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HOMICIDE. 4/3/19, 5:45pm. 3800 W Moreland St. Call @SilentwitnessAZ (480)WITNESS. STORY: https://t.co/ralUWQPecm pic.twitter.com/9P3v0Aqn0C— Phoenix Police Department (@phoenixpolice) April 4, 2019 209

I just received this statement from Michigan Medicine. It says that Bobby Reyes has been taken off the ventilator. pic.twitter.com/w2k8K73eVU— Kim Russell WXYZ (@kimrussell7) October 15, 2019 203

First came a high fever, drenching sweats and muscle aches. Then, almost a month later, a weird numbness that spread down the right side of her body.Darlene Gildersleeve thought she had recovered from COVID-19. Doctors said she just needed rest. And for several days, no one suspected her worsening symptoms were related — until a May 4 video call, when her physician heard her slurred speech and consulted a specialist.“You’ve had two strokes,” a neurologist told her at the hospital. The Hopkinton, New Hampshire, mother of three is only 43.Blood clots that can cause strokes, heart attacks and dangerous blockages in the legs and lungs are increasingly being found in COVID-19 patients, including some children. Even tiny clots that can damage tissue throughout the body have been seen in hospitalized patients and in autopsies, confounding doctors’ understanding of what was once considered mainly a respiratory infection.“I have to be humble and say I don’t know what’s going on there, but boy we need to find that out because unless you know what the pathogenic (disease-causing) mechanism is, it’s going to be tough to do intervention,” Dr. Anthony Fauci, the nation’s top infectious disease expert, remarked during a medical journal interview last month.Doctors and scientists at dozens of hospitals and universities around the globe are seeking answers while trying to measure virus patients’ risks for clots and testing drugs to treat or prevent them.Gildersleeve said health authorities “need to put out an urgent warning about strokes” and coronavirus. Not knowing the possible link “made me doubt myself” when symptoms appeared, she said.Some conditions that make some COVID-19 patients vulnerable to severe complications, including obesity and diabetes, can increase clot risks. But many authorities believe how the virus attacks and the way the body responds both play a role.“COVID-19 is the most thrombotic (clot-producing) disease we’ve ever seen in our lifetime,” said Dr. Alex Spyropoulos, a clot specialist and professor at Feinstein Institutes for Medical Research in Manhasset, New York.Clotting has been seen in other coronavirus infections, including SARS, but on a much smaller scale, he said.Scientists believe the coronavirus enters the body through enzyme-receptors found throughout the body, including in cells lining the inside of blood vessels. Some theorize that it may promote clotting by somehow injuring those vessels as it spreads. That injury may cause a severe immune response as the body tries to fight the infection, resulting in inflammation that may also damage vessels and promote clotting, said Dr. Valentin Fuster, director of Mount Sinai Heart hospital in New York.It’s unclear how many COVID-19 patients develop clots. Studies from China, Europe and the United States suggest rates ranging from 3% to 70% of hospitalized COVID-19 patients; more rigorous research is needed to determine the true prevalence, the National Institutes of Health says.Prevalence in patients with mild disease is unknown and the agency says there isn’t enough evidence to recommend routine clot screening for all virus patients without clotting symptoms, which may include swelling, pain or reddish discoloring in an arm or leg.Some hospitals have found 40% of deaths in COVID-19 patients are from blood clots. Spyropoulos said that’s been true at his 23-hospital system in the New York City area, Northwell Health, which has treated over 11,000 COVID-19 patients.Cases there have dropped by almost half in the past month, allowing more time for research before an expected second and maybe third wave of infections, he said, adding: “We’re racing against time to answer the key clinical questions.”Patients hospitalized with any severe illness face increased risks for clots, partly from being bedridden and inactive. They commonly receive blood-thinning drugs for prevention. Some doctors are trying higher-than-usual doses for prevention in hospitalized coronavirus patients.A few have used powerful clot-busting medicines typically used to treat strokes, with mixed results. In guidance issued May 12, the NIH said more research is needed to show whether that approach has any benefits.Fuster was involved in preliminary research on nearly 2,800 COVID-19 patients at five hospitals in the Mount Sinai system. A look at their outcomes suggests slightly better survival chances for virus patients on ventilators who received blood thinners than among those who didn’t. Although the results are not conclusive, all COVID-19 patients at Mount Sinai receive blood thinners for clot prevention unless they are at risk for bleeding, a potential side effect, Fuster said.Some COVID-19 patients, like Gildersleeve, develop dangerous clots when their infections seem to have subsided, Spyropoulos said. Patients treated at Northwell for severe disease are sent home with a once-a-day blood thinner and a soon to be published study will detail their experiences. Spyropoulos has been a paid consultant to Janssen Pharmaceuticals, makers of Xarelto, the drug’s brand name.In addition, Northwell is taking part in a multi-center study that will test using blood thinners for clot prevention in COVID-19 patients not sick enough to require hospitalization.In a small study published May 15, University of Colorado doctors found that combined scores on two tests measuring clotting markers in the blood can help determine which patients will develop large dangerous clots. One test measures a protein fragment called D-dimer, a remnant of dissolved clots. High levels sometimes indicate dangerous clots that form deep in leg veins and travel to the lungs or other organs.Dr. Behnood Bikdeli of Columbia University’s Irving Medical Center, said D-dimer levels in many of his COVID-19 patients have been alarmingly high, as much as 50 times higher than normal.Concerns about blood clots in COVID-19 patients prompted a recent 30-page consensus statement from an international group of physicians and researchers. Bikdeli is the lead author.It says that testing to find clots that require treatment includes X-rays or ultrasound exams, but poses a risk for health care workers because the virus is so contagious. Bikdeli said he fears when protective gear was more scarce, some dangerous clots were undiagnosed and untreated.Social distancing may make people more sedentary and more vulnerable to clots, particularly older adults, so doctors should encourage activity or exercises that can be done in the home as a preventive measure, the statement says.Warnell Vega got that advice after collapsing at home April 19 from a large clot blocking a lung artery. Doctors at Mount Sinai Morningside think it was coronavirus-related. Vega, 33, a lunch maker for New York City school children, spent a week in intensive care on oxygen and blood thinners, which he’s been told to continue taking for three months.“I just have to watch out for any bleeding, and have to be careful not to cut myself,” Vega said.Gildersleeve, the New Hampshire stroke patient, was also sent home with a blood thinner. She gets physical therapy to improve strength and balance. She still has some numbness and vision problems that mean driving is out, for now.Doctors are unable to predict when or whether she’ll regain all her abilities.”I’m trying to remain positive about recovering,” she said. ’’I just have to be patient and listen to my body and not push too hard.”___Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.___The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’ 7639

Greetings from the Salton Sea – California’s largest lake. In its heyday, this body of water was called the Southern California Riviera, attracting people from across the country.Decades later, this desert oasis is now dying. “It smells like death you know,” said one local man. “You can tell something died.”The Salton Sea is stinking and shrinking and what’s left is a being called a major health hazard.“The Salton Sea has gone to hell if you ask me,” another man said. “We used to go fishing there before and you can’t go fishing there anymore because there’s nothing to fish for because it’s polluted.”The sea is polluted with sewage, heavy metals and agricultural run off.With no natural run off and not much rain coming in, the Salton Sea has been decaying for decades. Experts say now the conditions are getting worse and the problems go well past county lines. “All of that dust on windy days gets aerosolized and people can inhale it for hundreds of miles actually,” said Sam J. Weiss, MD of Eisenhower Health in Palm Desert, Ca. Weiss says Imperial County’s air quality is some of the worst in the state.And as the Salton Sea dries up, more dangerous dust goes into the air and ultimately gets into people’s lungs. “If it becomes drier and drier and saltier and saltier we’ll see more and more problems unless there’s remediation of the sea,” Weiss said. In an attempt to slow down this problem, the Imperial Irrigation District dug trenches to suppress the dust.“IID models all of our project areas to control the most dust as possible,” said Jessica Humes of the Imperial Irrigation District. Humes says the Salton Sea is twice as salty as the Pacific Ocean and that ratio is impacting wildlife. “It is reducing reproduction of fish, fish are eaten by birds, and if there’s no fish, that causes a huge issue for them,” she said.Humes went on to say that the Salton Sea has more than 20,000 acres of dusty ground exposed -- a number she expects to increase overtime. “This boat dock had water in it over 10 years ago,” she said. “Today completely dry and the Salton Sea is hundreds of yards away.”Conditions are so bad that local leaders recently made an emergency declaration over air quality. “I’m worried about the impacts that are unknown and the sea receding so fast that you can’t plan for it,” SAID Ryan Kelley, chairman of the Imperial County Board of SupervisorsKelley says this is the latest bid to save the Salton Sea. And if the state recognizes this request – it puts rehabilitation efforts on a fast track to happen now.“If they were to listen to what our concerns are and to take up our emergency they could get back to neutral on what they promised to do under the management program,” he said. California Governor Gavin Newsom's office sent us a statement saying, ” The Salton Sea is an urgent issue, and we are intensely focused on solutions. The state is reviewing the Imperial County Board of Supervisors’ action, but we are not waiting to act on projects that can help. Several efforts are already underway to address Salton Sea-related air quality issues, including dust suppression and collaboration with local, state and federal agencies.”Meanwhile, those that live here recognize the problems are at their doorstep“The sea all winter long was full of pelicans,” said Mary Jane Mulrooney, who has been living near the Salton Sea for more than 30 years. “Now you don’t see any pelicans.” Mulrooney says she’s tired of watching this lake waste away.“It’s sad that nobody cares enough to save it,” she said. Now she and others hope this latest effort reignites a sense of urgency and ultimately action. 3648

I.M. Pei, the Chinese born architect who was best known for designing the courtyard to the Louvre in Paris, the Rock and Roll Hall of Fame in Cleveland and the Kennedy Library in Boston, has died at the age of 102, the New York Times confirmed. The cause of Pei's death has not been announced. Pei moved to the United States at age 22, and learned from renowned architects such as Le Corbusier. Pei's first professional design was built in Atlanta in 1949. It was a simple mixed-used facility, which was torn down in 2013. In 1964, Pei was picked by John F. Kennedy's family to design his presidential library. The library ended up taking nearly 15 years to complete. In the 1981, Pei's design of the Louvre's pyramid courtyard opened to the public. During his career, he won many awards, including being awarded the Presidential Medal of Freedom by George H.W. Bush in 1992. Pei was preceded in death by his wife Eileen of 70 years. 946

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