Chuckles of the Day

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Preachers

Three preachers were returning from a conference with their wives when their car was in a crash and they all departed from this earth.

St. Peter was at the pearly gates waiting for them.

The first pastor and his wife went up and St. Peter looked in the book. He shook his head and said. “I’m sorry brother. But all your life yo’ have been concentrated on money not on the Word. You hoarded money. You dreamed money. You were obsessed to the point that you married a women named Penny. Sorry, go away. We don’t need your kind here.”

The second pastor went up and St. Peter looked in the book. He shook his head and said, “I’m sorry brother. but all your life you have been concentrating on hard drink. You hoarded liquor. You dreamed liquor. you were obsessed to the point that you married a women named Brandy. Sorry, go away. We don’t need your kind here.”

At this point the third pastor looked at his wife and said, “come on Fanny, You and I may just as well get out of here.”

* * * * * * *

Heaven

It was getting a little crowded in Heaven, so G-d decided to change the admittance policy.

The new law was that, in order to get into Heaven, you had to have a really bad day the day you died. The policy would go into effect at noon the following day.

So the next day at 12:01 the first person came to the gates of Heaven.

The angel at the gate, remembering about the new law, promptly asked the man, “Before I can let you in, I need you to tell me about the day you died.”

“No problem,” said the man. “Well, for some time now, I’ve thought my wife was having an affair. I believed that each day on her lunch hour, she’d bring her lover home to our 25th floor apartment and have sex with him. So today I was going to come home too and catch them. Well, I got there and busted in and immediately began searching for this guy. My wife was half-naked and yelling at me as I searched the entire apartment. But, I couldn’t find him! Just as I was about to give up, I happened to glance out onto the balcony and noticed that there was a man hanging off the edge by his fingertips! The nerve of that guy to think he could hide from me! Well, I ran out there and promptly stomped on his fingers until he fell to the ground. But, wouldn’t you know it, he landed in some bushes that broke his fall, and he didn’t die.”

“This angered me even more, so in a rage I went back inside to get the first thing I could get my hands on to throw at him. And oddly enough, the first thing I could grab was the refrigerator. I unplugged it, push it out onto the balcony and heaved it over the side. It plummeted 25 stories and crushed him!”

“The excitement of the moment was so great that right after that I had a heart attack and died almost instantly.”

The angel sat back and thought for a moment. Technically, the guy DID have a bad day, and it WAS a crime of passion, so he announced, “OK, Sir. Welcome to the Kingdom of Heaven,” and let him in.

A few seconds later the next guy came up. “OK. Here’s the rule. Before I can let you in, I need to hear about the day you died.”

“Sure thing,” the man replied. “But you’re not gonna believe this. I was out on the balcony of 26th floor apartment doing my daily exercises when I got a little carried away and accidentally fell over the side! Luckily however, I was able to catch myself by my fingertips on the balcony directly beneath mine. When all of a sudden this crazy man comes running out of his apartment and starts cussing and stomping on my fingers! Well, of curse I fell. I hit some trees and bushes on the way down which broke my fall so I didn’t die right away. As I’m laying there face up on the ground, unable to move and in excruciating pain, I see the man push his refrigerator, of all things, over the ledge and it falls directly on top of me and kills me!”

The angel is quietly laughing to himself as the man finishes his story. “I could get used to this new policy,” he thinks to himself. “Very well,” the angel announces. “Welcome to the Kingdom of Heaven,” and he lets the man enter.

A few seconds later the third man in line comes up to the gate. “Tell me about the day you died,” said the angel.

“OK. Picture this,” says the man. “I’m naked inside the refrigerator…”

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U.S. Provincetown Outbreak Shows Delta Can Spread Among Vaccinated, But Cases Are Mild

Ernie Mundell and Robin Foster wrote . . . . . . . . .

The Cape Cod resort town of Provincetown draws big crowds every summer. In July, those largely vaccinated crowds — packed into bars, restaurants and private homes — were the genesis of an outbreak of the Delta variant that could be a sobering model for the nation.

New data on the outbreak, released Friday, shows there were a known total of 469 COVID-19 cases “associated with multiple summer events” among Provincetown revelers. Three-quarters (74%) of those cases occurred among people who’d gotten their COVID vaccinations an average of almost three months before.

In 89% of those cases, the highly contagious Delta variant was implicated, concluded a team led by Dr. Catherine Brown of the Massachusetts Department of Public Health.

There was some good news, however: While many of the 346 cases among vaccinated individuals might have made them feel miserable for a time — coughs, headache, sore throat, aches and fever being the major symptoms — there were only four cases (1.2%) in this group that required hospital care.

In all four of those hospitalized cases, patients had underlying medical conditions that upped their odds for severe COVID-19, the researchers found.

A fifth case requiring hospitalization occurred in an unvaccinated patient, Brown’s team noted, and that case also involved an underlying medical condition.

There were no deaths linked to the outbreak.

The researchers noted that it’s not surprising that three-quarters of cases in the Provincetown outbreak occurred among the vaccinated, because a full 69% of the town’s vaccine-eligible residents have gotten their shots — a number that’s much higher than the national average.

Equal viral loads

However, given the increased transmissibility of the Delta variant, Brown’s team believe their findings “suggest that even jurisdictions with substantial or high COVID-19 transmission might consider expanding prevention strategies.”

Those strategies should include “masking in indoor settings regardless of vaccination status, given the potential risk of infection during attendance at large public gatherings,” they said.

The Provincetown findings also confirm that, unlike its predecessor, the Delta variant appears to produce high viral loads in people’s systems, upping transmission risks.

“Specimens from 127 vaccinated persons with breakthrough cases were similar to those from 84 persons who were unvaccinated,” the research team noted.

That finding helped drive the CDC’s decision this week to reverse course on its masking advisory. The agency now recommends that even the vaccinated once again don masks in many indoor settings, to lessen the odds they might transmit SARS-CoV-2 to others.

It also adds new energy to federal, state and local efforts to get more Americans vaccinated.

However, one leading infectious disease expert stressed that the one thing the Provincetown report should not do is lessen the average American’s faith in the power of vaccines to protect against what’s most important: Severe illness.

“The new data should not alarm anyone, but reinforce that vaccinations are the solution to the pandemic,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

A return to masking indoors

“That severe breakthrough infections were rare is testament to the vaccines, which limit the harm an infection can do in a fully vaccinated person,” he said. “It’s also important to remember the breakthroughs that occurred in this situation are likely not completely applicable to the everyday life of the vaccinated, as the intensity and nature of exposure was in the context of a large public gathering.”

Another expert said the implications of the findings are clear.

“At this time, even fully vaccinated people need to consider large gatherings as a potential place to contract the virus,” said Dr. Teresa Murray Amato, chair of emergency medicine at Long Island Jewish Forest Hills, in Queens, N.Y. “This also means that for Americans that are not yet vaccinated,” they should strongly consider doing so.

Adding to the Provincetown findings, a new internal federal government document also finds the Delta variant can cause more severe illness than earlier coronavirus variants, especially among the unvaccinated, and spreads as easily as chickenpox.

In laying out the evidence that this variant looks like the most dangerous one yet, the document urges health officials to “acknowledge the war has changed,” the Washington Post reported.

The document mirrors the data in the Provincetown study, finding that vaccinated people infected with Delta have viral loads similar to those who are unvaccinated and infected with the variant, the Post reported.

CDC scientists were so alarmed that the agency changed masking guidance for vaccinated people earlier this week, even before making the new data public, the newspaper said.

CDC Director Dr. Rochelle Walensky said in a statement on Friday that the Provincetown investigation “is one of many CDC has been involved in across the country and data from those investigations will be rapidly shared with the public when available.”

The Provincetown study was published in the CDC journal Morbidity and Mortality Weekly Report.

Source: HealthDay

Two Types of Blood Pressure Meds Prevent Heart Events Equally, But Side Effects Differ

People who are just beginning treatment for high blood pressure can benefit equally from two different classes of medicine – angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) – yet ARBs may be less likely to cause medication side effects, according to an analysis of real-world data published today in Hypertension, an American Heart Association journal.

While the class of blood pressure-lowering medicines called angiotensin-converting enzyme (ACE) inhibitors may be prescribed more commonly, angiotensin receptor blockers (ARBs) work just as well and may cause fewer side effects. Currently, ACE inhibitors are prescribed more commonly than ARBs as a first-time blood pressure control medicine.

The findings are based on an analysis of eight electronic health record and insurance claim databases in the United States, Germany and South Korea that include almost 3 million patients taking a high blood pressure medication for the first time with no history of heart disease or stroke.

Both types of medicines work on the renin-angiotensin-aldosterone system, a group of related hormones that act together to regulate blood pressure. ACE inhibitors lower blood pressure by blocking an enzyme early in the system so that less angiotensin, a chemical that narrows blood vessels, is produced, and blood vessels can remain wider and more relaxed. ARBs block receptors in the blood vessels that angiotensin attaches to, diminishing its vessel-constricting effect.

“In professional guidelines, several classes of medications are equally recommended as first-line therapies. With so many medicines to choose from, we felt we could help provide some clarity and guidance to patients and health care professionals,” said RuiJun Chen, M.D., M.A., lead author of the study, assistant professor in translational data science and informatics at Geisinger Medical Center in Danville, Pennsylvania, and NLM postdoctoral fellow at Columbia University at the time of the study.

The AHA/ACC 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults says the primary medications for treating high blood pressure are thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers as they have been shown to reduce cardiovascular events. Physical activity and other lifestyle changes are recommended for managing all levels of high blood pressure, even if medication is required.

Health records for patients who began first-time blood pressure-lowering treatment with a single medicine between 1996-2018 were reviewed for this study. Researchers compared the occurrence of heart-related events and stroke among 2,297,881 patients treated with ACE inhibitors to those of 673,938 patients treated with ARBs. Heart-related events include heart attack, heart failure or stroke, or a combination of any of these events or sudden cardiac death recorded in the database. The researchers also compared the occurrence of 51 different side effects between the two groups. Follow-up times varied in the database records, but they ranged from about 4 months to more than 18 months.

They found no significant differences in the occurrence of heart attack, stroke, hospitalization for heart failure, or any cardiac event. However, they found significant differences in the occurrence of four medication side effects. Compared with those taking ARBs, people taking ACE inhibitors were:

• 3.3 times more likely to develop fluid accumulation and swelling of the deeper layers of the skin and mucous membranes (angioedema);
• 32% more likely to develop a cough (which may be dry, persistent, and bothersome);
• 32% more likely to develop sudden inflammation of the pancreas (pancreatitis); and
• 18% more likely to develop bleeding in the gastrointestinal tract;

“We did not detect a difference in how the two types of medicine reduced the complications of hypertension, but we did see a difference in side effects,” said George Hripcsak, M.D., senior author of the study and professor and chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeons and medical informatics services director at New York-Presbyterian/Columbia University Irving Medical Center. “If a patient is starting hypertension therapy for the first time, our results point to starting with the ARB over the ACE inhibitor.”

“ARBs do not differ in effectiveness and may have fewer side effects than ACE inhibitors among those just beginning treatment,” said Chen. “We unfortunately cannot extend these conclusions to people who are already taking ACE inhibitors or those who are taking multiple medications. We would reiterate that if you experience any side effects from your medicine, you should discuss with your doctor whether your antihypertensive regimen may need to be adjusted.”

The study is limited by wide variation in the length of time patients were included in the different databases. Although many people were followed for a long period of time, those who had shorter follow-up periods may not have taken the medications long enough to experience their full benefits in preventing cardiovascular disease events. Most of the participants taking ACE inhibitors (80%) were taking lisinopril, and the most used ARB (45% of those taking this class of medication) was losartan, so the results may not be fully generalizable to other medicines in these classes. It is also important to note that results from this analysis of first-line therapy may not be generalizable to people with hypertension who have been prescribed combination treatment or who switch from one type of medication to another.

“In addition to encouraging patients to live a healthy lifestyle and taking medication as prescribed to control blood pressure, the American Heart Association recommends regular self-blood pressure monitoring with a validated device and working with a health care professional on a plan to reduce blood pressure,” said Willie Lawrence, M.D., interventional cardiologist and medical director for Health Equity, Spectrum Health, Benton Harbor, Michigan and head of the American Heart Association’s National Hypertension Control Initiative Oversight Committee.

Source: American Heart Association

Creamy Tarragon Chicken Medallions

Ingredients

450 g chicken cutlets
1/4 tsp pepper
pinch salt
2 tsp olive oil
3/4 cup white wine
1/2 cup sodium-reduced chicken broth
1/4 cup whipping cream (35%)
2 tbsp chopped fresh tarragon (or 2 tsp dried)
1 tbsp grainy mustard

Honey Mustard Veggies

2 tbsp olive oil
2 sweet potatoes, peeled and cut in 1/2-inch cubes
255 g green beans, cut diagonally in 1-inch pieces
1 tbsp liquid honey
1 tbsp grainy mustard

Method

1. Sandwich chicken between plastic wrap; using meat mallet or heavy-bottomed saucepan, pound chicken to 1-inch thickness. Sprinkle with pepper and salt.
2. In skillet, heat oil over medium-high heat. Brown chicken, turning once, 6 to 8 minutes.
3. Add wine and broth. Cover and cook until chicken is no longer pink inside, about 5 minutes. Transfer to plate and keep warm.
4. Boil pan juices until reduced to 1/2 cup. Whisk in cream, tarragon and mustard. Cook until thick enough to coat back of spoon, about 2 minutes. Serve over chicken.
5. Make the veggies. In nonstick skillet, heat oil over medium-high heat. Cook sweet potatoes, stirring occasionally, until tender-crisp, about 10 minutes.
6. Add green beans. Cook for 2 minutes.
7. Add 1/4 cup water. Cover and cook until potatoes are fork-tender, about 2 minutes.
8. Drain. Toss with honey and mustard. Serve with chicken.

Makes 4 servings.

Source: The Complete Chicken Cookbook

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Today’s Comic

What’s for Dinner?

Luxurious Seafood Set Meal at Kaneshichi Fisheries in Kamogawa City, Japan

The price is 2,750 yen plus tax.