with the surge in cases in Tokyo. New cases in the city rose to 103 on Monday (1/03) from 84 the day before, the highest since Oct. 8.
According Governor Yuriko Koike said Tokyo recorded 25 cases of Omicron, of which 11 cases were likely community transmission. Japan anticipates an increase in the number of new infections after the New Year holidays.
In Okinawa, a beach resort that is a magnet for foreign tourists, COVID-19 infections rose to 130 on Monday. The figure was the highest since September 25. As of Monday (1/03), authorities in Okinawa reported a total of 88 cases of Omicron.
The Omicron variant also spreads across a number of other prefectures. Kanagawa Prefecture, which borders Tokyo, confirmed one case of Omicron on Monday, Kyodo reported.
Meanwhile, Hiroshima in western Japan recorded 12 new cases of Omicron, bringing the total to 14, the Chugoku Shimbun newspaper reported. [antaranews/photo special]
ATTRACTIVE PACKAGES ARE OFFERED TO INCREASE DOMESTIC TOURISM
OMICRON VARIANTS SPREAD OUT, CDC SUGGESTS PEOPLE NOT TO TAKE CRUISES

redpajama_set_name: RedPajamaCommonCrawl


text:
ALLEA calls for a broader exception for text and data mining
The ALLEA Permanent Working Group Intellectual Property Rights calls for a broader exception for Text and Data Mining in the proposed Directive on copyright in the Digital Single Market.
The position, prepared by the ALLEA Permanent Working Group Intellectual Property Rights, responds to a European Commission Directive on copyright in the Digital Single Market, currently under trilogue discussion between the European Council, the European Parliament and the European Commission and which will be voted on by the European Parliament at the end of November 2017.
About ALLEA
ALLEA, representing 59 academies from more than 40 countries from the Council of Europe region, urges the European Institutions to elaborate a more balanced exception for TDM taking the needs of science and research in Europe better into account. ALLEA is prepared to engage with the European Commission, the members of the European Parliament and the Council to to further elaborate a balanced Directive.
Press release ALLEA
Statement The Text and Data Mining Exception and the Enhancement of Access to Scientific Information in Europe (PDF)
All European Academies


2017 was one of our best years yet!
We not only celebrated our 25th year in business, but also donated our time and money to 25 local nonprofit organizations, and completed countless projects for our incredible clients. Check out some of our highlights from the year.


text:
Apodanthera mandonii är en gurkväxtart som beskrevs av Célestin Alfred Cogniaux. Apodanthera mandonii ingår i släktet Apodanthera och familjen gurkväxter. Inga underarter finns listade i Catalogue of Life.

Källor

Externa länkar

Gurkväxter
mandonii

redpajama_set_name: RedPajamaWikipedia


Last year, Autodesk had purchased the Bitsquid engine. Now, Autodesk has launched Stingray a new game engine built around Bitsquid.
According to Engadget the primary goal behind the development of Stingray was creating a game engine for smaller studios which provides customization options without much need of programming.
Along with this, the company wanted Stingray to be well-equipped and offer a good competition to market competitors like Unity engine and Unreal engine 4.
Stingray will also come equipped with features like- post-processing effects, high-performance reflection system, physical shading and more.
Currently, major companies are using game engines like the Unreal 4 or the Unity 5 and it will be difficult for Autodesk to establish their market in these places. Hence, they have chosen to target small to medium sized companies.
The product will provide developers with comfortable scripting tools available via simple drag and drop. But you want complete control, the source code is also at your disposal.
said , Autodesk's senior vice president of media and entertainment, Chris Bradshaw in a press statement.
Stingray will be supported on mostly all major OSes and – Windows 7, Windows 8, iOS, Android, PlayStation 4, the Xbox One and even Oculus Rift DevKit 2.
said Arrowhead Game Studios CEO Johan Pileated.
The Stingray is quite affordable with a subscription of just $30 a month. Subscriptions will start August 19 and any Autodesk's Maya LT desktop subscriber will be eligible for access to Stingray.


Biodynamic Association Patron, Patrick Holden, talked to Borough Market this month about why the food we produce, like biodynamic food, needs to be of high nutritional quality, otherwise we'll continue to have the problems we're experiencing in the National Health Service. Plus why our food system needs to change if irreversible climate change, a biodiversity catastrophe and the breakdown of civil society are to be avoided. "I've been involved with advocacy for more sustainable food systems since the 1970s; it's only now I feel that change is happening" says Patrick.


text:
package br.com.snk;

import com.beust.jcommander.Parameter;

/**
 * Parameters
 *
 * @author SnK
 */
public class StartParameters implements br.com.snk.Parameter {

    @Parameter(names = {"--port", "-p"}, description = "HTTP port number" )
    private int port = 8080;

    /**
     * Get HTTP port
     *
     * @return HTTP port
     */
    public int getPort() {
        return port;
    }

}

redpajama_set_name: RedPajamaGithub


How can I enable code outlining for C#?
I'm using the C# language in the syntax editor and while other capabilities started working immediately, code outlining never became enabled. Do I need to explicitly enable that feature? If so, how?
1. Setting the editor's Document.Language property to a new CSharpSyntaxLanguage instance.
2. Setting Document.OutliningMode to OutliningMode.Automatic.
Note that I am using text binding, in case that makes a difference.
Also, will C# outlining account for region tags (as in #region - #endregion)? It doesn't seem to in your samples, which is why I'm asking.
That should be in the docs for the add-on (just noticed it's not), and we'll get it in the Getting Started topic for the next build. The XML language's Getting Started topic does have the info that is appropriate here.
Outlining will work out of the box without you having to set automatic. Regions aren't outlined just yet. That is on our TODO list since they are sort of out-of-band from the real AST data, similar to XML comments.


text:
Home » Blogs » Harrison Broer's blog » The Numerous Benefits of Black Seed
Submitted by Harrison Broer on Fri, 08/02/2019 - 20:59
Nigella sativa, also known as black seed or black cumin seed, has been exalted. The seed has been found in the Egyptian pharaoh Tutankhamun's tomb, which dates back 3,000 years [1, p. 204]. Mohammad also praised the seed as the cure for anything but death.
Occasionally, we will mention a black seed, but we have not even fully begun to investigate its numerous benefits. Published research has noted the seed's many benefits, such as its effectiveness against MRSA, ability to stimulate the regeneration of dying beta cells within a diabetic pancreas, and ability to heal a body damaged by poisonous chemicals.
These are only three of black seed's benefits.
In this article, we will examine sixteen benefits of black seed oil, as noted by published evidence. *
Type-2 Diabetes
In a 2010 study, researchers investigated the effects black seed would have on the glycemic control of patients with type-2 diabetes [2]. The researchers noted that 2 grams/day for twelve weeks improved beta-cell function, lowered insulin resistance significantly, and decreased HbA1C measurements, among other improved parameters [2].
Helicobacter Pylori Infection
H. Pylori is extremely harmful bacteria that can live in the digestive tract, and after many years, they can cause ulcers in the stomach or small intestine lining. This bacterium can also lead to stomach cancer.
In a 2010 study, researchers investigated the effects black seed would have on H. Pylori bacteria [3]. Researchers noted, "N. sativa seeds possess clinically useful anti-H. Pylori activity, comparable to triple therapy [taking three types of antibiotics]. Further clinical studies combining N. sativa with antibiotics are suggested" [3].
In a 2007 double-blind, crossover clinical trial, researchers investigated the effects black seed would have on children with refractory epilepsy, also known as uncontrollable, drug-resistant epilepsy [4]. The results showed the mean frequency of seizures reduced significantly during treatment, and the authors concluded, "The water extract of Nigella sativa L. has antiepileptic effects in children with refractory seizures" [4].
In a 2006 randomized, double-blind, placebo-controlled trial, researchers investigated the effects black seed would have on patients with mild hypertension (HT) [5]. The researchers noted black seed significantly reduced systolic and diastolic blood pressure when compared to the placebo group. The researchers also found there was a dose-dependent function, meaning the higher the dosage, the greater the response. Patients in the black seed groups even experienced a significant decline in their LDL measurements. The scientists concluded, "The results suggest that the daily use of NS seed extract for 2 months may have a blood pressure-lowering effect in patients with mild HT" [5].
One of the main ingredients in black seed oil called thymoquinone is superior to the drug fluticasone in an animal model of asthma, as concluded by a 2010 study [6].
In a 2010 study, researchers investigated the effect black seed extract would have on the airways of patients with asthma [7]. The researchers found that "the extract caused significant increases in all measured pulmonary function tests," in most time intervals [7]. The researchers concluded, "The results of the present study showed that Nigella sativa has a relatively potent antiasthmatic effect on asthmatic airways" [7].
Acute Tonsillopharyngitis
Tonsillopharyngitis, also known as tonsillitis or strep throat, is an infection of the throat and/or tonsils and is common in children. Tonsillopharyngitis is usually caused by a virus but may be caused by bacteria such as streptococcal bacteria.
In a 2008 comparative, parallel, randomized, double-blind, placebo-controlled study, researchers investigated the effects that the combination of Nigella sativa (360 mg) and Phyllanthus niruri (50 mg) extracts would have on patients with tonsillopharyngitis over seven days [8].
From day 0-2, participants in the treatment group experienced significant alleviation of pain and needed significantly less paracetamol than those in the placebo group. Further, by the end of the study, a substantially higher proportion of patients in the treatment group were healed entirely than in the placebo group [8].
The researchers concluded, "NSPN extract was also found to be safe and well-tolerated in acute tonsillopharyngitis patients. This study proved significant benefits of NSPN extract in the treatment of acute tonsillopharyngitis as compared to placebo" [8].
Chemical Weapons Injury
In a 2008 randomized, double-blind, placebo-controlled trial, researchers investigated the effects black seed extract would have on chemical war victim [9]. The study lasted for two months and contained two groups: a treatment group (n=20) and a control group (n=20). The treatment group received a daily dose of black seed extract, and individuals in both groups visited the researchers three times during the study [9].
The researchers noted, "All respiratory symptoms, chest wheezing, and PFT [pulmonary function test) values in the study group significantly improved in the second and third visits compared to the first visit," with improvements noted in the third visit over the second [9]. Also, the results in the control group were much less significant than the results in the treatment group.
The researchers concluded, "The results of this study suggest a prophylactic [medicine used to prevent disease] effect of N. sativa on chemical war victims and warrant further research regarding this effect" [9].
In a 2006 study, researchers investigated the effects thymoquinone would have on colon cancer cells [10]. The researchers found thymoquinone suppressed colon cancer growth similar to the chemotherapy drug 5-fluorouracil but without any of the adverse side effects associated with such medications [10].
In a 2003 study, researchers investigated the effects black seed oil would have on rats with colon cancer [11]. The researchers noted the extract has "significant antiproliferative activity in both initiation and postinitiation stages and especially in the latter," noting that N. sativa can inhibit colon cancer carcinogenesis of rats in the postinitiation state, with no evident adverse side effects [11].
In a 2008 study, researchers investigated the effects black seed extract would have on MRSA [methicillin-resistant Staphylococcus aureus] [12]. The researchers concluded, "The results indicated that N. sativa has an inhibitory effect on MRSA. This finding warrants the necessity of further investigation of this product of folk medicine" [12].
Additional studies have noted these results [13] [14].
Opiate Addiction and Withdraw
In a 2008 study, researchers investigated the effects black seed extract would have on the treatment of opioid dependence in thirty-five patients [15]. The researchers concluded, "Non-opioid drug Nigella sativa is effective in the long-term treatment of opioid dependence. It not merely cures the opioid dependence but also cures the infections and weakness from which the majority of addicts suffer" [15].
In a 2013 study, researchers investigated the protective effects of black seed oil thymoquinone on radiation-induced nitrosative stress in brain tissue [16]. After conducting the research, the researchers offered a frank conclusion: "Nigella sativa oil (NSO) and its active component, TQ, clearly protect brain tissue from radiation-induced nitrosative stress" [16].
Heart Attack Damage
In a 2013 animal study, researchers investigated the protective effects of thymoquinone on the experimental model of a heart attack [17]. The researchers divided the rats into two groups, a treatment group and a placebo group. Then, the rats were injected with isoproterenol, a drug that simulates a heart attack. Then, their biochemical markets were analyzed for myocardial injury. The researchers concluded, "Results of our study revealed that thymoquinone protects the heart from injury induced by isoproterenol" [17].
Kidney Damage That is Associated with Diabetic Neuropathy
In a 2014 study, researchers investigated the effect of thymoquinone on chemically induced diabetic neuropathy [18]. The researchers had three groups: a control group, an untreated diabetic group, and a diabetic treated group with thymoquinone. After chemically inducing diabetic neuropathy, the researchers concluded, "Thymoquinone has protective effects on experimental diabetic nephropathy. Both mesenchymal and epithelial markers serve as excellent predictors of early kidney damage and indicators of TQ responsiveness in STZ-induced diabetic nephropathy" [18].
Alzheimer's Associated Neurotoxicity
In a 2013 study, researchers investigated the effects of thymoquinone on beta-amyloid plaques, which are associated with the pathology and progression of Alzheimer's disease [19]. The researchers concluded that their findings suggested that thymoquinone may be useful for preventing neurotoxicity and called for further research about its potential to reduce the risks of developing Alzheimer's disease [19].
In a 2013 animal study, researchers investigated the effects of thymoquinone on breast cancer tumor growth [20]. The scientists found that thymoquinone possessed anti-proliferative and pro-apoptotic [inducing cell death] effects against these cancer cells [20].
In a 2013 study, researchers conducted a similar investigation and came to a complementary supplementary [21].
Glioblastoma Brain Cancer
In a 2013 in vitro study, researchers investigated the effects of thymoquinone on glioblastoma brain cancer cells [22]. The researchers concluded thymoquinone induced apoptosis and stated, "In this vein, our results describe a novel mechanism of action for TQ as an autophagy inhibitor selectively targeting glioblastoma cells" [22].
As indicated by the above research, black seed oil and its main component, thymoquinone, possess numerous health-promoting qualities. This article does not even begin to examine the benefits of this compound thoroughly.
If you are interested in a black seed supplement, check out Healthmasters' Black Seed Oil.
[1] Zohary, D., & Hopf, M. (2000). Domestication of plants in the old world (3rd ed.). Oxford: Oxford University Press.
* This article is for informational purposes only. By providing the information herein, Healthmasters and its associates are not diagnosing, treating, curing, mitigating, or preventing any disease or medical condition. Before beginning any natural, integrative, or conventional treatment or regime, it is advisable to seek the advice of a licensed healthcare professional


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text:
InsurerCPA Alliance Expands
By Barry Higgins
May 19, 2002 at 08:00 PM Share & Print
With many insurance companies looking for new ways to distribute their products, industry experts say the CPA channel is drawing a great deal of attention.
Mass Mutual Financial Group, Springfield, Mass., recently announced it formed a strategic alliance with RSM McGladrey, Inc., a business consulting, accounting, and tax firm located in Bloomington, Minn. RSM McGladrey serves clients from over 100 offices nationwide, dealing with mid-sized businesses and their owners, according to Connie Smith Benning, communications director for RSM McGladrey.
As part of the venture, Mass Mutual joins two other carriers in the alliance, National Life Insurance Company, Montpelier, Vt., and Pacific Life Insurance Company, Newport Beach, Calif.
"Mass Mutual has been dealing with accountants for a very long time," says Philip Stevens, vice president of institutional distribution for Mass Mutual. "They've always been a good source for referrals, and excellent partners in planning," he says.
Stevens feels that many CPAs would like to expand their practice beyond the typical accounting services to other types of financial services, including life insurance.
RSM McGladrey's goal with the alliance is to provide its clients with a full menu of services that meets all their financial needs, says Benning.
Stevens notes that while working with CPAs is nothing new to Mass Mutual, the arrangement with RSM McGladrey was a way of formalizing access to the firm's clients, as well as many more CPAs in a national alliance.
All three carriers are making their products available to a network of agents who are designated to work with the RSM McGladrey partners.
These agents are not RSM employees, but are independent agents who may or may not have had relationships with the three carriers involved, says Ann Dehner, vice president of marketing operations for National Life.
While the agents in the network may either be independent or affiliated with any of the carriers, the agents Mass Mutual is selecting to participate are among its top producers, says Stevens.
"RSM has to feel good about the agent and the individual offices have to feel good about our people–that's why we've made this available to our top tier," says Stevens.
"There's a pretty extensive due diligence done when appointing agents to work with the RSM McGladrey group," adds Mike Pinkans, vice president of sales and promotion for National Life.
AALU Speaks Up For COLI
"We're looking for the agent who maintains a significant level of production, and also has a process that falls in line with providing solutions–rather than the sale of product," says Steve Mulder, COO of the RSM McGladrey Insurance Alliance.
Mulder explains that when a client has a situation that may involve the use of life insurance as a solution, the case is reviewed by an internal advisor. "We have licensed advisors who are both securities and insurance licensed."
From that stage the advisor evaluates the case and refers it to one of the licensed alliance agents, he continues.
The agents affiliated with the alliance are licensed with all three carriers, and are also able to use other carriers through a brokerage arrangement in the event none of the primary carriers have the product to fit the situation, he says.
Many observers say the biggest challenge agents face when dealing with CPAs–whether there is an arrangement in place or not–is building the trust between the CPA and the insurance agent.
"It takes a lot for a CPA to trust an agent in front of his client," says Dehner.
Stevens also feels it takes some work to raise a CPA's comfort level about including life insurance as a component of an estate plan solution.
Pinkans agrees, "The biggest problem you have with any CPA is to get them to consider that life insurance is needed as part of the overall planning process."
Mulder says there are some obvious barriers, since insurance is so different from the accounting business. But RSM has been overcoming those barriers and is seeing some success in the program, he says.
"The evolution of the relationship has gone very well in building the trust necessary to make those referrals," he says.
Last year, approximately 80% of their partners participated in the referral program, and Mulder is expecting that to increase over the next year.
"Once they go through the process and see the value added, the partners feel good about it," says Benning. "Once someone has a successful referral, they become a strong supporter of the program."
Reproduced from National Underwriter Life & Health/Financial Services Edition, May 20, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.


A hybrid of Banksia spiulosa and Banksia ericifolia. It is distinctive for its large orange flower spikes to 40cm in length. A dense shrub growing to 4.5m tall and a similar width branching near to ground level.
cultural notes A tough and vigorous plant that prefers well drained soils in full sun.
flower colour Large bronze-orange flower spikes, abundant when grown in full sun.
foliage colour Bright to mid green linear foliage.
recommended uses A hardy and attractive plant useful as an informal hedge or windbreak.


text:
Q: NAnt task running "svn import" fails I would like to import a build product to Subversion in a NAnt build task.
But it fails for me.
The following works fine for me from the command-line:

svn.exe import -m 'Importing build 14' build/project.zip http://svn/builds/14/project.zip --username builder --password secret

In NAnt I have the following task:

<exec program="svn.exe"
              commandline="import -m 'Importing build 14' build/project.zip http://svn/builds/14/project.zip --username builder --password secret" />

But executing a NAnt target with this task yields the error message: "Too many arguments to import command".
Have you any idea why I get this error message in NAnt, and not when run from the command-line?

A: Seems like it might be having trouble escaping the quotes. If values to attributes contain quotes, generally these should be escaped (deals with special characters and xml parsing).
This should do the trick:
<exec program="svn.exe" commandline="import -m "Importing build 14" build/project.zip http://svn/builds/14/project.zip --username builder --password secret"/>

To learn more about the XML and what needs to be escaped you can reference this article as it discusses it. It also shows you other escape codes if you need it.

redpajama_set_name: RedPajamaStackExchange


text:
www.thebodyshop.com/en-gb/
66 Oxford St, Westminster, London W1D 1BL
374 Oxford St, Westminster W1C 1JR
Founded in 1976 in Brighton, England, by Anita Roddick, The Body Shop is a global beauty brand built on making people feel so good – face, body and soul. The Body Shop seeks to make a positive difference in the world by offering high-quality, naturally-inspired skincare, hair care and make-up produced ethically and sustainably. The Body Shop® sources fine raw ingredients and accessories from the four corners of the globe, with a commitment to trade fairly with small-scale farmers, traditional artisans and rural co-operatives that are experts in their field.
Get directions 66 Oxford St, Westminster, London W1D 1BL374 Oxford St, Westminster W1C 1JR
Login to add itinerary
300 Oxford St, Westminster, London W1C 1DX
175-179 Oxford St, London W1D 2JS
14-28 Oxford St, London W1D 1AU + 1 more address


Having the right kitchen tools makes preparing healthy food fast and easy. Consider your kitchen tool purchases to be an investment in your good health.
These links are affiliate links and they support this site. If you click the link and buy something, I receive a small commission for the sale. It doesn't cost you anything extra and you are free to use the link or not as you choose.


text:
The NM Political Report
The NM Political Report - New Mexico's best political reporting. Period.
The NM Political Report (https://nmpoliticalreport.com/2018/09/12/on-the-hiking-trail-with-heinrich/)
Environmental Project
On the (hiking) trail with Heinrich
By Andy Lyman | September 12, 2018
Last weekend, U.S. Sen. Martin Heinrich and his wife Julie pulled up to an Albuquerque trailhead and were greeted by a group of eager supporters with hiking poles and hydration packs at the ready. Almost immediately, Heinrich became an impromptu trail guide, educating his constituents on the different native plants along the trail and which animals use them as food sources. At least twice, unsuspecting hikers recognized the affable sportsman who has worked in Washington, D.C. since 2009. One family hiking towards the top of the trail passed the Heinrich entourage on its way back to the trail head. As the two groups converged, one woman looked at Heinrich and asked, "Is it really you?
"It's really me," Heinrich responded.
As an avid hunter, outdoorsman and an advocate for protecting public lands, this is Heinrich's wheelhouse.
Related: The Hard Hat and The Beast: Mick Rich crisscrosses the state looking for votes
Fittingly, the trail Heinrich picked for a hike with some of his constituents included sharp turns and switchbacks, just as the race for U.S. Senate has seen a sharp turn in the last six weeks.
The U.S. Senate race morphed from what appeared to be an easy win for Heinrich to a frantic fundraising and campaigning effort weeks after the primary.
Heinrich began his reelection campaign with only one opponent—Republican political newcomer Mick Rich—and then State Land Commissioner Aubrey Dunn clinched the Libertarian nomination for U.S. Senate and it became a three-way race. A June poll showed Heinrich with about a 10 point lead over Rich and Dunn in last place with the support of about five percent of likely voters.
But when former governor Gary Johnson replaced Dunn as the Libertarian nominee, the Senate race took another turn. Now, some polls show Johnson in second place, while others say it's Rich behind Heinrich. Those newer polls seem to have changed the Heinrich campaign's focus—to beat a former Republican governor, turned two-time Libertarian presidential nominee, who wants to legalize marijuana.
Threat level, unknown
In the weeks since Johnson entered the race, the tone of Heinrich's campaign emails have changed. Earlier this year, fundraising emails cited money and ads from the "Koch Brothers" as a major threat to the campaign, but did not mention either challenger by name. Now, fundraising emails have a sharper focus on Johnson and the Elect Liberty PAC, a committee based out of Utah supporting Johnson. The latest campaign finance reports show Heinrich with more more cash-on-hand than Johnson, but Heinrich acknowledged that could easily change. He pointed to when he barely won the election for the open U.S. Senate seat against former U.S. Rep Heather Wilson.
"In 2012, I was sitting on about a 12 point lead over Heather Wilson and we saw just millions of dollars in advertising come in from outside groups in August," Heinrich said. "It narrowed that gap to five on election day."
He blames the landmark Citizens United decision for an increase of money from outside sources like Super PACs and what is often referred to as dark money. Heinrich said it can be hard to predict who might inject cash into a race and when they might do it. For this race, he is anticipating a lot of activity from the Elect Liberty PAC and he wants to be able to counteract their narrative.
"If someone decides they want to put several million dollars in that PAC, we need to be able to tell our side of the story," Heinrich said.
But, the senator said he doesn't mind Johnson's run because he thinks the Libertarian will "spice things up a little bit."
"I welcome the attention that Gary's brought to the race, because it was hard getting people to focus, especially with the governor's race, on the Senate race," Heinrich said. "So, I'm happy to have Gary in the race."
On a deeper level, though, Heinrich has some concerns about Johnson's free-market and limited government views. As he and his supporters stopped at a lookout point along the hiking trail for water before heading back down, one person asked bluntly what Heinrich thought about his Libertarian opponent. He responded just as bluntly.
"We already have a Rand Paul in the Senate, we don't need two," Heinrich quipped.
Paul, a Republican Senator from Kentucky with libertarian leanings recently endorsed Johnson.
Heinrich said from his experience, Republican senators with libertarian views like Paul and Utah's Mike Lee have created more divide, not less. Further, Heinrich said, Johnson's limited government views, beyond social issues, will hurt New Mexico.
"I agree with Gary on marijuana policy and I agree we shouldn't be the world's policemen, but coming with that on his side, comes wanting to cut Medicaid [and] Social Security and that would be devastating," Heinrich said. "In this state, that would be absolutely devastating."
The great equalizer
Heinrich calls public lands "the great equalizer," meaning almost everyone can use them regardless of income.
"It doesn't matter if you're somebody making $25,000 a year or somebody making $100,000 a year, it doesn't matter how thick your wallet is, these lands are available to everyone," Heinrich said.
While Heinrich and Johnson's views about the role of government are at odds with each other, Heinrich's views on public lands may contrast most with his Republican opponent, Rich. In a previous interview with NM Political Report, Rich compared closing lands off from energy companies and ranchers to that of the hypothetical owner of an expensive car who never drives it.
Heinrich called Rich's view "flawed."
"Just because something isn't being exploited to its very limits of what it can withstand, doesn't mean it's not working for us," Heinrich said.
He said he has also had conversations with Democratic gubernatorial candidate Michelle Lujan Grisham about creating an office of outdoor recreation if she is elected.
But he seems less enthusiastic about the thought of Lujan Grisham's opponent, Steve Pearce, becoming governor.
"I think it's important that people remember that the biggest advocate for shrinking the Organ Mountains [monument] was Steve Pearce," Heinrich said. "He's done a remarkable job remaking himself, as part of this election cycle, and trying to run as a moderate Republican."
Pearce is a member of the uncompromising Freedom Caucus that frequently takes hardline conservative positions on legislation and seeks to move House Republicans further right. Former Republican Speaker of the House John Boehner called the freedom caucus "anarchists" who want "total chaos."
Regardless of allies in state government, though, Heinrich will still do a majority of his work in the nation's capital and will be tasked with making alliances there, even as his most prominent Republican ally won't return.
Heinrich faced criticism when he moved his family to Silver Spring, Maryland, citing a strong need to spend time with his wife and children.
Living near Washington D.C., Heinrich told NM Political Report, also helps him build relationships with other lawmakers.
"If you're going to be an effective senator you also have to truly get to know your colleagues which means having people over to dinner and actually spending time together," Heinrich said.
But one senator Heinrich has spent plenty of time with, Republican Sen. Jeff Flake of Arizona, will only be around for a few more months.
Heinrich and Flake's friendship began with the two sharing pictures of their respective outdoor adventures during a late-night Senate budget debate, Heinrich said. That shared passion for outdoor recreation eventually led to the two taking part in a survival reality show on a secluded island in the South Pacific Ocean, an idea initially suggested by Flake.
"[Flake] came back to me a few weeks [after the budget debate] and said, 'I've got a crazy idea,'" Heinrich said.
Earlier this year, Flake and Heinrich cosponsored a bill to ban bump stock devices in response to a mass shooting in Las Vegas, Nevada. Heinrich credits that kind of bipartisan cooperation to their trip together.
"It built a trust where we could determine within five minutes of talking whether we could work on an issue together or not," Heinrich said.
Still, Heinrich has received a lot of criticism for his decision to move his family out of New Mexico.
Rich, whose children are adults, has publicly said he would fly back to New Mexico at every opportunity and would not live in or near Washington, D.C. Johnson also said he would maintain his residence in Taos.
Heinrich and his wife still own a house in southeast Albuquerque.
He didn't move until about eight months into his Senate term and reportedly often slept on a mat in his office throughout his two terms as a U.S. Representative.
"I love coming home [to New Mexico] because this is where I chose to live," Heinrich said.
But in less than two months, voters will ultimately have a large part in where he calls home next year.
Correction: This story originally referred to Silver Spring, Maryland as Silver Springs.
2018 U.S. Senate
Martin Heinrich
Political 'retribution': The DOI rejected 100% of New Mexico's proposed LWCF projects
After cheering the passage of the Great American Outdoors Act, which secured permanent funding for the Land and Water Conservation Fund (LWCF), New Mexico wildlife and conservation advocates were shocked to learn every single project proposed to the U.S. Department of Interior (DOI) for LWCF funds was rejected. The LWCF, created by Congress in 1965 to support public land management using offshore oil and gas royalties, received $900 million annually under the Great American Outdoors Act, which was passed by Congress and signed into law by President Donald Trump in August. It marked just the second time since its creation that the program is fully funded.
Growing Forward and looking to the past
'When history deals a bad hand:' Las Vegas struggles as tourism comes to a halt
View all Featured articles →
Multiple cannabis legalization bills expected during the NM Legislative session
New Mexico's 2021 legislative session will surely be marked with debates over education issues, state finances and abortion rights. But the Legislature is also set to weigh the pros and cons of recreational-use cannabis.
Lawmakers want to give local school boards the authority to open in-person learning
Biden becomes 46th President of the United States, pledges to seek unity
View all News articles →
Herrell finishes review of ballots, won't challenge election results
After inspecting absentee ballots from the 2nd Congressional District's most-populous county, Republican Yvette Herrell decided not to challenge the results of the election she lost to Democrat Xochitl Torres Small in November. Herrell announced the news Monday, the deadline to challenge the results.
2018 Top Stories #1: Lujan Grisham wins election
2018 Top Stories #2: Haaland makes history
View all 2018 elections articles →
Democrats hold big cash advantages in federal races
While Democrats led the way in fundraising in the latest quarter, federal campaign finance reports filed Monday show, one candidate considerably outraised the rest. NM Political Report first reported that Xochitl Torres Small, a Democrat seeking the 2nd Congressional District seat, raised over $1.9 million yesterday.
Candidate Q&A: Martin Heinrich, U.S. Senate candidate
Candidate Q&A: Gary Johnson, U.S. Senate candidate
View all 2018 U.S. Senate articles →
Bill raising film tax rebate cap goes to governor
Gov. Michelle Lujan Grisham said she was going to take the "shackles" off the state's film industry by removing an annual $50 million cap on tax rebate payouts to eligible production companies that film in the state. While she didn't exactly get her wish, Senate Bill 2 comes close.
Governor pushes for payoff of film credit backlog
The next legislative session could echo 2003
View all Gary Johnson articles →
The U.S. House of Representatives voted to impeach President Donald Trump for the second time, with two of the three representatives, both Democrats, in New Mexico's delegation voting in favor of the historic vote on Wednesday. The House voted 237-197 to impeach Trump, saying that Trump incited violence and the storming of the U.S. Capitol last week when his supporters took control of the building, driving lawmakers into hiding while some called for the death of Vice President Mike Pence and Speaker of the House Nancy Pelosi.
Right-wing mob of Trump supporters takes over U.S. Capitol; NM and other lawmakers evacuated
Amy Coney Barrett confirmed to Supreme Court, as New Mexico's senators vote against
View all Martin Heinrich articles →
NM Elections Roundup: Straight-ticket voting, campaign finance reports and more...
Feds continue environmental rollbacks with new methane emissions rule
New Mexico's 2021 legislative session will surely be marked with debates over education issues, state finances and abortion rights.
Biden's first day: Trump's methane rule reversed and U.S. rejoins Paris Agreement
President Joe Biden wasted no time in starting to tackle some of the country's most pressing climate change issues after being inaugurated on Jan.
As state education officials continue to look for ways to safely reopen schools to students, Republican legislators want that power to be put in the hands of local school boards.
About Andy Lyman
Andy Lyman is an Albuquerque based reporter. He previously covered the New Mexico's legislative session for the New Mexico News Network and served as a reporter and host for numerous news outlets.
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