well... you certainly are not supposed to be here.

Malaria presents with periodic flu-like symptoms and should be suspected in any ill patient with a history of travel from an endemic region. Diagnosis is primarily made by examining thick and thin blood smears for speciation and percent parasitemia. All malarial species produce intra-erythrocytic rings (trophozoites). Rapid antigen testing may also be available and can distinguish between P. falciparum and P. vivax. Treatment with chloroquine is standard for mild-to-moderate disease. Due to chloroquine resistance, however, artemisinin combination therapy (ACT) is commonly used. ACT options include dihydroartemisinin, artesunate, mefloquine, or artemether in combination with other antimalarials (eg, piperaquine or mefloquine).

Severe disease should be treated with intravenous artesunate. The anti-hypnozoite drug primaquine is also necessary for P. vivax and P. ovale because of their ability to cause relapse due to dormant hypnozoite forms within the liver. To prevent acute hemolysis, it is important to test for glucose-6-phosphate dehydrogenase deficiency prior to initiating primaquine. Of note, P. falciparum is known to produce fulminant disease, including hemolytic anemia, renal failure, pulmonary edema, central nervous system disease, hypoglycemia, liver failure, and lactic acidosis. Rapid treatment is therefore essential to prevent poor outcomes.

Gonorrhea is diagnosed with NAAT of a swab or culture on Thayer-Martin media. Once the samples have been obtained, the patient can be initiated on antimicrobial therapy. The standard therapy would be ceftriaxone 250 mg intramuscularly (IM) as a single dose, plus azithromycin 1 g orally (due to increasing resistance) or doxycycline 100 mg orally twice daily for 7 days.

Wilson disease results in inappropriate deposition of copper in the liver, brain, and other tissues due to impaired clearance of copper into the bile. It is an autosomal-recessive disease affecting chromosome 13. Signs and symptoms are the consequence of cirrhosis, basal ganglia deterioration, and deposition of copper in other tissues, causing hepatic failure, neurologic abnormalities, hemolytic anemia, and Kayser-Fleischer rings around the iris.

Basic labs will reveal hemolytic anemia (decreased hemoglobin and hematocrit with elevated bilirubin as well as decreased haptoglobin and increased reticulocyte count) and elevated liver enzymes due to liver inflammation and cirrhosis. Decreased ceruloplasmin (less than 20 mg/dL) and low serum copper concentration are consistent with Wilson disease and should prompt confirmatory workup, including 24-hour urine copper excretion. Low serum copper levels may seem paradoxical; however, it should be remembered that ceruloplasmin is the primary copper binding protein and is responsible for the majority of copper contained in the serum. Low ceruloplasmin results in a low total serum copper, despite the fact that total-body copper is in excess. This excess, while not measurable in the serum at a specific point in time, is measurable as increased urinary excretion over the course of the day, which is why a 24-hour urine copper is needed.

Kayser-Fleischer rings are present in 50% of patients with active liver disease but without any neurologic involvement. When neurologic symptoms present (dysarthria, dystonia, tremor, parkinsonism, choreoathetosis, ataxia, cognitive impairment), Kayser-Fleischer rings are present in 98% of patients.

Gastric cancer presents with left supraclavicular lymphadenopathy. Left supraclavicular adenopathy (known as the Virchow node) suggests an abdominal source, such as the stomach, gallbladder, or pancreas.

In any patient with an upper GI bleed, it is important to ask for recent anticoagulation use and a history of prior bleeding or endoscopy as up to 60% of recurrent GI bleeding is from the same lesion. Other important considerations in the history include: if the patient has a history of H. pylori, cirrhosis, odynophagia, or the use of antiplatelet agents.

Esophageal varices and peptic ulcers are common and easily treatable causes of bleeding in pts with cirrhosis.

Bottom Line: The most common causes of upper GI bleeding include peptic ulcer disease, severe or erosive gastritis/duodenitis/esophagitis, esophagogastric varices, portal hypertensive gastropathy, angiodysplasia, Mallory-Weiss syndrome, mass lesions (polyps/cancers).

Besides varices, other major complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, hepatopulmonary syndrome, however, in patients with acute decompensation due to upper GI bleeding, the most urgent conditions to evaluate for include the development of hepatic encephalopathy, SBP, and hepatorenal syndrome.

Bottom Line: A patient with cirrhosis and acute upper GI bleeding should have 2 large-bore IVs or a large-bore, single-lumen central catheter placed, be resuscitated with IV fluids, transfused blood as needed, started on an IV proton pump inhibitor drip, an IV octreotide drip, and IV antibiotics for SBP prophylaxis, and will generally require ICU admission. An EGD should be performed within 24 hours of admission, but ideally as soon as possible, once the patient is hemodynamically stable.

Management of critical patients with upper GI bleeding generally follows the same trajectory. Get as much history as possible to localize risk factors for bleeding and options to inform immediate pharmacologic treatment (PPI vs octreotide vs both). Give blood and fluids. Consult gastroenterology for EGD. If the patient cannot undergo EGD or this is not available or had a recent EGD with bleeding that is not amenable to further endoscopic therapy, consult IR for embolization.

Those patients found to have SBP should receive hepatorenal syndrome prophylaxis with albumin on days 1 (1.5g/kg) and 3 (1g/kg) of admission if they meet the criteria.

Multiple trials evaluating the effectiveness of prophylactic antibiotics in cirrhotic patients hospitalized for GI bleeding suggest an overall reduction in infectious complications and possibly decreased mortality. Antibiotics may also reduce the risk of recurrent bleeding in hospitalized patients who bled from esophageal varices.

Diagnose pheochromocytoma with urine metanephrine and normetanephrine levels. The most appropriate drug therapy prior to adrenalectomy for suspected pheochromocytoma consists of phenoxybenzamine followed by the addition of propranolol (if needed for heart rate control). Preoperative treatment for surgical resection of pheochromocytoma involves alpha-receptor blockade. This can be followed by beta-receptor blockade if needed for further heart rate control, usually 2 to 3 days before surgery.

7 to 14 days of phenoxybenzamine and 2 to 3 days of propranolol prior to surgery (if needed for heart rate control), with the continuation of propranolol perioperatively. The most important aspect of treatment in patients with pheochromocytoma with respect to preoperative antihypertensive therapy is alpha-receptor blockade. Alpha-receptor blockade prevents the hypertensive effect of overstimulation by the catecholamines released from the adrenal medulla. Beta-receptor blockade should follow, which prevents rebound tachycardia (goal heart rate should be 60-80/min) in the setting of unopposed alpha blockade. The clinical guidelines from the Journal of Clinical Endocrinology and Metabolism released in 2014 currently support the use of alpha-blockers for blood pressure control prior to surgery. Beta-blockers can be added afterward if needed. Of note, selective alpha-1-receptor blockers, such as prazosin or doxazosin, may be used instead of phenoxybenzamine in certain situations, such as in patients who have significant benign prostatic hyperplasia and may already be on low doses of these medications or if the patient cannot tolerate the first-line agents listed above. Metoprolol can also be administered instead of propranolol or atenolol.

There is a rule of 10's associated with pheochromocytoma: 10% are extra-adrenal, 10% are bilateral, 10% are malignant, and 10% occur in children. Some people add that 10% will recur after excision within 10 years and 10% will be found after a significant stroke. It was previously thought that about 10% were familial; however, that number has been adjusted upward as more and more genetic and familial diseases have been linked with the development of pheochromocytoma. It is now thought that about 40% of pheochromocytomas are associated with some kind of underlying genetic predisposition. Malignant pheochromocytomas are biologically and histologically indistinguishable from benign pheochromocytomas. The only way to determine malignancy is to observe local infiltrative disease or find evidence of metastatic spread. Thus, even benign pheochromocytomas found on excision will need clinical follow-up.

Most authors advocate obtaining 24-hour fractionated urine metanephrines if the clinical suspicion is low, and serum metanephrines if the clinical suspicion is high. Serum metanephrines have a decreased specificity, and positive testing may result in unnecessary imaging and follow-up, which is why it is not recommended as the first-line test for all patients.

HAs, diaphoresis, HTN = pheo

Gastrinoma (Zollinger-Ellison) - initial test that should be ordered is a fasting serum gastrin level. If elevated, it should be followed by a secretin infusion test. Somatostatin-receptor scintigraphy is the imaging test of choice as it detects for primary or metastatic lesions. Treatment includes intravenous (IV) proton pump inhibitors and surgical resection. Zollinger-Ellison syndrome is also associated with multiple endocrine neoplasia (MEN) type 1. MEN 1 is also known as Werner's syndrome and presents with the 3 Ps: parathyroid tumors; pituitary tumors, including prolactinoma; and pancreatic endocrine tumors, including insulinomas, vipomas, glucagonomas, and Zollinger-Ellison syndrome.

The initial test of choice for Zollinger-Ellison syndrome is a fasting serum gastrin (off proton pump inhibitors). The diagnosis is confirmed with a secretin infusion test. It is associated with MEN1.

I Coulda Just Asked

Prologue:

The war in the Pacific was massive in terms of equipment and supplies. And it wasn't all bullets and bombs and tanks.  In 1943, the year I was born, the U.S. Army was fighting mosquitoes and malaria in New Guinea almost as much as they were fighting the Imperial Japanese soldiers.  U.S grunts on the ground were consuming thirty million anti-malarial pills per month.  Just on New Guinea alone.  Thirty million little white Atabrine pills.   Manufactured, shipped and distributed one pill at a time to soldiers scattered all across the almost impenetrable New Guinea jungles.  Each month another thirty million!  Mind boggling as that sounds, it was like half a drop of water in an ocean of supporting supplies.

I never really knew my dad.  I thought I did.  But it turns out I didn't.  And now I have one great big question, among many, that will never get answered.

My dad served in New Guinea during World War II.  Many years later, when I would visit and the two of us would sit around with nothing much to talk about, I never asked about the war or about his time in New Guinea.  

The fighting in New Guinea was some of the bloodiest in the Pacific.  What was it like?  How close to the fighting was he?  Was he scared?  Did he lose friends?  Did he see horrible things?  Did he get Malaria?  How did he get to New Guinea?  When did he leave?  How did he get back to the States? 

I never asked.  I had lot's of chances to ask - but I didn't. 

In what must be some sort of twisted joke being played on me by the Universe, I stumbled upon a possible connection between my dad in New Guinea me later on.  

Maybe, possibly, who knows? A cosmic coincidence connecting me and my dad across time and space.

A connection between something that happened to my dad in 1944 and something that happened to me in 1968.  

And now the question is an irritating itch I can't scratch.

In September, 1944 the USS General R. E. Callan (AP-139) put out from San Francisco, California filled with fresh Army troops bound for New Guinea.  They were offloaded at Oro Bay and Langemak Bay in New Guinea.  

After offloading, the USS Callan brought aboard some 2,700 troops and casualties and transported them back to the States - arriving in San Francisco November 1st, 1944. 

Here is what she looked like filled with troops.

Was my dad one of those soldiers leaving New Guinea on the USS Callan heading home?

The odds are very slim - maybe infinitesimally so.   But 2,700 Army soldiers did leave New Guinea on that ship and one of them could have been my father.

Seventeen years later, the USS Callan was transferred to the U.S. Air Force and rebuilt as a Missile Range Instrumentation Ship.  She was renamed USAFS General H. H. Arnold. 

In July 1964 the Arnold was acquired by the U.S. Navy and designated USNS General H. H. Arnold (T-AGM-9). She tracked missiles in the Atlantic and later in the Pacific - which is where I came aboard as an electronics field engineer working for RCA in 1968.

Here is what she looked like when I came aboard.

I was on the Arnold for almost 6 years.

Was there a connection between a father and a son across time and space?  One a soldier standing at the starboard rail, heading home, with a 20 month old son waiting for him.  

And vibrating at the other end of that cosmic thread, that same son 24 years later standing at the starboard rail watching the Pacific Ocean slide by?  

One heading home from a hot war in the Pacific and one decades later serving in a cold war traversing the same Pacific waters on the same ship?

Probably not. The odds are greatly against it.  2,700 troops represents only .007% of the estimated 400,000 American soldiers on the Island in 1944.

But the Universe can be a real prankster sometimes.

If I get lucky and ascend to a new plane of existence after... you know... after.....  

And if, as they say, we will meet up with all of our loved ones....

....I'm gonna walk up and say, "Hey Dad, let's sit for awhile, I've got a few questions." 

Development the β-Arrestin Trafficking Circumstances regarding Ghrelin Receptor GHCaramboxina: C-Tail-Independent Molecular Determining factors in GPCRs

Heat surprise proteins (Hsps) are typically related to anxiety reply and patience. The actual Native indian catfish, Clarias batrachus, is often a river air-breathing hypoxia understanding teleost and is possibly critical catfish kinds regarding aquaculture and then for their financial benefit as meals. The existing research aimed at deciding your transcriptional reply regarding three Hsps, CbHsc71, CbHsp90 leader and CbHsp10 in hypoxia understanding Indian native catfish, D. batrachus, below trial and error and also normal hypoxia. The term report regarding above 3 genes have been analyzed under different periods regarding hypoxia, by means of qRT-PCR. Primers specified via ESTs attained through SSH collections constructed from hypoxia dealt with within a. The Hsp10 ESTs and deduced necessary protein was in silico indicated due to the ORF and then for the physical as well as compound qualities, correspondingly, using GeneScan, blastp, scanprosite, superfamily along with other programs. The phylogenetic sapling ended up being created depending on deduced protein series regarding Hsc71, Hsp90 leader https://www.selleckchem.com/products/Methazolastone.html , Hsp90 experiment with regarding Homo sapiens and also other fish together with CbHsp10 necessary protein throughout MEGA4. The actual deduced proteins patterns associated with CbHsp10 is discovered to have characteristic Hsp10 family signatures, which is proposed regarding inclusion associated with methionine from the general opinion sequences of Hsp10 household signature, as soon as the "proline" deposit. In transcribing amount, these kinds of genes were found to get differentially governed beneath hypoxia strain, in different cells regarding D. batrachus. Your CbHsc71 and also CbHsp90 alpha have been up-regulated following small and long-term hypoxia, whereas CbHsp10 has been considerably down-regulated after short-term hypoxia. The particular differential appearance of such Hsps may play a role throughout safety along with success under hypoxia caused oxidative anxiety in H. batrachus.Self-assembled peptide dependent nanostructures gained ample recognition because of their effortless biocompatibility and numerous prospective apps. An outstanding model of self-assembly associated with hydroxyethylamine based peptide nanostructures ended up being produced and also seen as DIS and also TEM. Spherical ipod nano houses involving I along with III ended up seen using chemical size comparable to Fifty and similar for you to Eighty nm, correspondingly. Additional, My spouse and i selleck chemicals llc as well as III were screened-in against anti-malarial goal, falcipain-3 (FP3), a vital cysteine protease concerned as being a key hemoglobinase regarding Plasmodium falciparum. Curiously, ingredient Hi there completely inhibited the activity regarding FP3. Your efficient attention (1.5 mu Mirielle) of 3 seen to be Wiki wealthier than My spouse and i. This kind of biochemical outcome was substantiated through molecular-docking scientific studies implying Three to be greatest chemical associated with FP3. This is the initial statement displaying that his / her hydroxethylamine dependent peptide nanostructures is quite efficient inhibitor. involving malarial cysteine proteases. (H) 2013 Elsevier Ltd. Almost all rights set aside.Qualifications. Many of us examined the protection and efficiency of growing dosages associated with autologous body patch pleurodesis for treating prolonged atmosphere water leaks in sufferers with innovative continual obstructive lung disease (Chronic obstructive pulmonary disease). Methods. Forty-four individuals using COPD as well as impulsive pneumothorax (SP) about the In 7th place next day of intercostal tube water flow were at random assigned to Some groupings, with 12 patients in each team.

Outer-membrane-acting peptides and fat II-targeting prescription medication cooperatively eliminate Gram-negative pathoenic agents.

Venous blood samples had been attracted regarding malaria diagnosis (microscopy and also RDT), way of life and handle blood rely. Left over spots had been stored with -80 levels H as well as useful for extra RDT investigation as well as PCR. A good RDT focusing on both PfHRP2 along with Pf-pLDH has been executed upon most trials regarding direct assessment of diagnostic precision with microscopy since guide technique. PCR ended up being executed to discover false-positive RDT benefits. Results: Throughout 376 regarding 694 (Fifty four.2%) integrated kids, malaria had been microscopically confirmed. Level of sensitivity, uniqueness, good predictive benefit (PPV) and also damaging predictive price ended up A hundred.2, 70.Being unfaithful, Sixty nine.Some and A hundred.0%, correspondingly with regard to PfHRP2-detection along with Ninety eight.Several, Ninety four.2, Ninety one.Half a dozen and also 99.1%, correspondingly for Pf-pLDH-detection. Specificity as well as PPV were considerably lower pertaining to PfHRP2-detection (p < 2.001). For both discovery antigens, specificity was most affordable for youngsters 1 to 5 years and inside the rainy season. Pay per view for antigens has been highest within the wet period, because of greater malaria prevalence. Bogus positive PfHRP2 effects were related to preceding anti-malarial remedy as well as good PCR benefits (98/114 (86.0%) trials analyzed). Conclusion: Among kids showing along with significant febrile sickness in the in season hyperendemic malaria tranny location, the actual research observed equivalent level of responsiveness however decrease specificity and Cpv regarding PfHRP2 in comparison with Pf-pLDH-detection. Further reports need to assess the analytic precision as well as protection associated with an appropriate Pf-pLDH-detecting RDT in field options and if enjoyable, replacement of PfHRP2 by simply Pf-pLDH-detecting RDTs is highly recommended.All of us statement the case of your 20-year-old man which has a unusual constellation associated with imperfections * a practical thyroglossal cyst along with concurrent Etomoxir ectopic hypothyroid inside the floorboards of the oral cavity, lacking any orthotopic thyroid gland. To our information, here is the 3rd these kinds of statement inside the otolaryngology materials. It is important to know about the possibility of concurrent ectopic thyroid and thyroglossal cysts even without the a good orthotopic thyroid gland. Nearly all described installments of thyroid ectopy arise with the lower dialect. The occurrence of a great ectopic thyroid within the flooring with the mouth area is both strange instead of open for you to scientific examination. Even though there's very good usage about atomic imaging, the ectopic thyroid might be hypofunctioning. All of us go over the importance of thyroid image, plus the requirement for preoperative imaging with an proper operations technique from the treating individuals with this particular triad involving anomalies.Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) in the dorsum in the palms and/or feet might be affecting different inflamation related rheumatic diseases plus in haematological as well as sound types of cancer. McCarty ainsi que ing, described this kind of affliction the first time over two decades ago. Main malignancy ought to always be excluded in patients along with RS3PE syndrome.

Along Tides of Light - Chapter 2 (Teaser)

Chapter 1 (publicly available) Patreon - https://www.patreon.com/posts/along-tides-of-1-53939916 AO3 - https://archiveofourown.org/works/33620170/chapters/87393256 Chapter 2 (patron exclusive)

Patreon - https://www.patreon.com/posts/along-tides-of-2-56569439 “Shepard, I…”

Liara feels her tongue stick to the top of her mouth. Shepard just came back from a mission; she’d shucked her armored plates off and unzipped the undersuit from the collar down to her hipbones, leaving only a sleeveless compression garment that clings like paint and ends just centimeters below the curve of her breasts. She walked straight to the med-bay to show Liara something they found amid the wrecks of the Geth, pausing in the doorway only long enough to hand off her rifle and shotgun to the quartermaster who was chasing behind her like a malyk kitten afraid it would be abandoned. Liara was glad for the diversion. Her review of the ship’s unsecured camera feeds gave Liara time to scramble back to her lair in the storeroom before she was caught peeking around the corner, waiting to see if Shepard came back alive like some hopeless maiden in a filthy romance novel. Her current guilty pleasure is the Sunset of Malari series despite the fact it’s so full of anachronisms about eighth-wave industrialization that the anti-Justicar rants and fetishization of Ardat-Yakshis barely register.

Now Shepard stands against the inside of the bulkhead between the storeroom and med-bay, back against the wall, hips thrust forward. Her breathing slows only gradually as the exertion and adrenaline of combat fades and her skin shines with sweat. Liara wishes she had so exhausted this fearsome creature.

The smell of her is salty and musky and just so slightly bitter. Not objectionable in the least. She smells oceanic, like the beach near Sonalere after the spring bloom of seaweed recedes. Her abdomen is laddered heavily with muscle while the angular plane of flat sinew below the last pair of her–abs, wasn’t that what they’re called?–is flat and smooth and disappears into the bottom half of the suit like an arrow in flight. Her hip bones are pronounced on her lean frame, and Liara’s thumbs would sit so perfectly in the dips above them as they danced.

All that muscle means she’s not overly soft, most of her body fat in her small breasts, on the sides of her hips and over her ribcage. The anatomy books and other materials she got from the extranet say many things about human women and if Shepard would just be so kind as to unzip the suit another few centim–focus, Liara!–it amazes Liara that her skin is pink and dusted with both freckles and tiny scars. It’s as if the sculptor felt such lust while carving an idol of the huntress goddess Kurinth that her hands shook and she nicked the stone.

Yet somehow Shepard is treating this as a normal conversation, even as eezo and saltwater weeps from every fold on Liara’s back and the material of her jumpsuit rasps against oversensitive nerves in the tender furrows of skin over the arched spread of both her spines. If this behavior is normal amongst what humans consider ‘a lesbian’ then lesbians are either socially inept, oblivious, or evil.

“…I honestly did not hear that last question,” Liara admits.

That snaps Shepard out of her excited recounting of the mission, which apparently included finding the Prothean data disc which she offered to Liara cradled in her palms and with a gleeful smile.

“Are you feeling alright, doctor?”

Before Liara can come up with a convincing lie or beg the Commander to take her to bed and ravage her just to end the confusion, she finds the human’s palm pressed to her forehead. Shepard closes her eyes.

“You don’t feel hot.” Shepard gives her a smile that seems to hang from left to right. What did Kaidan say that was called? A smirk? “Well, you don’t feel fevered at least.”

=====

The door chime warbles. Liara leans over to the computer’s haptics and opens the audio channel.

“It’s me.”

She scrambles to straighten her posture and unlocks the door. This time, Athame be praised, Shepard is in her fatigues, instead of less than half of her armor. The sleeves end at the elbow with a pair of large pouches above biceps, and more pouches and straps line the thighs. Attachment points for three kinetic barrier discs can be seen and several chemical canisters for quick recharges are fed through the webbing.

Her favorite pistol hangs in a holster on her left calf. Liara’s research indicates it is called a Lamtkta, a pirated version of the Carnifex native to Tuchanka and named, naturally, after a lewd slang term for krogan male anatomy. A nameless engineer most likely from Clan Urdnot–no other clan has enough educational

infrastructure for occupations besides ‘soldier’, ‘breeder’, and ‘medic’–reworked the stolen schematics of the already brutish human weapon, enlarging the barrel, upper frame, ammo block, acceleration coils and firing chamber to take advantage of thicker bones and stronger muscles. Krogan hands are tiny in proportion to their bulk, not much larger than a human’s. And her extranet research indicates Shepard’s hands are extremely generous for a human female, a discovery that led to more questions, which led to Liara doubling her list of terms to search. Lesbian postings on the extranet lead in a thousand baffling directions at once.

Unlike most human women, Shepard has the hands, height, length of limbs and broadness of hips, shoulders, and stance to use it unmodified. Fearsome as she is, Chief Williams’ build is shorter, more padded, and more ‘womanly’ than the commander. The recoil would not dissipate along her bones before it reached her shoulder and shredded the tendons.

=====

Shepard is off duty, judging by the chrono, and slouched in Liara’s quarters in a uniform of fabric, titanium weave, and plastic bracing with only her sidearm and chocolate at her disposal. She drags her blunt nails across her right arm, scratching at some itch that must lie under the rosy, nearly translucent hairs. The curl of her fingers is slow and rhythmic and the sinews at her elbow flex and shift like a polar malyk slinking low in the reeds while stalking a turtle. Liara’s brain recalls vividly how good she looked half-naked and her imagination spirals into the potential uses of fingers so powerful and nimble she can work that gun and intricate biotics with equal ease.

One pouch on Shepard’s thighs has several plasticized wrappers poking out of it. Garish things of orange and black and silver. Shepard glances down, unbuttons the pouch and hands one over.

“Want one?”

Liara reaches for her omnitool to deactivate the translator. Because of the constant barely-there buzz of it, she leaves it off when she’s working, or around only Shepard who seems all too happy to practice her Serraci.

“Code Orange Chocolate Missile,” Shepard explains. “Obscure Earth candy.”

“How is a candy obscure? It’s not an ancient text!”

“I have to hit up four stores, on average, to find some. Maybe now that I’m a SPECTRE I can just get a crate

shipped.”

Liara watches Shepard bite the tip off hers, revealing a core of syrupy looking golden something flecked with what looks like bits of crystallized fruit. She unwraps her own and mimics Shepard.

Goddess. What is this coated in?

She hopes her groan isn’t too whorish as the sweet brown substance dissolves on her tongue.

“First time with chocolate?” Shepard jokes.

Liara holds up her hand.

This must be handled with scientific rigor.

=====

“Three targets, nineteen seconds. Only four wasted rounds. Not bad, doc. Especially not with a pistol I can tell you’ve never held before. But your form is off.”

“I’m sorry, Shepard. I’m used to the Acolyte. This is far lighter.”

Ashley lifts her head from the weapon bench.

“The what?”

“Asari-made pistol,” Shepard says over her shoulder. “Uses eezo and ice spliced with a carbon nanotube weave for ammo. Scary on its own. Only gets three or four shots per heat cycle but each detonates a three or four inch warp field.”

“What’s wrong with ammo blocks, like the Good Lord intended?” Ashley teases, waving one around. “Not good enough for you, prin-”

Shepard gives Ashley a look that makes the irreverent marine’s jaw shut with a click of the teeth.

“I do miss that gun, though. Curved, shiny, folded up tighter than any of ours. Sexy as hell.”

Suddenly, Shepard is all around her, one hand splayed on her hip, tugging it back, one sliding down her right arm, squeezing here and there. Adjusting the angle of her elbow, wrist, and shoulder. Making her body yield under the stern grip of powerful fingers.

Liara knew both humans and asari were endothermic or “warm-blooded” in Earth terms and that humans ran hotter by nearly seven degrees Kelvin.

But Goddess it’s different to experience it so intimately. To have Shepard’s hands mold her like metal in a forge.

The urge to meld gathers into an ache at the top of her skull and baser and more tactile impulses slick her azure and thicken her pulse to a throb between her legs.

“There. Much better stance. We’ll practice with a shotgun later. A real lifesaver, when you’re recharging your biotics, but the krogan is not quite dead yet.”

She’s released, and Shepard takes a sudden step back. She makes some guttural sound and Liara’s omnitool warbles out an indication that it wasn’t something it could translate.

“Sorry if I was…forward.”

She was. Athame have mercy, she certainly was, but Liara’s not complaining.

“I’ll reset the sim. This time you’ll only have one crate to work with and I’m going to put a krogan in. For a challenge.”

“Can it model their skeletons?” Liara asks.

“Sure. Why? Actually, never mind. I want it to be a surprise.”

She taps on her omnitool again. “Done.”

“My stance is better, correct?”

Shepard hums.

“Spread your legs,” she commands.

“Commander, I’m not sure this is the pla-”

Ashley breaks into a very un-marine-like fit of giggles.

“O-oh. Of course! I misunderstood what you meant.”

An Ironwood meta that just randomly popped into my head.

So I’ve been skimming over a lot of the observations on RWBY from @bionic-jedi and aside from the glurge of absolutely adorable Nuts ‘n Dolts stuff (Which I appreciate, I ship it now), the part that really got my attention was all the shit going down around Ironwood. I don’t watch the show anymore, not that I hated it or anything I just sorta lost interest in the show itself, decided it ultimately wasn’t really for me and mainly just enjoy it through fanart and shipping now, but from what I gathered from bionic-jedi’s Let’s Watch Ironwood sounds absolutely fascinating in all the ways that I don’t think was intentional by the CRWBY but is still pretty awesome that it’s there.

Forgive me if I get the details wrong since I haven’t kept up with the show and all my info is coming second hand from @bionic-jedi​, but from I could gather Ironwood comes across as a man who:

- Is an experienced veteran fighter who individually is very badass with a proven tactical record on the battlefield

- Has the natural charisma to instill genuine loyalty and belief in his cause into his subordinates (To paraphrase Mass Effect 3 for a bit, you can pay a man to fight, you can pay him to charge up a hill, but no amount of money in the world will ever convince a man to believe in you), and does possess a genuine care for the troops under his command

- Will nonetheless still engage in abusive behavior if a subordinate is not performing in a way he believes is proper for their duty (Yeah I would consider forcibly hacking a sapient being to count as that)

- Carries around a very cool badass revolver as a signature weapon 

- While brilliant tactically, possess horrible long term strategic assessment skills that if allowed to be acted upon could have/did end in disaster

You know what that sounds like? Ironwood is almost a perfect RWBY equivalent for George R. Patton (with maybe a bit of Bernard Montgomery thrown in).

Like, I think that the CRWBY may have accidentally written a scenario that asks “What if Patton was the Supreme Commander of the Western Front instead of Eisenhower?” And the results are an absolute clusterfuck unfolding in real time, but I feel I gotta clarify this.

Patton is one of America’s most celebrated and respected generals, and for good reason. Dude was a badass with a keen sense of armor tactics and mobile warfare that proved repeatedly that he could beat the Germans at their own game. His personal bravery could also never be called into question, having proven his mettle in direct combat during both the Hunt for Pancho Villa and WW1, as well as putting his own life in danger being very close to the front lines numerous times during WW2, one time even riding a tank into a German-occupied village to inspire his men. He also did genuinely care for the lives of his men, only ever seen openly weeping when mourning for the lives of his fallen soldiers, treating his wounded troops with the highest respect, and properly giving praise when they did a good job.

For all of Ironwood’s faults, his own mettle is certainly not into question given he suffered such grievous injuries that half his body is now cybernetics, and the man for sure knows how to fight and fight well, so that’s one similarity with Patton. He has also inspired real loyalty in Winter and the Ace Operatives, and in turn he does seem to actually care for them, and he had no real reason to give Yang a new prosthetic arm (and rather quickly fast tracking her an incredibly advanced one at that), so he’s not completely heartless or devoid of empathy. 

However, Patton was a man focused on the tactical short term in lieu of long term strategic planning, and possessed with some horrendous character flaws that bit him in the ass on several occasions. One of them being the, even by the standards of the 40′s, deplorable manner in which he treated soldiers wracked with what we in the modern day would diagnose as PTSD. The man flat out did not believe PTSD was a real thing, thinking of it as cowardice and...you know what? I’m just gonna let the Wikipedia quotes say it all, I bolded some choice quotes for convenience:

Private Charles H. Kuhl, of L Company, U.S. 26th Infantry Regiment, reported to an aid station of C Company, 1st Medical Battalion, on 2 August 1943. Kuhl, who had been in the U.S. Army for eight months, had been attached to the 1st Infantry Division since 2 June 1943. He was diagnosed with "exhaustion," a diagnosis he had been given three times since the start of the campaign. From the aid station, he was evacuated to a medical company and given sodium amytal. Notes in his medical chart indicated "psychoneurosis anxiety state, moderately severe (soldier has been twice before in hospital within ten days. He can't take it at the front, evidently. He is repeatedly returned.)" Kuhl was transferred from the aid station to the 15th Evacuation Hospital near Nicosia for further evaluation.

Patton arrived at the hospital the same day, accompanied by a number of medical officers, as part of his tour of the U.S. II Corps troops. He spoke to some patients in the hospital, commending the physically wounded. He then approached Kuhl, who did not appear to be physically injured. Kuhl was sitting slouched on a stool midway through a tent ward filled with injured soldiers. When Patton asked Kuhl where he was hurt, Kuhl reportedly shrugged and replied that he was "nervous" rather than wounded, adding, "I guess I can't take it." Patton "immediately flared up,” slapped Kuhl across the chin with his gloves, then grabbed him by the collar and dragged him to the tent entrance. He shoved him out of the tent with a kick to his backside. Yelling "Don't admit this son of a bitch," Patton demanded that Kuhl be sent back to the front, adding, "You hear me, you gutless bastard? You're going back to the front."

Corpsmen picked up Kuhl and brought him to a ward tent, where it was discovered he had a temperature of 102.2 °F (39.0 °C); and was later diagnosed with malarial parasites. Speaking later of the incident, Kuhl noted "at the time it happened, [Patton] was pretty well worn out  ... I think he was suffering a little battle fatigue himself." Kuhl wrote to his parents about the incident, but asked them to "just forget about it." That night, Patton recorded the incident in his diary: "[I met] the only errant coward I have ever seen in this Army. Companies should deal with such men, and if they shirk their duty, they should be tried for cowardice and shot."

Private Paul G. Bennett, 21, of C Battery, U.S. 17th Field Artillery Regiment, was a four-year veteran of the U.S. Army, and had served in the division since March 1943. Records show he had no medical history until 6 August 1943, when a friend was wounded in combat. According to a report, he "could not sleep and was nervous." Bennett was brought to the 93rd Evacuation Hospital. In addition to having a fever, he exhibited symptoms of dehydration, including fatigue, confusion, and listlessness. His request to return to his unit was turned down by medical officers. A medical officer describing Bennett's condition

And yet another incident like this:

Private Paul G. Bennett, 21, of C Battery, U.S. 17th Field Artillery Regiment, was a four-year veteran of the U.S. Army, and had served in the division since March 1943. Records show he had no medical history until 6 August 1943, when a friend was wounded in combat. According to a report, he "could not sleep and was nervous." Bennett was brought to the 93rd Evacuation Hospital. In addition to having a fever, he exhibited symptoms of dehydration, including fatigue, confusion, and listlessness. His request to return to his unit was turned down by medical officers. A medical officer describing Bennett's condition

The shells going over him bothered him. The next day he was worried about his buddy and became more nervous. He was sent down to the rear echelon by a battery aid man and there the medical aid man gave him some tranquilizers that made him sleep, but still he was nervous and disturbed. On the next day the medical officer ordered him to be evacuated, although the boy begged not to be evacuated because he did not want to leave his unit.

On 10 August, Patton entered the receiving tent of the hospital, speaking to the injured there. Patton approached Bennett, who was huddled and shivering, and asked what the trouble was. "It's my nerves," Bennett responded. "I can't stand the shelling anymore." Patton reportedly became enraged at him, slapping him across the face. He began yelling: "Your nerves, hell, you are just a goddamned coward. Shut up that goddamned crying. I won't have these brave men who have been shot at seeing this yellow bastard sitting here crying." Patton then reportedly slapped Bennett again, knocking his helmet liner off, and ordered the receiving officer, Major Charles B. Etter, not to admit him. Patton then threatened Bennett, "You're going back to the front lines and you may get shot and killed, but you're going to fight. If you don't, I'll stand you up against a wall and have a firing squad kill you on purpose. In fact, I ought to shoot you myself, you goddamned whimpering coward." Upon saying this, Patton pulled out his pistol threateningly, prompting the hospital's commander, Colonel Donald E. Currier, to physically separate the two. Patton left the tent, yelling to medical officers to send Bennett back to the front lines.

As he toured the remainder of the hospital, Patton continued discussing Bennett's condition with Currier. Patton stated, "I can't help it, it makes my blood boil to think of a yellow bastard being babied," and "I won't have those cowardly bastards hanging around our hospitals. We'll probably have to shoot them some time anyway, or we'll raise a breed of morons."

There were serious cries for Patton to get sacked after theses incidents, his reputation and job only saved because Eisenhower knew his tactical command abilities were simply too valuable to give up and so was only temporarily relieved of duty instead. Point I’m trying to make here is that while Patton could definitely hold sympathy and understanding for his men, it was contingent on them acting in a way he believed was properly honoring their duty. If they erred from his ideals of a how a proper soldier behaved, he could lapse into some seriously abusive behavior disturbingly quickly.

I can’t be the only one that sees some parallels between this and Ironwood hacking Penny am I? A man who cares for his troops but as soon as Penny acted in a way he deemed to be out of line, immediately sought to violate her autonomy and rights as a sapient being to force her back into line and back into his ideals of how a proper soldier should behave. Perhaps he wasn’t as violently physically aggressive about it as Patton, but arguably what Ironwood did was ethically much worse than slapping the shit out of and threatening people.

Patton also wasn’t the type to worry about the long term consequences of his actions. Before he died in a car accident shortly after WW2 he was unceremoniously sacked from his job after making one too many aggressive comments towards the Soviet Union, potentially nudging towards a potential Operation Unthinkable, and carelessly allowing former Nazis back into political power. Both of these were unthinkably horrible for obvious reasons.

There is one key difference between Patton and Ironwood however. Eisenhower was keenly aware of Patton’s potential shortcomings and he was kept on a leash and out of the highest levers of power, thus preventing him from ever being in a position where his worst traits would allow him to truly fuck up. Ironwood however I feel got Peter Principle’d hardcore and was promoted way above his level of competence (Always a risk for men who gain a reputation as “fightin’ generals”, see: John Bell Hood), where his positive qualities of personal physical bravery, combat skill and tactical leadership is wasted and his worst qualities of hyper-focus on short sighted tactical victories over long term strategic goals, paranoia and distrust leading to an excessive need for control, and moral cowardice are allowed to flourish.

And we see the consequences of it. He may have started with solid pragmatic ideas, but his insanely one-track minded obsession with short term strategic goals like making sure he has control over the Winter Maiden is costing him big long term strategically by burning bridges with potentially valuable allies and isolating himself and his command. Valuable time and resources that could have been spent coordinating forces against Salem wasted on various shenanigans involving Penny, RWBY and JN_R. Especially devastating given that Atlas is the only industrialized military power worth a damn in this world and isn’t reliant on mostly independent and unorganized Hunters and Huntresses (individually skilled but too few in number and takes far too long to train each one to reliably stop a Grimm invasion), and he’s just wasting the resources of the world power best able to hold the line against the Grimm.

Next part is a bit of a non-sequitur and really long so I put it in between the dotted lines if y’all ain’t interested and want to skip on over to the relevant Ironwood parts.

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Getting a feel for the strategic situation in Atlas, I get a strong sense that what Atlas needs more than anything else right now is a Dwight D. Eisenhower. Eisenhower the the exact man needed to lead the Western allies, and I can’t see anyone else doing as realistically as good a job as he did, this is a hill I’ll die on. It wouldn’t look like it at first, the man had never once commanded a unit in battle (a fact that made many of his “actually seen combat” rivals bitter), and his softer, more easy going disposition would seem at odds with the alpha-male take charge image cultivated by men like Patton and Montgomery that would be stereotypically expected of a general, much less a Supreme Commander. 

However, that calm exterior hid a man with a sharp eye on the necessary strategic goals needed for victory, expert resource and personnel management skills, the humility to listen to his subordinates and admit his own mistakes, and most importantly, both the smooth negotiating skills and the iron will necessary to deal with larger than life figures.

The western allies were made up of many different nations and factions and filled to the brim with what I would call (to put it lightly) strong personalities. This was an organization that involved: 

- Franklin D. Roosevelt

- Winston Churchill

- Charles De Gaulle

- Bernard Montgomery

- The aforementioned Patton

- Occasional dealings with Stalin even

All of them larger than life personalities, all of them strong willed and possessed of their own ideas of how to win the war as well as their own political/personal motives, and all of them vying for dominance in the strategic decision making of the Western Allies. It was like herding a clowder of cats, but all the cats had frggin tanks and bombs. Eisenhower actually managed to cut through the bullshit and resist all the arm twisting and actually got all the different countries, armies and leaders together to act upon a united plan. He did this while still being able to control his subordinates worst impulses and (mostly) was able to resist the shitty plans put up and embrace the good ones (for the most part, Montgomery did manage to convince him to approve of Operation Market Garden, and it was the last major German victory of the war mostly due to Monty’s mishandling). Tactical battle ability was largely irrelevant for Eisenhower’s role, and his ability to see the big picture clearly and being able to maneuver through the internal politics meant everything to his success as a Supreme Commander.

If Eisenhower or an Eisenhower-esque figure was in charge of Atlas during this latest season, you’d probably get a drastically different turn of events. An Eisenhower would not be so quick to drastic action as Ironwood was. An Eisenhower would probably sit down with their subordinates, hear out all their arguments for why or why shouldn’t a specific action be taken, then calmly consider their actions. An Eisenhower would probably then say “Working with an enemy agent to hack into the Winter Maiden is a dumb idea” and proceed to create plans on how to coordinate all available forces in Remnant to best fend off Salem.

Atlas as a whole doesn’t really strike me as the type of organization that would raise an Eisenhower though. Militaries are always offshoots of the cultures that create them, and I don’t believe it to be a coincidence that a Supreme Commander like Eisenhower would be American. The country was literally founded on democratic ideals and it was enshrined very early into its history that the military would always be subordinate to the civilian government. This precedent makes it necessary that anyone that rises high enough in the military must be able to respect a strong civilian presence and be able to work with both internal and external politics. Any general that rises high enough must be half-general half-politician by necessity (there’s a reason why former military often do have successful political careers after retiring from service, including the aforementioned Eisenhower who eventually became the 34th President of the United States).

Atlas just doesn’t strike me as having that same sort of cultural framework. If anything the Atlas military strikes me as having a cultural framework closer to WW2 Germany where tactical efficiency and high tech weaponry/tools is prized above all else, often at the cost of long term strategic goal setting. Nazi Germany and Imperial Japan never set realistic goals for themselves and predictably got steamrolled eventually. Occasionally you’ll get an online thread asking “What if Germany/Japan had smart top leadership during WW2?” But that’s a trick question. A WW2 Germany/Japan with sensible leadership...just isn’t WW2 Germany/Japan at all, it was intrinsic to the identity and character of those nations in that time period. Similarly, I just don’t see an Atlas military that sees a potential Eisenhower in their ranks and thinks to promote them to High Command as opposed to just shuffling them off as an aide to some random officer and never consider them for higher promotion. An organization that prizes short term tactical victory over long term strategic goals just isn’t the type of organization to do that.

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Thing is though, I think just from what I gathered, Ironwood just shot up to be my favorite RWBY character because of how frigging fascinatingly horrible he is. He’s not an entirely awful person (at least not at first), but his own paranoia and fear combined with his habit of confusing short term tactical advantage with long term strategic goals leads him down the path of utterly despicable actions while convincing himself that it’s all for the greater good. All while being an idiot and wasting the legitimate game-changer resources of having an actual army when everyone else is still dicking around with hunters and huntresses as their only defense.

Smart money is he’s gonna die, it seems to be where he’s heading. If CRWBY’s writing staff has some serious cajones however, it’d be really cool if they pulled a Catra on him and see how low they can make him sink before making him hit rock bottom, realize his mistakes and force him to work hard for a redemption arc. I dunno, maybe I’m giving him too much slack but I actually do feel for him a little bit. The dude was clearly an alright guy that had the world fall down on him and just wasn’t suited for the massive responsibility that circumstances forced on his shoulders. He’s still a soldier that genuinely wants to protect Atlas, he’s just too short sighted to see how his actions just aren’t what Atlas is gonna need in the long term. Maybe a harsh talking to by Glinda would do him some good (I still ship IronWitch don’t @ me). I dunno, I just think that a redemption arc would be a lot harder to write than just killing him off, and thus would be that much more satisfying to see it pulled off right like what Noelle Stevenson did with Catra’s character in She-Ra.

Death by pumpkin pie

Don’t ask how I found these cases, researching stuff for historical fiction takes you strange places.

Richmond, Va., January 1. A special to The Dispatch from Louray says the family of Benjamin Sours were poisoned today by eating pumpkin pies, which were supposed to contain rat poison. Sours and one child died, and others are dangerously ill. The Atlanta [GA] Constitution 2 January 1891: p. 2

Smoot, Wyo. A post mortem examination of the remains of James H. Bruce has been made, and the result will be known in a few days. Bruce died suddenly at his ranch near here a few days ago after eating a quantity of pumpkin pie. It is alleged that death was due to strychnine poisoning. Bruce did not have an enemy in the world, and the suicide theory is scouted. The Columbus [NE] Journal 3 April 1907: p. 6

On Thursday last the family of Charles H. Garber, of Norristown had pumpkin pie for dinner, of which all ate heartily. The flour with which the pie crust was baked subsequently proved to contain quantities of crystallized arsenic. When the victims of the poison were attacked with pains in the abdomen and violent vomiting Dr. Mahlon Preston, the family physician, was called in. He treated them for malarial fever. Dr. Munstead, the family physician of the visitors, also was called in. He prescribed for the same disorder. The ladies were removed to their homes after a few days. Mrs. Garber had but a slight attack. Henry B. Garber, the only son, recently admitted to the Montgomery county bar, is very weak and not expected to survive. Mr. Garber, the head of the family, died Thursday morning at half-past eleven o’clock.Last Saturday afternoon Mrs. Garber, having an errand to do, called from the street little Ivan [also reported as Ivins] Steinbright, a four-year old son of John Steinbright. In reward for the boy’s favor Mrs. Garber kindly gave him and his little sister each a piece of pumpkin pie, which she had baked the Wednesday previous, and some of which she had set before her family and visiting friends. The little girl ate a mouthful, but, disliking the taste, gave her piece to her little brother, who ate both pieces. Later in the afternoon, Ivan was taken violently sick and died early on the following morning. A post mortem examination showed a quantity of arsenic in the stomach. A small piece of Mrs. Garber’s pumpkin pie was fed by Dr. Ellwood Corson, the boy’s attending physician, to his cat. The cat was seized with violent vomiting within twenty-five minutes and has not been seen since. Dr. Corson obtained half a pound of her family flour from Mrs. Garber for chemical analyzation, but found it was unnecessary, as he could pick from the flour crystals of the poison.Mrs. Garber keeps her flour in a crock in her kitchen. She used some of it two weeks ago, but without bad effects. The poisoned pumpkin pie was baked from the same flour a week later. Some one probably threw the arsenic into the crock in the meantime. On Wednesday Mrs. Garber had left the house for awhile, leaving the back door ajar, and she supposes that during her absence some one had entered the house and done the mischief. Lancaster [PA] Daily Intelligencer 10 November 1882: p. 2

A singular part of the mystery is that the poison found is not what is known as common arsenius arsenic, but the pure acid, the finest kind of arsenic known to medicine….[a purer quality than that usually sold by druggists.]On Tuesday night, Nov. 1, the Garber family went to visit a friend up town. On their return they found the back door of the kitchen which led into a stall alley had been unlocked during their absence. As nothing was missing the matter was soon forgotten. The next day Mrs. Garber baked the fatal pie from the flour which was kept in the crock in the back kitchen near the door. Now it is claimed that the person who committed the deed saw the Garbers go out of the house, and knowing that the flour was kept in the rear kitchen, the assassin opened the door by means of a false key, put the poison in the flour in the crock, and got away. Daily Globe [St. Paul, MN] 13 November 1882: p. 5

Much of the inquest testimony was printed in the paper and Mrs. Garber hinted that her father, John Boileau and her brother Albanus might have had something to do with the poisoning. There was bad blood between the Boileaus and the Garbers over her mother’s will as well as money Mrs. Garber took from the house after her mother’s death. The inquest ended with a verdict of “death by poisoning,” but the poisoner was not named or charged. Perhaps I wrong her (and what was the motive?), yet I found this detail suggestive: “For desert they had pumpkin pie, of which all but Mrs. Garber partook heartily. Mrs. Garber ate but little.” Daily Globe [St. Paul, MN] 13 November 1882: p. 5

Like cures like – just love for the pets

Dr. Samuel Hahnemann is the originator of homeopathy founded almost 200 years ago. The medicine therapy practitioners or the homeopaths believed that “like cures like”. Being the dark era for medicine the homeopathy was introduced as a light of hope. Homeopathy cures incurable diseases too, as per a few studies “Homeopathic medicine = Energy e.g. E=mc2”

Animal Homeopathy

The human beings with the use of homeopathy were really happy with the result of homeopathy, so the invention was done for animals as well. Animal homeopathy or veterinary homeopathy follows the same principle as in humans. The medicines are available for all the big and small animals. People want side-effect-free medicine and conventional cures with better treatment for their animal families.

The regulatory requirement for the Homeopathy medicines

Homeopathic medicines include drugs that are recorded in Homeopathic proving and whose therapeutic efficacy has been established through long clinical experience as recorded in the authoritative Homeopathic literature of India and abroad. It must be prepared according to the techniques of homeopathic pharmacy and also includes a combination of drugs.

A license needs to be obtained for manufacturing or selling Homeopathic medicines wholesale. In 1973, the Government of India recognized Homeopathy as one of the National systems of medicine and set up the Central Council of Homeopathy (CCH) to regulate its education and practice. Licenses are valid for five years.

Applications are made to the State Licensing Authority for the manufacture of Homoeopathic medicines and to the Central Licensing Authority for the manufacture of NHMs. Drugs may be manufactured in small quantities for tests or analyses if the manufacturer holds the appropriate licenses.

What are Regulatory requirements for over-the-counter (nonprescription) medications?

The D&C Act or the Rules do not specifically mention OTC drugs. The two broad categories envisaged by the Act are prescription and nonprescription drugs. Prescription Drugs are those specified in Schedules H, H (1), and X of the D&C Act, but there is no specific schedule enlisting the nonprescription drugs. There are certain drugs, however, which can be sold in non-drug licensed stores i.e., in non-pharmacies. These drugs are specified in Schedule K of the D&C Act and include drugs such as quinine and other anti-malarial drugs and household remedies such as Aspirin tablets, Paracetamol, and Gripe water.

Do you know? OTC homeopathic drugs can be purchased from the same allopathic chemist shops.

The Centre has amended the Drugs and Cosmetics Rules, 1945 to allow the sale of homeopathic drugs over the counter from the allopathic chemist shops.

Now, homeopathic medicines can be purchased over the counter (OTC) from the common chemist shop selling allopathic drugs in INDIA. Under the existing laws, the sale of homeopathy and allopathic drugs from the same shop was not allowed.

Lupine Publishers | Experimental Approach, Computational DFT Investigation and a Biological Activity in the Study of an Organic Heterocyclic Compound

https://lupinepublishers.com/chemistry-journal/pdf/AOICS.MS.ID.000177.pdf

Abstract

The title compound TZ1 was synthesized by N-alkylation reaction, and its structure was confirmed by 1H NMR, 13C NMR and IR, it was screened for their in vitro antibacterial activity by the agar well diffusion method against four bacteria, Gram-positive (Bacillus cereus, Staphylococcus aureus) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa). The molecule was studied with the density functional theory (DFT) at B3LYP/6–31G (d,p) level in order to determine the relationship between the molecular structure and the antibacterial inhibition behavior. The molecular geometry, frontier molecular orbitals and Mulliken atomic charge of the compound are investigated to get a better insight of the molecular properties. The molecular electrostatic potential (MEP) for a compound was determined to check their electrophilic or nucleophilic reactivity. The theoretical parameters offer significant assistance to understand the antibacterial inhibition mechanism indicated by the molecule and are in full agreement with the experimental results.

Keywords:5-Chlorosatin derivatives; N-alkylation reaction; antibacterial activity; DFT; Molecular electrostatic potential

 Introduction

The 5-Chloroisatin is well documented as an important heterocyclic compound in the field of medicinal chemistry. My recently published book and review [1,2] contain a special chapter, dedicated to the chemistry of 5-Chloroisatin and their derivatives.

The 5-chloro-1H-indole-2 3-dione structure is a heterocyclic compound which easily participates in chemical reactions. Its bonding sites are analogous to pyrrole. As shown in Scheme 1, 5-Chloroisatin is reactive at four different positions including the carbon atom 3, nitrogen atom 1, the C2–C3 p-bond and the C2–N sigma bond.

This moiety of 5-Chloroisatin and their derivatives possess pharmacological and chemotherapeutic properties such as anti- cancer [3], anti-diabetic [4], anti-inflammatory [5], anti-malarial [6], anti-bacterial [7], anti-fungal [8], anti-viral [9] and others drugs for treatment of several diseases [10].

Density functional theory (DFT) has become a convenient method to decipher experimental results, in antibacterial activity; this technique makes it possible to accurately predict the inhibition efficiency of organic compounds on the basis of electronic and molecular properties as well as reactivity indexes [11]. The objective of current study is to explore relationship amongst structure and electronic properties of the synthesized 5-chloro-1- (2- (dimethylamino) ethyl) indoline-2,3-dione (TZ1) using DFT. Then, the evaluation of its antibacterial activity. (Scheme1)

 Experimental Details

Chemistry

Melting points were determined using the kofler bench apparatus and uncorrected. The spectra of 1H NMR spectra were recorded in CDCl3 on the Brucker Avance-300 spectrometer, operating at 300MHz and at 75MHz for 13C-NMR using TMS as an internal standard and Spin resonances are reported as chemical shifts (d) in parts per million (ppm). Infrared Spectra were run on AVATAR 320 AEK0200713 spectrometer and frequencies are reported in cm-1. The purity of the synthesized compound was confirmed by thin layer chromatography (TLC), performed on Silica gel 60 coated plates. UV light was used for the visualization of TLC spots [12].

General procedure

The 5-Chloroisatin derivatives TZ1 was prepared by mixing 0.2g (1.1 mmol) of 5-chloro-1H-indole-2,3-dione, (0.23g, 1.16mmol) of potassium carbonate in 15mL of N-N dimethylformamide (DMF) and (0.035g, 0.10mmol) of BTBA, then, the reagent is slowly added, the mixture is left at room temperature for 48 hours. The reaction mixture was concentrated by using rota vapor. The solid was separated out by filtration. It was carefully checked by thin layer chromatography. The compound was isolated by column chromatography by using different fractions of n-hexane and ethyl acetate [13-16].

Yield=89%; mp: 114 °C ; 1H NMR (CDCl3) δppm 7.53-7.54 (m, H, HAr); 7.51 (d, H, HAr, J=9Hz); 6.90 (d, H, HAr, J=9Hz); 3.85 (t, 2H, CH2, J=9Hz); 3.75 (t, 2H, CH2, J=9Hz); 2.15 (m, 6H, CH3). 13C NMR (CDCl3) δppm: 184.59 (C=O); 164.45 (N-C=O); 146.22, 141.13, 110.39 (Cq); 138.59, 126.08, 113.36 (CHAr); 55.90, 46.79 (CH2); 45.09 (CH3). Infra Red (KBr) cm-1: 3565, 3174, 30815 (C-H), 2975, 1720 (C=O), 1607 (NC=O), 1445, 1472 (C=C) 1185,1123 (N-C), 654 (C-Cl).

Antibacterial screening

Synthesized compound TZ1 was screened for their antibacterial activity against two Gram positive (Bacillus cereus and Staphylococcus aureus) and two Gram negative (Escherichia coli and Pseudomonas aeruginosa) bacteria by the agar well diffusion method, using LB medium (Luria Bertani medium: yeast extract 5.0g, peptone 10.0g, sodium chloride 5.0g, distilled water 1000mL). This technique was recommended by CLSI [17].

A sterile paper disk was placed on the surface of each plate and impregnated with 5μL of the TZ1 solution at a final concentration of 10mg/mL. Then, the plates were incubated at 4 °C for 2 hours to permit good diffusion before incubation at 37±2 °C for 24 hours. The diameters of the inhibition zones were measured in mm with the caliper. A disc impregnated with 2% dimethylsulfoxide as a negative control was made the experiment was carried out in triplicate.

In order to determine the Minimum inhibitory concentration (MIC) values, we started by the dilution of the TZ1 was prepared in a Mueller Hinton broth supplemented with bacteriological agar, to reach a final concentration between 5mg/mL and 0.004mg/ mL, 50μL of bacterial inoculum was added to each well at a final concentration of 106CFU/mL. DMSO (2%) was used as a negative control. The final concentration of our product was between 5mg mL-1 (3rd well) and 0.019mg mL-1 (well 11). Plates were incubated at 37 °C for 24 hours. After 2 hours of a subsequent incubation, bacterial growth was revealed by reduction of blue dye resazurin to pink resorufin [18].

Including, the minimum bactericidal concentrations (MBC) which is the last step in the protocol, a bactericidal control is carried out 24 hours earlier by streaking on a platelet agar, after microdilution to the broth by spreading 5μL of the negative wells on Luria Bertani agar plates.

Theoretical calculations

The computational studies of compound TZ1 were performed using the GAUSSIAN 09W [19] program package and visualized with the Gauss View on a personal computer using density functional theory (DFT) method with 6−31G (d,p) as the basis set [20]. The using HOMO and LUMO orbital energies, the ionization energy and electron affinity can be expressed as: IP = -EHOMO, EA = -ELUMO, respectively. The total hardness, η and electronegativity χ were given by the following relations: [21].

Result and Discussion

Synthesis of 5-chloro-1-(2-(dimethylamino) ethyl) indoline- 2,3-dione (TZ1) is outlined in Scheme 2, it was prepared according to a similar previous procedure [22]. 5-chloroisatin was used as a starting material for the synthesis of various substituted indole derivatives [23-27].

The (TZ1) was synthesized by the N-alkylation reaction of 5-chloro-1H-indole-2,3-dione in DMF, a base K2CO3 and a TBAB catalyst was added to a stirred solution at room temperature, Chloro-N,N-dimethylethanamine was added dropwise to the mixture under conditions of catalysis by phase transfer for 48 hours, the reaction was monitored by thin layer chromatography. After this time, the mixture was filtered and concentrated and dried under vacuum to afford the required product. The complex was obtained in good yield, stable in air, and is colored solid, soluble in methanol, chloroform, DMF, and DMSO.

The 1H-NMR, 13C-NMR and IR were used to assign the structure of synthesized compound. (Scheme 2)

Antibacterial activity

The In vitro antimicrobial screening tests of synthesized compound TZ1 was carried out as an antibacterial activity. the tested compound showed biological activity against different types of Gram-positive (Bacillus cereus and Staphylococcus aureus) and Gram negative bacteria (Pseudomonas aeruginosa, Escherichia coli), it showed zones of inhibition of MIC/MBC values ranging from 0.156/0.156 to 0.313/0.313mm against the Gram-positive bacteria and between 0.625/0.625 and 1.25/1.25mm against Gram-negative bacteria.

Coordination enhances the antibacterial activity and the TZ1 in the present study are more active against Gram-positive than Gram-negative bacteria [28]. On the other hand, it should also be noted that the presence of nitrogen and oxygen atoms which are the highest values of the negative charge on the molecule TZ1 suggesting that these centers have the maximum electron density and would preferentially interact with the micro-organisms Gram positive then increases the antibacterial potential.

Computational details

Frontier orbital energy analysis and other global reactivity descriptors: The all optimized structures along with the numbering scheme of TZ1 at DFT/B3LYP level using the 6-31+G (d,p) basis are shown in Figures 1-3.

The HOMO-LUMO orbitals help to characterize the chemical reactivity and kinetic stability of the molecule.

The analysis of the HOMO highlights the areas of the molecule that can donate electrons to electrophilic species while the analysis of the LUMO predicts the regions of the molecule with high affinity to accept electrons from nucleophilic species. The calculated HOMO–LUMO energy gap value is found to be 3.1673 eV.

The dipole moment (μ(debye= 5.6982) tells about the polarity of the molecule. The higher value of dipole moment in case of TZ1 molecule is mainly attributed to an overall imbalance in charge from one side of a molecule to the other side is also evident from the MESP plot. DFT calculation gives an idea about the substance reactivity and site selectivity of the frameworks. By the computed value of HOMO and LUMO energy values for the TZ1, the electronegativity (χ), total hardness (η), Softness (σ), can be calculated. The significance of (η) and (σ) is to evaluate both the reactivity and stability [31].

Molecular electrostatic potential (esp) map: The molecular electrostatic potential mapped surfaces show the charge distributions of molecules three dimensionally which give clear and special signature of the interactions of the compounds [31].

The molecular electrostatic potential is related to the electronic density and a very useful descriptor for determining sites for electrophilic attack and nucleophilic reactions as well as hydrogenbonding interactions [32].

The MEP mapped surface of the compound TZ1 was calculated by DFT/B3LYP at 6 31G (d,p) basis set and MEP surface are plotted in Figure 6. Red, blue and green colors represent regions of the most electro negative, most electro positive electrostatic and zero potential, respectively [33].

Mulliken charges analysis

The Mulliken atomic charges have a significant role in the application of quantum chemical calculations to molecular systems, by determining the electron population of each atom as defined by the basis function [34]. Table 3 exhibits the calculated mulliken atomic charges except for atoms H by DFT/B3LYP at 6 31G (d,p) basis set. Also, the color range in the scale of positive and negative charge and graphical representation for Mulliken atomic charges of TZ1 is shown in Figure 7.

From the listed tabulated values (Table 3) of atomic charge, we can summary that the charge on the carbon atom (C6) is greater than other carbon atoms in the all compounds because it is connected to electronegative chloride atom (Cl10). Then, all nitrogen and oxygen atoms (N13, N22, O14 and O15) are the most negatively charged ones, suggesting that these centers have the maximum electron density, which can interact with the positively charged part of the receptor easily.

Conclusion

In summary, we report the synthesis and characterization of 5-chloro-1- (2- (dimethylamino) ethyl) indoline-2,3-dione (TZ1) in excellent yield. The antibacterial activity of TZ1 has been explored experimentally and by quantum calculations. The frontier orbital energy analysis, mulliken atomic charges and electrostatic potential were also studied by using the DFT method at B3LYP/6–31G (d,p). The antibacterial bioassay showed that it possessed excellent activity.

Acknowledgements

The author would like to thank all the people who helped to carry out this work such as 1H NMR, 13C NMR, IR, and for antibacterial activity.

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Any fics that have a cold (sort of) Draco? I'm a sucker for fics where H has a hopeless crush on D (but she is trying to get over it) while he just completely ignores her existence or is mean in a light hearted way, despite her trying to get his attention. They usually work in close proximity in these fics. E.g. 'Conversion' and 'When he was Wicked'. Post Hogwarts and War. Yasss Smut. Happy dramione ending ♥ P.S. I adore all the admins. You guys are amazing at your jobs. Thank you!

Hello! I have a few to recommend and you can check under ourtags for more stories. Try these:

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>> Hermione is Draco’s Boss

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You should also check under our secret feelings tag forHermione.

Tags> Hermione> Hermione Has Secret Feelings For Draco

Black Rose by Dawn-Of-Indescribable-Colors- M, one shot

Draco is falling in love with Hermione, his Ministry co-worker, who hates his guts. However, he is also engaged in a passionate sexual relationship with Black Rose, a beautiful dancer in a sinful wizarding nightclub, but the gorgeous witch always keeps her carnival mask on when they are together…DRAMIONELOVE FEST FIRST PLACE WINNER!

Rude-olph by OogieBoogie- K, one shot

A little Christmas fic. Draco had something strange happen to him during the days leading up to Christmas and, well … he’s meant to find someone to love him for who he is by Christmas otherwise he stays in his strange state for the rest of his life. (Possible crackfic teehee) MERRY CHRISTMAS! [mild language]

Love That Red by OogieBoogie - T, one shot

Apparently Hermione Granger’s life lacks some colour. Warm earthy browns, neutral soft pinks and nudes are her safe colours. Can a change in colour – a lipstick colour – make a difference?

between fantasies and realities by MGO- M, one shot

That meeting room… that damn meeting room with that glass door and hidden corner. Oh how Hermione dreamed about being in that hidden corner with a certain grey eyed co-worker. It’s all just a fantasy… A Dramione smutty oneshot. AU WARNING, IT’S RATED FOR A REASON… LEMONS AHEAD

The Malaria Visions by galfoy- M, 3 chapters, complete

Hermione has a series of vivid dreams about Draco Malfoy after taking anti-malarial medication. Can she reconcile the real Draco with the one she sees when she sleeps?

Open Minded by OogieBoogie - M, 4 chapters, complete

Hermione refuses to speak her mind lately. That’s until she was cast by a spell. And now, as if through a powerful Sonorus Charm, her innermost thoughts can be heard by anyone within six feet of her – including Draco Malfoy, of course. Post-Hogwarts.

The Nymph Hunt by AkashaTheKitty- T, 5 chapters, complete

Sometimes you’re a hag in a nymph’s body, and sometimes you’re just a witch trying to hide the nymph in you… DMHG. Post-DH disregarding epilogue. Written for an exchange, see prompt inside.

- Wynken

Destruction By Neglect

by J. H. Jowett

"Make no provision for the flesh, to fulfill its lusts." - Romans 13:14

"Make not provision for the flesh." Let the evil thing die of famine. Let the ungodly suggestion perish for sheer lack of food. Let the presumptuous thought be destroyed by the withholding of appropriate support. Kill your spiritual enemies by starvation. Make no provision for them. This appears to be the principle advocated by the great Apostle for the culture of the spiritual life. Our enemies are to be conquered by neglect. It is a principle which prevails along purely material planes.

Some two or three years ago the Liverpool School of Tropical Science sent out a body of qualified experts to investigate the causes of the malarial fever which works immeasurable havoc in the lives of multitudes of our fellow citizens throughout the Empire. The investigations have resulted in the discovery of the malarial microbe, which is the germ of this awful and widespread destruction. A further discovery has been made of the nutriment by which the microbe is sustained, and now our scientists are seeking to discover the means by which the microbe and its sustenance may be divorced. Can we separate it from its nutriment? Can we isolate it from its means of maintenance? That is the problem, and there is every prospect of its being satisfactorily solved. Our experts propose fighting the malarial microbe by surrounding it with conditions of famine.

It is even so in the realm of the spirit. When the microbes of evil appear in the life -- little baby germs, infantile suggestions of revolt, weaklings of unclean desire -- the effective method of destroying them is by deliberate and studious neglect. We are to annihilate them by refusing proper maintenance. We are to see to it that there is no food about the life on which they can thrive. We are to make no provision for them.

Now there is no method more absolutely efficient and assured in its working than the method of destruction by neglect. "Where no wood is, there the fire goes out." Deny the fuel, you exhaust the flame. If the enemy in the spirit hunger, starve him. If we surround him with plentiful food, if he finds rich provision for the maintenance, he will speedily become full grown and tyrannical. But if we starve him he will never be "fulfilled." He will pass away of sheer exhaustion.

I want to give this apostolic word "flesh" the apostolic content. We perilously impoverish its significance if we limit its comprehensions to the rise and sovereignty of carnal desire. It embraces dispositions and tendencies which appear to have no immediate relationship with carnality. The Apostle has broken up the surface of the word and enabled us to see its varied and manifold significance. He has proclaimed that, in his conception of the term, there are involved such presences as "wrath," "strife," "sedition," "drunkenness," "uncleanness." But whichever of these manifold guises the flesh may assume, the Apostolic method works a sure destruction. We are to slay them by withholding congenial food. Let us apply the principle to two or three of the enemies which besiege the souls of men.

Wrath. How shall I deal with unholy anger, with anger whose only influence is self-destruction? How shall I contend with passion that boils over and scalds and destroys the sensitiveness of my spirit? The way to destroy it is to "make no provision for it." It must find no food on which to grow strong. It must find no fuel with which to feed its flame. Now the nutriment of wrath is thought. There can be no anger if there be no thought. Thought is the fuel by which the fire is fed. We recognize this in our everyday speech. Here is a man who is under the impression that he has been contemptuously treated by his fellow. His feelings are worked into a passion, and his speech becomes violent and threatening. What counsel do we give him? We say to him, "Don't think about it." That is to say, we counsel him to withdraw his thought and to occupy it with other things. We assume that if the thought be withheld, the passion will subside. . . It is when we "dwell upon a thing" that our feelings are aroused. "As I mused the fire burned." . . Make no provision by thinking, and anger will languish and die.

Strife. This is another of the carnal enemies described by the Apostle Paul. "Whereas there is strife among you, are ye not carnal?" Strife is the opposite of a fruitful and blessed peace. Now the germ of strife is usually found in a tiny misunderstanding. The misunderstanding in its earliest stages may be small and puny, but we may make provision for it until it grows into fierce and violent strife. There are two correlative ways in which strife is engendered and matured.

We may make provision for strife by indiscreet conversation. To gossip about a misunderstanding will almost surely aggravate it. Misunderstandings grow by being talked about to others. To make them the topic of idle speech is to inflame and exaggerate them. It is a very device of the evil one that when we talk about a supposed injury it assumes colossal proportions. The way to deal with a misunderstanding is to make no provision for it. . . If we talk about it at all, let it be in frank and sanctified speech with the one in whom the misunderstanding has occurred. . . .

We may make provision for strife by indiscreet hearing. It is not only the speaker but the listener who may be making provision for the flesh. We may nurse the spirit of strife by being unwise and receptive hearers. There would be no talkers if there were no listeners. . . Let us make no provision for it, and let us close our ears when deliberate deafness will help to annihilate evil.

Envyings. This is another of the offsprings of the flesh characterized by the Apostle Paul. It suggests an ill relationship to another which, if nourished, will grow into ill will and manifest itself in positive attempts at injury. Let me give two or three familiar examples of its work. A young girl in a business establishment is very popular in her circle. She has many attractions, many gifts, and much personal charm. She is admired and sought after and lives in the light of ceaseless favor. Another girl in the same establishment enjoys no such popularity and is little sought and not conspicuously admired. What space there may be here for the growth of envy; and if suitable provision is made, how speedily envy will mature into ill will and grievous attempts to injure! . . .

A missionary comes to conduct special evangelistic services in a town. There is nothing conspicuously great about his addresses. There is nothing extraordinary in his matter or manner. Indeed, he appears to be rather commonplace; and yet men and women are drawn into the Kingdom in crowds. And here is another minister of greater culture and apparently wealthier gifts, preaching the same Gospel, depending upon the same Lord, and yet only now and again has he the joy of drawing men and women into decided surrender to God. What an occasion there may be for the rising of envy! . . .

Have any of us felt the birth of these baby-devils within us? Let us make no provision for them. If the ugly thing has just shown its head, let us kill it by starvation. And how shall we do it? By withdrawing the thought on which it feeds and providing another kind of thought which be as poison. There is only one way of doing it. We must pray for those we envy, we must tell God all about it; and in these conditions the evil thing will languish away and die. We must look at the enviable one in our Master's presence, and he will become to us the lovable one. Envy is asphyxiated in the atmosphere of prayer. In prayer is no provision for the flesh.

USA We've been flooded with thousands of reader questions on coronavirus. We're answering them.

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An epidemiologist answers the biggest questions she's getting about coronavirus. Wochit As the coronavirus pandemic continues to shut down daily life across the globe, thousands of our readers across the nation have asked us questions about COVID-19. And we're answering them. For basic facts about the virus – what it is, how it spreads and where it's located – you can get caught up by reading our in-depth explainer here. We've also debunked some viral coronavirus myths.  But you're curious and continue to ask important questions via our newsletter, Coronavirus Watch. (Not a newsletter subscriber? Sign up for it here!) So below, you can find answers to questions such as: Is it OK to be outside? How old are people who are dying in the U.S.? Is it safe to get carry-out food? If you don't see an answer you're looking for, check out our newest Q&A where we talk about UV radiation, antibodies, cats and more.  What else would you like to know? Ask us by filling out the form you can find here.

USA Can UV radiation from the sun kill the virus?

– Charlie from Dade City, Florida Experts have advised against using concentrated UV light to prevent or treat the coronavirus and do not recommend going in the sunlight to kill the virus. Only levels of concentration of UV light much higher than what is found in sunlight can kill viruses, the experts note, and the levels that are able to kill viruses can cause irritation to human skin and should be avoided. Neither sunlight or UV light is listed as a preventative measure on the websites of the World Health Organization or the U.S. Centers for Disease Control and Prevention. Fact check: Sunlight does not kill the new coronavirus

USA My primary income is from rentals. If my tenants are unable to pay their rent, what kind of relief is available to me?

– Vicki from Santa Rosa, California Trump in March signed the largest economic stimulus package in U.S. history. The stimulus provides forbearance on mortgage payments for up to a year but just for federally-backed loans. Some states and banks are also issuing relief for other types of mortgages. Once forbearance ends, borrowers would have to work out a repayment plan or loan modification with the mortgage servicer, the National Housing Law Project says. Still, several states are granting moratoriums to renters but not owners, potentially forcing owners to pay their mortgage, utilities, taxes and other costs even though they have less rental income.

USA Is it true that everyone who is on unemployment due to COVID-19 will receive an additional $600 a week as part of the stimulus package?

– Hannah from Canton, Ohio  The stimulus package expands unemployment insurance benefits. If you've lost your job because of the outbreak, you will see your weekly state insurance benefits – which average about $400 – increased by $600 for four months. And if you are still unemployed after state benefits end, you could get an additional 13 weeks of help.

USA What are the results so far with the tests of the Z-Pak and malaria med, hydroxychloroquine?

– Pat from Alexandria, Virginia There are no approved therapies or drugs to treat COVID-19. Anecdotal reports suggest that a known anti-malarial (hydroxychloroquine) combined with a common antibiotic (azithromycin, sold as Zithromax and Z-Pak) may offer some benefit in the treatment of hospitalized COVID-19 patients. A very small study in France of just a couple dozen patients found some evidence that the combination was effective in fighting COVID-19. A subsequent study of 80 patients in France found clinical improvement in all but one. Studies in China have suggested similar results. Researchers have warned that the drugs can have risky side effects and could cause subtle heart changes and increase a person's risk of developing arrhythmia.  Clinical trials of the drug combination began in New York on March 24, and the FDA on March 29 granted emergency use of hydroxychloroquine by hospitals. Several other clinical trials are in the works, according to ClinicalTrials.gov. But it's still too early to say whether the drugs are effective.

USA How many people have recovered from the virus?

– Stephanie from Mt Pleasant, South Carolina More than 191,000 people worldwide have recovered from the virus as of Wednesday, according to data from Johns Hopkins University. Most of the recoveries have been in China, followed by Spain, Germany, Italy and Iran. Of the more than 203,000 confirmed cases in the U.S., more than 8,000 have recovered.

USA Will families who receive food stamps be eligible for the stimulus check?

– Renda from Miami, Florida Yes, families who receive food stamps are eligible to receive a stimulus check! The $2 trillion stimulus plan includes one-time payments of $1,200 per adult and $500 per child, $367 billion for small businesses, $500 billion for loans to larger industries, $100 billion for hospitals and the health care system, and $600 more per week in unemployment benefits for those out of work.  Here's how you can calculate the amount of stimulus money your household can expect.

USA Is the virus a DNA molecule protected by a thin layer of fat that will disintegrate if that fat layer is removed outside your body?

– Rita in Las Vegas, Nevada SARS-CoV-2 particles are spherical bundles of genetic material (RNA) surrounded by a fatty outer layer (lipids) with proteins called spikes protruding from the surface. These spikes latch onto receptor proteins on human cells in the lungs and other tissues and change the structure of those human cells, allowing the viral genes to enter the host cell to be copied, producing more viruses. Viruses need a host to "survive," and the fat layer breaks down when it is out on its own in the environment. Preliminary researc h suggests that the virus is stable outside the body for different periods of time, depending on the climate and surface. You can "kill" the virus using soap, extreme heat and ultraviolet light, and each attacks a different part of this virus structure. Soap breaks up the fatty outer layer. Heat breaks up the protein spikes. And UV light breaks up the genes inside.

USA Has anyone with preexisting conditions gotten the coronavirus and survived?

– Dee from Arlington, Texas Yes, many people have. While the risk for serious disease and death from COVID-19 is higher in people who are older or who have certain preexisting conditions, thousands have survived. Data from the CDC published Tuesday found that, as of March 28, the U.S. reported 2,692 patients who had one or more underlying health conditions. Of those patients, 173 died. This limited data suggests that thousands of people who have one or more underlying health conditions have not died. Moreover, a February WHO study of more than 70,000 coronavirus patients in China found that people with preexisting conditions had higher fatality rates than those without preexisting conditions: 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer. However, those figures suggest that large percentages of people with preexisting conditions survived.

USA Can coronavirus be transmittedthrough secondhand smoke?

– David from Columbus, Georgia "It’s not the main mode of transmission. There's probably some component of airborne, but I don’t think secondhand smoke would be a compounding factor," said Tania Elliott, clinical instructor of infectious diseases at NYU Langone. If the smoke irritates your lungs and causes you to cough, that poses a greater risk of transmission since the virus is thought to mainly spread through respiratory droplets when someone coughs or sneezes, Elliot said. Smokers are likely to be more vulnerable to COVID-19 as the act of smoking means that fingers and possibly dirty cigarettes are in contact with lips, according to the WHO. Smokers may also already have lung disease or reduced lung capacity which would greatly increase risk of serious illness, the WHO says. While data is still evolving about how long the virus may remain alive, a recent study found that viable virus could be detected up to three hours later in the air.

USA Is cross-country road travel advisable to destinations outside of COVID-19 'hot spots'?

– Roland from Albuquerque, New Mexico The White House is asking Americans to stay home as much as possible to slow the spread of the virus, and some states and local governments have issued "stay home" and "shelter-in-place" orders. "I don’t think now’s the time to do it," Elliott said. "If you have a house somewhere else, that's fine. But I wouldn’t recommend being in hotels or crowded public settings. If you want take a road trip and go camping, there's risk associated with that."

USA Can you catch the virus from people who've died?

– Nikki from Albany, Georgia The main way the virus is thought to spread is through respiratory droplets produced when an infected person coughs or sneezes, and this is not a concern after death, according to the CDC. But people should consider not touching the body of someone who has died of COVID-19, the CDC says. There is no known risk associated with being in the same room at a funeral or visitation service with the body of someone who died of COVID-19, the CDC says. Kissing, washing and shrouding should be avoided before, during and after the body has been prepared, if possible. But holding the hand or hugging after the body has been prepared for viewing may pose less of a risk, the CDC says. CLOSE

Reviewed editor-in-chief David Kender shares creative ways to keep your kids engaged while you're stuck at home. USA TODAY

USA What is the value of testing for the coronavirus if there is currently no treatment?

– Linda from Brevard County, Florida There is value to getting tested because there are many reasons why someone would seek medical care for their symptoms, and ruling out the coronavirus is helpful in seeking other causes, said Jason Christie, chief of pulmonary medicine at Penn Medicine. "The biggest problem is we don’t have a quick and reliable test right now. Without that, we have to be smart and ration the testing to those people that need them most. So don’t go out and get tested right now unless you’re sick," Christie said. Testing also helps health officials figure out how prevalent and contagious a virus is.

USA Is it safe to get groceries during senior shopping hour?

– Pamela from Wellsville, Pennsylvania Acknowledging that older adults and persons with underlying health conditions are more susceptible to COVID-19, a growing number of stores are dedicating time or opening earlier for senior shoppers and other at-risk groups. But Elliott says she doesn't advise it. "That gives a false sense of security," she said. "By encouraging older people with chronic diseases to go out at a dedicated time, you're still exposing them to a bunch of other people, and if one person in that crowd is infected, then the virus will spread." Elliott said she'd rather see stores limiting the number of people who can enter during a given time period so that there are fewer people in the store. She also encourages healthy people to do the shopping.

USA Can the virus be transmitted through the mail? Should I stop sending greeting cards?

– Pam from Seven Lakes, North Carolina The chances of transmission through your mail is very low, Elliott says. "Parts of the virus can fall on surfaces and survive on surfaces for up to 72 hours. But you have to have pretty good conditions for that to happen. So the likelihood would be very small, even with no precautions," she said. Elliott advises people to put their mail down on a plastic plate instead of directly on a counter top or table, to use a letter opener, and to wash hands thoroughly after touching the mail. Research on how long a virus may live on surfaces is evolving. The CDC has said there is likely very low risk of transmission of COVID-19 from products or packaging that are shipped over a period of days or weeks "because of poor survivability of these coronaviruses on surfaces." A recent study found that viable virus could be detected up to three hours later in the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. But a subsequent report from the CDC found that genetic material from the virus can live on surfaces for more than two weeks.

USA Are plastic grocery bags considered the plastic that you have to wait hours to touch?

– Elizabeth from Greenfield, Indiana You should take precaution with any containers, Elliott says. "The plastic grocery bags I’d throw out right away, wash your hands and then clean your food. Chances (of infection) are low," she said. "But better yet, bring your own bags! It’s better for the environment anyway."

USA They keep saying stay isolated for two weeks. But what happens after the two weeks?

– Al from Topeka, Kansas Officials suggest self-quarantining for two weeks if you've had exposure to somebody with the virus and might be infected. It's a way to monitor if symptoms develop and, at the same time, avoid any possible spread to others. Since the incubation period for the virus is up to 14 days, you're "cleared" for the virus after two weeks, Elliott said. After that, you still need to practice social distancing.

USA Is it advantageous for a younger healthy person to get the coronavirus to build immunity to it?

– Danny from Sundance, Wyoming No, for several reasons, says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. While a protective antibody is generated in those who are infected, scientists are not yet sure whether that immunity will last for a short period of time, for years or for life. Some say the possibility of reinfection is very likely. Moreover, a new federal health report says Americans of all ages have faced serious health complications amid the outbreak. Data from the CDC show that among the roughly 12% of COVID-19 cases in the U.S. known to need hospitalizations, about 1 in 5 were among people ages 20 to 44. Anywhere from 14% to 21% of adults ages 20 to 44 with COVID-19 have been hospitalized, the CDC data estimates. Two to 4% of cases led to ICU admissions, and less than 1% were fatal. Finally, it's important to avoid getting and spreading the virus. While the young may not be the most at risk, they're carrying the disease to those who are more vulnerable, such as older people and those with underlying conditions. Dr. Deborah Birx, a member of the White House coronavirus task force, on Wednesday urged "the millennial generation" to take special precautions. "You have the potential to spread it," she said.

USA Does getting pneumonia shots given to elderly people help if you get this virus?

– Linda from Hendersonville, Tennessee Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenzae type B vaccine, do not provide protection against the new coronavirus, according to the World Health Organization. The vaccines simply guard against those specific bacterial infections. The COVID-19 virus can, in fact, cause pneumonia, but the vaccines cannot prevent this pneumonia.

USA I see people in my neighborhood out running, riding bikes and walking their dogs. Is that OK?

– Patti from Carmel, Indiana Yes, that's OK! Just be sure to maintain distance from other people. The CDC recommends a distance of about 6 feet. Even in states and counties where residents are being asked to stay home or "shelter in place," it's still fine to go for a run, hike or do other outdoor activities, as long as proper social distancing is observed. Just don't be like Chicago, where city officials closed trails and parks after crowds of hundreds of people were seen congregating along the city’s lakefront. Remember: The White House recommends that you should avoid social gatherings involving more than 10 people, as well as all non-essential travel, shopping trips and social visits. Social distancing: Why it's so important to stopping the spread of coronavirus  CLOSE

Social distancing matters. Here is how to do it and how it can help curb the COVID-19 pandemic. USA TODAY

USA Are there any projections to estimate the spread of COVID-19 and a timeline of its passing?

– Dennis from Las Vegas Yes, there are many projections, but scientists say they all hinge on how people behave. That's why it's essential to social distance and do what you can to prevent spread. A conservative USA TODAY analysis based on data from the American Hospital Association, U.S. Census, CDC and WHO estimates that 23.8 million Americans could contract COVID-19, leaving almost six seriously ill patients for every existing hospital bed. Another analysis finds that America’s trajectory of community spread is trending toward Italy’s, where circumstances are dire. One researcher at the Global Center for Health Security estimated last month that as many as 96 million Americans could be infected. The U.S. population on March 27 is estimated at 329 million. The Johns Hopkins Center for Health Security estimated that 38 million Americans will need medical care for COVID-19. The CDC's worst-case-scenario is that about 160 million to 210 million Americans will be infected by December. Under this forecast, 21 million people would need hospitalization and 200,000 to 1.7 million could die by the end of the year. Outside the U.S., leaked British documents projected that a coronavirus outbreak could rage until spring 2021. German Chancellor Angela Merkel said 60% to 70% of her country's population could eventually become infected. USA TODAY analysis: America's coronavirus 'curve' may be at its most dangerous point

USA Is it safe to get carry-out food?

– Debby from Omena, Michigan The CDC and WHO have not issued formal guidance on carry-out food. While the CDC says that there is no evidence to support transmission associated with food, a person may get COVID-19 by touching a surface or object that has the virus on it and then touching their own face. The virus can, for example, survive on cardboard up to 24 hours, according to a recent study. The issue of carry-out food also raises concerns about the risk couriers are facing by interacting with customers during their shifts. That's why some companies are now offering "contactless" delivery options that help people maintain social distancing by allowing couriers to ring the doorbell and leave the package outside. Study finds: Coronavirus can live in the air for hours and on surfaces for days CLOSE

It's vital to clean surfaces you touch every day amid the coronavirus outbreak. Here are mistakes to avoid. USA TODAY

USA How soon after exposure can you test positive?

– Pam from Easton, Maryland There's no specific data on this question yet, according to Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group. However, we do know that someone infected with the virus may begin showing symptoms anywhere between one and 14 days after catching the virus, most commonly around five days, according to the WHO. "The peak viral shedding occurs during the first five days after the onset of symptoms. My guess is that within a few days of being exposed, these patients are beginning to shed virus," Poland said. A recent report from the CDC studying an outbreak at a care home in Washington State found that among 23 residents who tested positive for the virus, 13 were asymptomatic. Within a week, 10 of those 13 developed symptoms, with onset at 3 days.

USA Do the symptoms for COVID-19 come together or can you have separate symptoms showing up at different times?

– Carlos from Los Angeles The most common symptoms are fever, tiredness and dry cough, according to the WHO. Shortness of breath is also among the most common symptoms, according to the CDC. In most cases where symptoms present, those symptoms come together, Hotez said. "Usually it presents with fever and cough, or fever, cough, and shortness of breath," he said. "It might present with one of those symptoms first, but then it rapidly progresses to the others." Some patients also have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. Some people do not have symptoms at all. A New York neurosurgeon is warning people against looking out for fever as the first tell-tale symptom of the virus. His symptoms began with a little bit of congestion and only later progressed to a fever, body aches and chills. More on testing: Coronavirus test swabs aren't your standard Q-tips, and they're running out as testing ramps up

USA How do you actually die from the coronavirus? What happens?

– Catherine from Carson City, Nevada In some cases, the virus ultimately damages tiny air sacs in the lungs, restricting oxygen to the bloodstream and depriving other major organs – including the liver, kidney and brain – of oxygen. Severe cases of coronavirus: Some result in brain damage, inability to walk In a small number of severe cases, that can develop into acute respiratory distress syndrome (ARDS), which requires a patient be placed on a ventilator to supply oxygen.  However, if too much of the lung is damaged and not enough oxygen is supplied to the rest of the body, respiratory failure could lead to organ failure and death. Here's what that looks like inside the body.

USA What is the age range of U.S. deaths from COVID-19?

– Becky from Bentonville, Arkansas In the U.S., ages range from an infant less than one year old to people in their 90s, according to state and local health departments. The Illinois Department of Public Health said Saturday that an infant coronavirus patient younger than one year old in Chicago had died. An investigation was underway to determine the cause of death. "There has never before been a death associated with COVID-19 in an infant," department Director Dr. Ngozi Ezike said. This week health officials also reported that a 17-year-old teen in New Orleans died after contracting the virus. And a 2-month-old in Nashville who tested positive for the virus could be the youngest patient in the nation, officials say. However, this range is not conclusive because health officials have not released the specific ages of several other patients, and new deaths are being reported each day.

USA If a person is sick with the coronavirus and gets tested for the flu, would the flu test be positive?

– Antonio from Patchogue, New York No, the presence of the coronavirus would not turn a flu test positive. However, it's possible to have both the coronavirus and the flu at the same time. In that case, the flu test would be positive. The opposite is also true: Presence of the flu would not result in a positive coronavirus test. It's important to note that, even if someone tests negative for the coronavirus, they still may be infected with the coronavirus. CLOSE

We answer the often searched question: "What are the symptoms of coronavirus versus the flu?" USA TODAY

USA I was told I should be tested if I could not easily inhale a large breath and hold it for at least 10 seconds. Is this good advice?

–Ted from Scottsdale, Arizona No. While shortness of breath is among the most common symptoms of the virus, according to the CDC, that diagnosis does not necessarily involve holding a large breath for 10 seconds. Medically known as dyspnea, shortness of breath is often described as "an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation," according to the Mayo Clinic. If you think you may be sick, call your doctor and follow CDC guidance.

USA Can masks be reused by an infected person or used only once?

– Debra from Dayton, Ohio The longer a mask is used and the more damp it becomes, the less effective it is, Poland said. "But it is definitely better than the alternative of no mask!" Contributing: Molly Stellino, Adrianna Rodriguez, Dalvin Brown, Marco della Cava, Jayme Fraser and Matt Wynn Follow Grace Hauck on Twitter @grace_hauck Autoplay Show Thumbnails Show Captions Last SlideNext Slide Read or Share this story: https://www.usatoday.com/story/news/health/2020/03/19/coronavirus-reader-questions-death-age-flu-symptoms-food-timeline/2863776001/ Read the full article

How To Know If Your Own Doctor (Or A Doctor You Might See) Is A Quack

Last week, a group of medical professionals calling themselves America’s Frontline Doctors stood in front of the U.S. Supreme Court and insisted that hydroxychloroquine is a “cure” for the coronavirus despite medical studies to the contrary.

In addition to that claim about the anti-malarial drug, their press conference also pushed such potentially harmful misinformation as the idea that mask-wearing isn’t necessarily a good choice. A day later, Vice President Mike Pence reportedly met with the doctors.

As Anthony Fauci, the government’s top infectious diseases expert, has said repeatedly, there’s little concrete evidence that hydroxychloroquine is effective as a COVID-19 treatment ― even if President Donald Trump continues to promote it. Last month, the Food and Drug Administration warned against using hydroxychloroquine to treat coronavirus patients, following reports of “serious heart rhythm problems” and other health issues in those who received the drug.

Still, in part thanks to a retweet by the president, the doctors’ clip went viral. It racked up tens of millions of views, even in the face of a widespread effort by social media companies to remove the video and penalize some who shared it, including presidential son Donald Trump Jr.

What may have been more startling, though, was what the news media found out about Stella Immanuel, the doctor who led the press conference. Immanuel, who works as a primary care physician and pastor in Houston, doesn’t just believe hydroxychloroquine is a valid coronavirus treatment. She also believes that gynecological issues like endometriosis and cysts are caused by people having sex in their dreams with demons and witches, that alien DNA is currently used in medical treatments and that gay Americans practice “homosexual terrorism.” Online, Immanuel hawks a prayer she claims can remove “generational curses” passed on from ancestors and transmitted through the placenta.

The fact that so many Americans may have fallen for claims made by Immanuel and the other doctors ― most of whom are only debatably “on the frontlines” of the COVID-19 crisis ― without knowing much about their backgrounds or possible political motives is deeply troubling to Lydia Kang, a practicing physician and co-author of “Quackery: A Brief History of the Worst Ways to Cure Everything.”

“I was incredibly fearful for the health of those people who would trust her for two reasons: Her thinking agreed with their own, and they were looking to a medical professional to substantiate their own beliefs,” Kang told HuffPost.

“Many people feed upon hope, which is important, but it can be frightening when that hope leads to believing things that could be incredibly harmful,” she said.

“It’s very depressing how easily Americans bought into [Dr. Stella] Immanuel’s message even knowing her history of bizarre claims.”

– David H. Gorski, a doctor and managing editor of the blog Science-Based Medicine

As unnerving as it was that so many Americans shared the video, it was actually a good thing that Immanuel has a history of using her platform to promote conspiracy theories, said David H. Gorski, a surgical oncologist and professor of surgery at Wayne State University School of Medicine. Gorski is also the managing editor of Science-Based Medicine, a medical blog that exposes non-scientific research and practices.

“The sex with demons and other claims provided the press a good ‘in’ to debunk and discredit her as a source,” he said. “If the astroturfers had chosen a less disreputable figure, it might have been more difficult to counter the message.” (Astroturfing is the practice of masking the sponsors of a message or organization, whether it’s a political, religious or advertising group, to make it appear as though the message or group had organically sprung from grassroots efforts.)

That being said, Gorski added that “it’s very depressing how easily Americans bought into Immanuel’s message even knowing her history of bizarre claims.”

Still, the fact remains that Immanuel does have a full medical license in Texas, USA Today reported pointing to the Texas Medical Board’s online records. She told the board she has a primary specialty in pediatrics and a secondary specialty in emergency medicine. Her bizarre beliefs and the products she sells on her site may ― or, worse, may not ― come as a surprise to patients she’s had.

It makes you wonder: What kind of questionable beliefs might your doctor have that aren’t endorsed by the medical community ― and how can you dodge doctors like Immanuel the next time you’re in the market for a general practitioner or specialist?

Below, Gorski, Kang and other medical experts share how to tell if a doctor might be a quack.

A few signs your doctor may be pushing some dubious beliefs:

They sell their own supplements and treatments.

It’s a significant warning sign if a doctor puts their patients on unconventional mixes of medications and supplements, some of which they sell, Kang said.

“One major red flag is when a physician directly touts their own brand of medicines or supplements to take out of their own store,” she said. “It’s a serious conflict of interest.”

They rely on single-person testimonies, social media or TV endorsements rather than peer-reviewed data.

Many of the doctors we spoke to cited television’s Mehmet Oz and his show “Dr. Oz” as an example of a physician using their platform to hawk questionable treatments. Though Oz has an Ivy League medical degree, a 2014 study in the peer-reviewed British Medical Journal found that in 40 randomly selected episodes from Oz’s show, his health recommendations were based on evidence just 46% of the time.

If you’re concerned about your doctor making dubious health recommendations, ask yourself if their claims are supported by scientific evidence. In place of hard evidence, your doctor may claim they have anecdotal evidence that something works ― or that it’s been endorsed by this expert or that celebrity, including TV doctors. That’s not enough.

“Be wary if they mention social media endorsements or they talk about testimonials and single-patient stories,” said Arthur Caplan, director of the division of medical ethics at NYU Grossman School of Medicine.

Any doctor worth their salt should be citing peer-reviewed articles and scientific studies that rely on well-designed clinical trials, not patient anecdotes and their own personal experience, Caplan said.

SDI Productions via Getty Images

Be wary of doctors who promise a 100% cure rate or speak in absolutes. For instance, “all mainstream doctors have got it wrong on this subject.”

They say their treatment is a “miracle cure” with an unbelievably high success rate.

Be leery of a doctor who promises a 100% (or ridiculously high) cure rate. If it sounds too good to be true, it usually is too good to be true, Gorski said. He used the example of certain clinics that claim they have a 90% cure rate for stage IV cancer.

They speak in absolutes.

Does your doctor tend to make sweeping generalizations or speak in absolutes? For example, “All mainstream doctors have it wrong” or “I’m the only one who can help you.” That’s another major red flag, Kang said.

“A good doctor will carefully weigh the pros and cons of any treatment, and are careful about promising anything as a ‘perfect fix,’” she explained.

When the treatment goes wrong, they blame the patient.

Because quack doctors often make overbroad claims about their treatments and products ― “it’s worked for everybody I’ve prescribed it to” ― any instances where the cure-all doesn’t work has to be the patient’s fault.

“They’ll usually blame failure of their treatment on the patient’s failure to adhere to their protocol closely enough,” Gorski said.

How to do your due diligence when selecting a doctor:

Look at rating sites with a healthy dose of skepticism.

To avoid a quack, Googling can be helpful, but stay skeptical when searching, Kang said. Be aware, for instance, that anyone can add a review on those health score websites where you see how many stars your doctor has, just like you would rate a restaurant on Yelp.

People can give a one-star or five-star rating without any proof as to “who they are, whether they actually saw the doctor, or how many times they vote,” Kang said.

Gorski suggested that Yelp-like sites rating medical professionals are inherently biased toward negative reviews.

“Patients should know that it is the very nature of rating sites that those who’ve had a negative experience will be more likely to want to post a review than those who’ve had a positive or at least acceptable or decent experience,” he said.

It’s often wiser to look at ratings put out by medical institutions themselves, Kang said, because they’re usually vetted to ensure that only patients who’ve seen the doctor vote and they vote only once.

Find out where they went to medical school and what they studied.

When sizing up a physician, especially a specialist, look up their credentials. Have they completed the proper training in their specific field?

“For example, a plastic surgeon without true training in plastics (via a residency and/or fellowship) or not board certified in plastic surgery would be a concern,” Kang said.

Coolpicture via Getty Images

When a doctor makes an interesting or surprising claim, check to see if it has garnered support from others in the medical community.

Check to see if their claims are supported by other doctors.

If you’re reading up on a treatment a doctor promotes online or elsewhere, look to see if it has garnered support from other doctors. Stay away if the doctor is making health claims outside of peer review and then marketing their product to laypeople.

“Look to see if they’ve published anything and be ready to get a second opinion if you have doubts,” Caplan said. “Are they a solo practice ― no peers checking them? Do they advertise and if so, are they making sweeping promises in their ads?”

If they have a social media presence, look to see what kind of information they’ve shared.

These days, many medical professionals have Twitter or Facebook pages where they comment on trending medical news. If your doctor has a public profile, read it to get a better feel for their beliefs, Kang said.

A quick Google search of Immanuel, the pastor-physician who led the press conference last week, would have pulled up her Twitter page, where she’s been tweeting about witchcraft and “21 day water fasts to demolish satanic embargo to our progress” since as far back as 2012.

Of course, not every social media page is going to be medically focused.

“Keep in mind, not all doctors tweet and Instagram about health topics alone,” Kang said. “They show their personal lives ― we are normal people, after all! we go on vacation and hang out in swimsuits sometimes! ― and political beliefs.”

But if a doctor is selling dubious products to their patients, they’re probably also posting about it, which allows you to weed that person out from the get-go.

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Moringa may be immunologically useful in the treatment of malaria and malnutrition.

PMID:  Malar J. 2020 Feb 7 ;19(1):62. Epub 2020 Feb 7. PMID: 32033605 Abstract Title:  Moringa oleifera treatment increases Tbet expression in CD4T cells and remediates immune defects of malnutrition in Plasmodium chabaudi-infected mice. Abstract:  BACKGROUND: Malaria is a worldwide problem that affects millions of people yearly. In rural areas where anti-malarial drugs are not easily accessible, many people use herbal treatments, such as Moringa oleifera, to treat a variety of diseases and ailments including malaria. While Moringa is reported to possess potent and curative anti-malarial properties, previous studies have mostly been restricted to assessment of parasitaemia. In this study, the effect of Moringa on malaria immunity in a murine model was investigated.METHODS: Using a high dose (60 mg/mouse) for a short time (7 days) or low dose Moringa (30 mg/mouse) for a longer time (3 weeks), cytokine production, and Tbet expression by effector CD4T cells (Teff) were determined. Mice were also treated with Moringa after infection (curatively) or before infection (prophylactically) to determine the effect of the plant extract on parasitaemia and immunity. Given that Moringa also possess many nutritional benefits, the contribution of Moringa on malnourished malaria infected mice was determined. Malnutrition was induced by limiting access to food to only 4 h a day for 4 weeks, while control mice had unlimited access to mouse laboratory chow. All data was collected by flow cytometry and analysed using one-Way ANOVA or two tailed Student's t test.RESULTS: Moringa-treated mice had increased numbers of effector CD4T cells accompanied by an increase in Tbet expression compared to control untreated mice. Mice that were treated with Moringa curatively also exhibited increased effector CD4T cell numbers, IFN-gamma and TNF secretion. Interestingly, the mice that were treated prophylactically had significantly higher Tbet expression. In the absence of adaptive immunity, high parasitaemia was observed in the RAG1 knockout mice. The food limited mice (malnourished) had reduced numbers of CD4T cells, TNF proportions, and significantly greater Tbet expression compared to the control group. Supplementation with Moringa in the limited group slightly restored CD4T cell activation, IL-2, and IL-10 production.CONCLUSIONS: Taken together, these data suggest that Moringa treatment leads to increased CD4T cell activation, Th1 differentiation and production of pro-inflammatory cytokines after malaria infection. Thus, Moringa may be immunologically useful in the treatment of malaria and malnutrition. Further investigations are required to identify the active components in Moringa.

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