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Lili's Art Decors Group

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Ryan Mitchell
Ryan Mitchell

Fa La Na Cute Tranny

Transmission of Chagas disease by blood transfusion was initially suggested by Dias (1945). The first infected donors in Brazilwere reported by Pellegrino (1949) and Pellegrino et al. (1951) and the first cases ofpeople who acquired the infection were described by Freitas et al. (1952). Nussenzweig et al.(1953) experimented with chemoprophylaxis by means of gentian violet in bloodfrom donors. It has been estimated that in Brazil alone in the 1970s, there were 100,000new cases of Chagas disease through blood transfusion every year (Dias & Schofield 1999). Several serological surveys were carriedout in Brazil and in the Americas from 1970 onwards (Wendel & Dias 1992, Dias & Schofield1999). Before this, however, local surveys were carried out (Pellegrino 1949, Pellegrino et al. 1951, Freitas et al.1952). Coura (1966) conductedserological surveys in two blood banks in RJ, involving 4,595 donors, among whom 58donors were positive (1.26%). From these, 24 blood recipients were located. Six, whowere autochthonous to RJ, were infected (25%) and one of these individuals developed anacute form of Chagas disease, with an overall increase in the heart area and signs ofacute myocarditis seen on electrocardiogram (Fig.4A,B).

fa la na cute tranny


Chagas disease in the Brazilian Amazon Region has always been considered to be anenzooty transmitted between vectors and wild animals, since the time when Chagas (1924) confirmed T. cruzi asa parasite, isolated from a Saimiri scireus monkey in the state of Pará(PA). Thereafter, it was only 45 years later that Shawet al. (1969) described the first four acute cases of Chagas disease in Belém,PA, which were probably transmitted orally. Since then, hundreds of acute cases of thedisease due to oral transmission have been described in the Amazon Region, which has ledto classification of the region as endemic (Valente etal. 1999, 2009). Pinto et al. (2008) alone described 233 acute cases of the disease,most of which were caused by oral transmission in the states of Amapá (AP), Maranhão(MA) and PA. A high proportion of these cases presented the severe acute form of Chagasdisease, probably due to a greater inoculation of T. cruzi in oraltransmissions (Fig. 5). In 1990, we raised thehypothesis that Chagas disease was endemic to the Brazilian Amazon Region (Coura 1990) and, later on, we carried out a shortreview of the 38 cases of the disease that had been described up until that time in thestates of Acre, PA, AP, AM and MA (Coura et al.1994b). Oral transmission of Chagas infection within the natural history ofthe disease was reviewed by Coura (2006).

So far, in AM, there have been three descriptions of outbreaks of acute Chagas diseasedue to oral transmission, respectively in Tefé, in 2004 (Medeiros et al. 2008), in Coarí, beside the Solimões River, in 2008 (Barbosa-Ferreira et al. 2010), and in Santa Izabel doRio Negro, in 2010 (Souza-Lima et al. 2013).

Several other isolated outbreaks of the disease have been observed in Brazil, with nomajor repercussion. The greatest outbreak of oral transmission of T. cruziinfection, which involved 103 acute cases of Chagas disease, occurred inCaracas, Venezuela, with great international repercussion (de Noya et al. 2010).

As if that was not enough, the sum of $322 million and 5.5 million from the Abacha loot which was illegally transferred to Col. Dasuki by a former Finance Minister, Dr. Ngozi Okonjo-Iweala for prosecuting the war on terror has also been criminally diverted. Part of the stolen fund was used to fund the campaign for the re-election of President Goodluck Jonathan in the 2015 general elections. The suspects arrested by the Economic and Financial Crimes Commission have admitted their involvement in the sharing of the money meant to procure weapons to fight terrorism. Apart from diverting the fund for acquiring military equipment, some corrupt public officers also stole money set aside for acquiring the necessary gadgets and equipment for securing the Nigerian people. For instance, the $470 million contract awarded in 2009 for the installation of CCTV cameras in Abuja, the seat of the federal government, was poorly executed due to corrupt practices. Thus, the identification of terrorists who launched bomb attacks in public places in Abuja has been frustrated by the government officials who stole the contract sum.

Although the country has prosecuted the war on terror for five years, the Federal Government did not deem it fit to equip the hospitals in the war-torn areas. Consequently, thousands of people including school children who were injured during bomb attacks in Abuja and other cities in Nigeria were rushed to public hospitals, but the majority of them died due to lack of adequate medical facilities. In the same vein, hundreds of soldiers who were injured in the battle front were rushed to military hospitals, but they too lost their lives because such hospitals are not well equipped. Hence, following the bombing of the United Nations building at Abuja in August 2011, a majority of the people who were injured in the building were flown to hospitals in South Africa for medical treatment.

In February 2015, under the pretext that they needed time to end the war on terror, the military authorities blackmailed the Independent National Electoral Commission to postpone the general election by six weeks. But the 6-week extension was however used by the service chiefs and Col. Dasuki to further enrich themselves to the detriment of national security. Based on such acts of sabotage and betrayal on the part of the former military authorities former President Jonathan was forced to admit publicly that there were members of the Boko Haram sect in his government. But the members of the sect in the government were not prosecuted for sponsoring and promoting terrorism in the country.

Notwithstanding the deliberate refusal of the military authorities to purchase arms and armament due to the criminal diversion of the security fund, Col. Dasuki gave a lecture at Chatham House in London on February 8, 2015, where he claimed that Nigeria had acquired adequate equipment to prosecute the war on terror. At the time he was addressing his London audience, Col Dasuki was well aware that the fund for procurement of weapons had been stolen by himself and his cohorts.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible for coronavirus disease 2019 (COVID-19), has caused morbidity and mortality at an unprecedented scale globally1. Scientific and clinical evidence is evolving on the subacute and long-term effects of COVID-19, which can affect multiple organ systems2. Early reports suggest residual effects of SARS-CoV-2 infection, such as fatigue, dyspnea, chest pain, cognitive disturbances, arthralgia and decline in quality of life3,4,5. Cellular damage, a robust innate immune response with inflammatory cytokine production, and a pro-coagulant state induced by SARS-CoV-2 infection may contribute to these sequelae6,7,8. Survivors of previous coronavirus infections, including the SARS epidemic of 2003 and the Middle East respiratory syndrome (MERS) outbreak of 2012, have demonstrated a similar constellation of persistent symptoms, reinforcing concern for clinically significant sequelae of COVID-19 (refs. 9,10,11,12,13,14,15).

Multidisciplinary collaboration is essential to provide integrated outpatient care to survivors of acute COVID-19 in COVID-19 clinics. Depending on resources, prioritization may be considered for those at high risk for post-acute COVID-19, defined as those with severe illness during acute COVID-19 and/or requirement for care in an ICU, advanced age and the presence of organ comorbidities (pre-existing respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplant or active cancer). The pulmonary/cardiovascular management plan was adapted from a guidance document for patients hospitalized with COVID-19 pneumonia76. HRCT, high-resolution computed tomography; PE, pulmonary embolism.

Patients with cardiovascular complications during acute infection or those experiencing persistent cardiac symptoms may be monitored with serial clinical, echocardiogram and electrocardiogram follow-up

Early reports have now emerged on post-acute infectious consequences of COVID-19, with studies from the United States, Europe and China reporting outcomes for those who survived hospitalization for acute COVID-19. The findings from studies reporting outcomes in subacute/ongoing symptomatic COVID-19 and chronic/post-COVID-19 syndrome are summarized in Table 1.

Retrospective data on post-acute thromboembolic events, although limited by small sample size, variability in outcome ascertainment and inadequate systematic follow-up, suggest the rate of venous thromboembolism (VTE) in the post-acute COVID-19 setting to be

Mechanisms perpetuating cardiovascular sequelae in post-acute COVID-19 include direct viral invasion, downregulation of ACE2, inflammation and the immunologic response affecting the structural integrity of the myocardium, pericardium and conduction system. Autopsy studies in 39 cases of COVID-19 detected virus in the heart tissue of 62.5% of patients115. The subsequent inflammatory response may lead to cardiomyocyte death and fibro-fatty displacement of desmosomal proteins important for cell-to-cell adherence116,117.

Despite initial theoretical concerns regarding increased levels of ACE2 and the risk of acute COVID-19 with the use of RAAS inhibitors, they have been shown to be safe and should be continued in those with stable cardiovascular disease126,127. Instead, abrupt cessation of RAAS inhibitors may be potentially harmful128. In patients with ventricular dysfunction, guideline-directed medical therapy should be initiated and optimized as tolerated129. Withdrawal of guideline-directed medical therapy was associated with higher mortality in the acute to post-acute phase in a retrospective study of 3,080 patients with COVID-19 (ref. 130). Patients with postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia may benefit from a low-dose beta blocker for heart rate management and reducing adrenergic activity131. Attention is warranted to the use of drugs such as anti-arrhythmic agents (for example, amiodarone) in patients with fibrotic pulmonary changes after COVID-19 (ref. 132). 041b061a72


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