Chuckles of the Day

---

---

---

The Old Mule

An old hillbilly farmer had a wife who nagged him unmercifully. From morning ’til night she was always complaining about something. The only time he got any relief was when he was out plowing with his old mule. He plowed a lot. One day, when he was out plowing, his wife brought him lunch in the field. He drove the old mule into the shade, sat down on a stump, and began to eat his lunch..

Immediately, his wife began nagging him again. Complain, nag, complain, nag – it just went on and on.

All of a sudden, the old mule lashed out with both hind feet, caught her smack in the back of the head. Killed her dead on the spot.

At the funeral several days later, the minister noticed something rather odd. When a woman mourner would approach the old farmer, he would listen for a minute, then nod his head in agreement; but when a man mourner approached him, he would listen for a minute, then shake his head in disagreement. This was so consistent, the minister decided to ask the old farmer about it.

So after the funeral, the minister spoke to the old farmer, and asked him why he nodded his head and agreed with the women, but always shook his head and disagreed with all the men.

The old farmer said, “Well, the women would come up and say something about how nice my wife looked, or how pretty her dress was, so I’d nod my head in agreement.”

“And what about the men?” the minister asked.

“They wanted to know if the mule was for sale.”

* * * * * * *

Did Anyone See My Face?

A hooded robber burst into a Texas Bank and forced the tellers to load a sack full of cash. On his way out the door a brave Texas customer grabbed the hood and pulled it off revealing the robber’s face.

The robber shot the customer without a moment’s hesitation. He then looked around the bank and noticed one of the tellers looking straight at him. The robber instantly shot him also. Everyone else, by now very scared, looked intently down at the floor in silence.

The Robber yelled, “Well, did anyone else see my face?”

There are a few moments of utter silence, in which everyone was plainly afraid to speak.

Then one old man tentatively raised his hand and said, “My wife got a good look at you.”

---

---

---

Advertisement

What’s for Dinner?

Home-cooked 3-course Dinner

Mini tomatoes, broad beans, kiwi, and onions salad

Spinach and peas curry with rice

Dessert – Vanilla ice cream with passion fruit

Survival Of The Fittest: The Rise Of BA.2.12.1

William A. Haseltine wrote . . . . . . . . .

Contrary to the popular belief that Covid infections are receding universally, recent reports show that several countries are in the midst of accelerating Covid rates. This draws cause for concern with the Summer fast approaching. Recall that Summer 2021 was dominated by Delta variant infections. This Summer may be in for something similar. The current increase is almost certainly due to new members of the Omicron family of viruses.

Current estimates suggest that BA.2 variants have replication rates at least 30% greater than BA.1 variants. Two variants, BA.4 and BA.5 in Europe, were recently identified as strains to monitor by the World Health Organization. Figure two illustrates how rapidly descendants of Omicron have diversified and established themselves not only in the United States, but around the world.

One such subvariant is already causing significant case numbers in the American Northeast. In the GISAID SARS-CoV-2 database, BA.2.12.1 is attributed to roughly 2,000 sequenced infections, which suggests that the actual number of BA.2.12.1 cases is at least in the tens of thousands. A recent analysis by the CDC suggests that BA.2.12.1 comprises at least 19% of new cases while BA.2 lineages overall comprise over 90%.

As its lineage name suggests, BA.2.12.1 is a descendant of the BA.2 virus. BA.2 was the main driver of the winter wave of Omicron infections that peaked in the United States on January 14th, 2022, when the daily average was over 800,000 new infections. Part of BA.2’s viral fitness was its remarkably high transmissibility, and another was its expert evasion of the immune system, including antibodies developed from previous infections and vaccinations.

The BA.2 virus’s viral fitness is attributed to its wealth of mutations within and external to the Spike protein. The BA.2 genome contains 53 amino acid mutations, 29 of which are in the Spike protein, far outnumbering the Spike mutations of previous variants of concern and interest.

One mutation lies in the receptor-binding domain. This is a substitution of lysine for glutamine at position 452 (L452Q). This mutation is notable for two reasons. First, L452Q has been previously identified in several variants of concern, like Lambda, Delta, Delta plus, and Epsilon. Second, unlike many mutations where we must only speculate on their impact on viral fitness, L452Q was studied and found to increase escape immunity, allowing the virus to attach more strongly to human cells and avoid neutralizing antibodies.

The second mutation is more mysterious. It is a substitution from serine to leucine at position 704 (S704L). Unlike L452Q, S704L is a relatively rare mutation by way of major variants, and its exact impact on the virus is unstudied. Based on its position in the S2 region of the Spike protein, we can speculate that the mutation may affect either viral fusion or furin cleavage efficiency, but further study would be welcome.

We can say with near certainty that BA.2.12.1 is at least as transmissible and immune evasive as BA.2. It is unlikely that the two Spike mutations would decrease either of these facets of the virus strain. However, due to the wealth of BA.2 cases in previous months, the BA.2.12.1 virus may be impeded by antibodies developed from infections during that wave, which could explain why cases are low relative to the Omicron wave.

However, it is critical to remain vigilant in our surveillance of these subvariants. Recent reports from Hong Kong note that Omicron BA.2 subvariants deliver a similar fatality risk to those infected relative to earlier strains of SARS-CoV-2. This is contrary to many assumptions that Omicron is less severe than previous strains. Additionally, there are indications that Omicron is as dangerous in terms of long-term complications in children as the Delta variant of last summer.

We also note the growing danger of long Covid. As many as 30-50% of Omicron recoverees describe at least some lingering issue post-infection. This is independent of vaccination status and severity of their given infection—the rate increases for those hospitalized.

A new wave of Omicron with BA.2.12.1 or another variant yet to be identified could be as catastrophic as the wave from December to February. At the time of writing, 988,610 people died due to Covid-related complications. We should make every effort to keep that number from continuing to increase. One such avenue is to continue surveilling new variants to inform public health measures and aid the development of Covid-19 treatments.

Source : Forbes

Thai-style Spare Ribs

Ingredients

1 clove garlic, peeled
2 coriander roots and stems
pinch ground white pepper
2 oz sugar
1/2 tsp salt
2 tbsp dark soy sauce
1 tbsp Maggi seasoning
2 tbsp vegetable oil
300 g pork rib cage, in one piece
green salad leaves and coriander leaves to garnish
store-bought Thai Sweet & Sour Sauce to serve

Method

1. In a mortar, pound the garlic with the coriander roots and stems.
2. Mix all the ingredients and 2 tbsp hot water together except for the rib cage to make a homogenous marinade.
3. Marinate the rib cage with the marinade for 24 hours in the refrigerator.
4. Grill the marinated ribs, on both sides for about 20 minutes on a low heat, preferably over charcoal, until golden-brown.
5. Place the ribs on a chopping board and cut between the bones to separate them, then arrange on a serving dish lined with salad leaves. Sprinkle coriander on top. Serve ribs with Thai Sweet & Sour Sauce separately in a bowl.

Makes 1 serving.

Source: Royal Thai Cuisine

---

Today’s Comic

Uncontrolled Blood Pressure, Diabetes May be Common Among People with Heart Failure

Laura Williamson wrote . . . . . . . . .

Many people with heart failure also have diabetes or high blood pressure. But new research suggests those conditions, even when treated, aren’t well controlled, placing people at risk for worsening heart problems.

“We know that controlling hypertension and diabetes is critical for people with heart failure,” said Dr. Madeline Sterling, a primary care physician at Weill Cornell Medicine in New York City. “But few studies have been able to ascertain how well those risk factors have been controlled. This study really takes a big step forward in doing that.”

Sterling wrote an editorial accompanying the study that appeared in the American Heart Association’s journal Circulation: Heart Failure.

Heart failure occurs when the heart can’t pump as well as it should and fails to deliver enough oxygen to the body, making it harder for people to perform everyday tasks. Hypertension, another name for high blood pressure, and diabetes are major risk factors for heart failure, which affects more than 6 million people in the U.S., especially those who have other heart problems or who have had heart attacks.

In the new study, researchers analyzed 18 years of data from the National Health and Nutrition Examination Survey, a series of federal studies assessing the prevalence of major diseases and their risk factors among U.S. adults.

While just 8% of 1,423 people diagnosed with heart failure had poor glycemic control, defined in the study as a hemoglobin A1C level of 8% or higher, 21% of those being treated for diabetes failed to meet blood glucose goals. This did not vary by race or ethnicity.

Researchers also found 48% of people with heart failure had uncontrolled hypertension, which the researchers defined as a systolic blood pressure, the top number in a reading, of at least 130. Among people prescribed blood pressure-lowering medication, poor control was even higher, at 51%. Black adults had higher uncontrolled rates than their white peers, at 53% compared to 47%.

That higher rate of poor blood pressure control among Black adults with heart failure was not surprising since it mirrors racial disparities in blood pressure control in the general population, said Dr. Sadiya Khan, senior author of the study, funded in part by the AHA.

“This speaks to a larger problem, which is a systemic failing to control the leading risk factors that account for the greatest number of non-communicable deaths worldwide,” said Khan, an assistant professor of medicine at Northwestern University Feinberg School of Medicine in Chicago.

“The reasons for these disparities are manifold,” said Dr. Leah Rethy, a resident physician at the University of Pennsylvania Perelman School of Medicine and lead author of the study. They include the history of structural racism in the U.S., which is largely responsible for disparities in access to health care, proximity to green spaces where people can safely meet exercise goals and “all sorts of things that influence somebody’s life course up until the time they get heart failure,” she said.

While the vast majority of people in the study had insurance, they also reported incomes below the poverty line, which could affect their access to quality care or the ability to pay for medications, said Sterling, who was not involved in the research. The study also did not track whether people being treated for high blood pressure and diabetes were actually taking the medications prescribed to them.

The study documented only the prevalence of uncontrolled blood pressure and poor glycemic control, not why those risk factors were uncontrolled, Rethy said.

“We think there’s probably a number of reasons that include a lack of understanding or focus from providers about the importance of blood pressure control, but also perhaps a lack of accessibility to consistent and affordable primary and specialty care for adults with heart failure,” she said, “particularly those under age 65 who don’t qualify for Medicare.”

Sterling added that “it’s actually quite hard to control these risk factors. It’s not just a matter of giving people medications. This study is shedding light on this.”

Many people who have heart failure are older, frail and may have cognitive issues, so it may be difficult for them to perform the extensive self-monitoring needed to manage their health, she said. “A lot is put on patients to manage this at home, and it’s a challenge.”

But that doesn’t mean it’s an insurmountable one, Rethy said. The key is finding ways to help health care professionals and patients put into practice what researchers know about how to get blood pressure and blood glucose levels under control.

“There are many good medications and lifestyle interventions that we know work,” she said. “We shouldn’t think of it as too lofty to achieve. We have access to lots of tools to help fix it.”

Source: American Heart Association