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As Dr. Javaid Perwaiz faces trial, the women he treated question decades of care

CHESAPEAKE, Va. — The last time Brittni DuPuy-German saw her trusted gynecologist, she once again explained that the stabbing, mystery pain in her abdomen had not gone away.

It first appeared two years earlier, after she said her doctor, Javaid Perwaiz, surgically tied her tubes. To fix it, he had proposed more surgery — three additional procedures in nine months that she said included a hysterectomy when she was 29. But the pain persisted.

So on Nov. 8, 2019, at his private-practice office, Perwaiz and DuPuy-German discussed the possibility of yet another surgery, she said. He scheduled an ultrasound for just days later, a sign of the efficiency that DuPuy-German had come to expect from her family’s longtime gynecologist. He was her mother’s doctor, her sister-in-law’s doctor, her best friend’s doctor. Perwaiz had delivered DuPuy-German and delivered her children.

Which is why, when her phone buzzed the day after her appointment, she was shocked by the headline she was reading: “Chesapeake doctor tied women’s tubes, performed hysterectomies without their consent, feds say.”

She absorbed the details of the FBI investigation. Her doctor, the news report said, was accused of lying to patients and persuading them to have life-altering surgeries they didn’t need. DuPuy-German began doubting everything Perwaiz had told her about her own body.

“That’s when all of the things that I didn’t question before started popping up,” she said.

As Perwaiz faces trial this week, a year after his arrest, DuPuy-German has received few answers to those questions — even as the FBI’s investigation expanded and the list of alleged victims grew. There are 29 patients specified in court documents and hundreds of others who contacted authorities after the doctor’s arrest.

DuPuy-German, now 32, is not cited in the criminal case but has filed a lawsuit against Perwaiz.

The U.S. attorney’s office for the Eastern District of Virginia would not say how many women in total were allegedly mistreated by Perwaiz, but in a recent trial memorandum prosecutors wrote that “the identified patients are only ‘examples’ of the scheme to defraud.”

The case, which authorities said was launched in 2018 after a hospital employee’s tip, first hinged on one charge each of health-care fraud and false statements. Federal prosecutors now allege that Perwaiz executed an “extensive scheme” spanning nearly a decade that endangered women’s pregnancies, robbed their ability to conceive and pressured them into unnecessary procedures based on unfounded cancer diagnoses and exams using broken equipment.

The more procedures Perwaiz performed, authorities said, the more money he made off insurance companies. He used the profits, according to prosecutors’ trial memorandum, “to support his lavish lifestyle.”

Perwaiz, who is jailed without bond, pleaded not guilty. He has not spoken publicly about the allegations but defense attorneys said in a court document he is “prepared to defend himself at trial.” His lawyers in the criminal case have not responded to multiple requests for comment, but have argued unsuccessfully in numerous motions to dismiss that, among other things, some charges were duplicative.

Mice with diabetes successfully treated with EMFs

Researchers have worked out how to use electromagnetic fields to treat mice with type 2 diabetes.

Scientists have discovered that they can successfully treat type 2 diabetes in mouse models by exposing the rodents to electromagnetic fields.

The research, which appears in the journal Cell Metabolism, opens the door to further studies confirming the findings and exploring whether the therapy could be suitable for use in humans.

According to the Centers for Disease Control and Prevention (CDC), more than 34 million people — approximately 1 in 10 — in the United States have diabetes. Of these individuals, the vast majority have type 2 diabetes.

Type 2 diabetes occurs when a person’s cells do not react to the hormone insulin properly. Insulin, which the pancreas produces, mediates the ability of a person’s cells to receive blood sugar.

In this situation, a person’s body can tell that their cells are not receiving blood sugar properly, and the pancreas produces more insulin in response. At a certain point, the pancreas cannot meet the insulin demand, and, as a consequence, blood sugar levels increase.

The CDC highlight that high blood sugar levels can cause various serious health conditions, including vision loss, kidney disease, and heart disease.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, key approaches to treating type 2 diabetes include eating a more healthful diet and being more physically active.

There are also many medications that can help a person manage the symptoms of diabetes.

However, adherence to type 2 diabetes treatment is relatively low. Research has suggested that at least 45% of people with type 2 diabetes are unable to control their blood sugar levels effectively.

A range of factors may contribute to a person’s ability to keep diabetes symptoms in check, including the perceived difficulties around accessing and taking medications.

In this context, the scientists behind the present study believe that they may have made a significant discovery in the form of an effective and accessible way of treating mice with type 2 diabetes using electromagnetic fields.

The discovery came about by chance. Sunny Huang, an M.D.-Ph.D. student at the University of Iowa (UI) Carver College of Medicine and the co-lead author of the study, needed access to mice to practice taking their blood and measuring their blood sugar levels.

Dr. Calvin Carter, a postdoctoral researcher in the same lab, let Huang borrow the mice that he was using in an experiment on how electromagnetic fields affect the brains of the animals.

According to Huang: “It was really odd because normally these animals have high blood sugar and type 2 diabetes, but all of the animals exposed to [electromagnetic fields] showed normal blood sugar levels. I told Calvin, ‘There’s something weird going on here.’”

This was especially unusual given that the researchers had either genetically modified the mice in question to give them diabetes or induced the disease by feeding them a 60% high fat diet.

“That’s what sparked this project,” Dr. Carter adds. “Early

Dexamethasone side effects and risks, the steroid Trump was treated with

Trump’s doctors at Walter Reed National Military Medical Center in Bethesda, Md., cited the positive research when they disclosed that they prescribed the steroid after Trump’s oxygen levels concerningly dropped to 93 percent. Healthy blood oxygen levels range from 95 to 100 percent.

For covid-19 patients on ventilators or receiving oxygen, taking dexamethasone increased their chance of survival, according to the research published in July. But patients receiving dexamethasone who didn’t require ventilation or oxygen fared no better than patients on the normal course of treatment.

In fact, giving dexamethasone to coronavirus patients who are not at risk of severe illness could further endanger their health, according to research published in the August issue of the Journal of Hospital Medicine.

In its guidelines, the National Institutes of Health recommends against using dexamethasone for covid-19 patients who do not require supplemental oxygen.

Dexamethasone is not often prescribed toward the start of a patient’s infection, experts say, because it can suppress the immune system’s ability to ward off the virus. But Trump’s doctors opted to administer the steroid less than two days after Trump publicly disclosed that he had tested positive.

“We decided that in this case the potential benefits early on in the course probably outweighed the risks,” Conley said Sunday.

Dexamethasone can also have concerning side effects, ranging from blood clots, blurred vision, and headaches to “psychic derangements,” such as insomnia, mood swings and “frank psychotic manifestations,” according to the drug label.

Doctors know what to expect with dexamethasone because the drug itself is not new. The steroid, which is used to treat asthma, Crohn’s disease, IBS and some cancers, is 60 years old and ubiquitous.

“It’s cheap as borscht, as my grandparents would say,” Isaac Bogoch, an infectious-disease specialist at Toronto General Hospital, previously told The Washington Post. “It’s widely available. Every single physician on the planet that practices hospital-based medicine is comfortable using this drug.”

Another well-known, therapeutic effect of the drug is a sensation of euphoria. But the relief a patient may feel should not be confused with physical improvement, said Paul B. Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center.

Before departing Walter Reed on Monday, Trump boasted on Twitter that he felt better than he did two decades ago.

“Feeling really good! Don’t be afraid of Covid. Don’t let it dominate your life,” he wrote after his brief hospitalization for the disease that has killed more than 210,000 Americans.

Patients who are prescribed a steroid like dexamethasone can over-exaggerate how well they feel, Bach told The Post. But he advises patients who take the steroid not to be deceived by the reprieve and overexert themselves.

“Having taken this myself, for a herniated disc, I felt like a million bucks,” Bach said, “but actually I was barely able to move.”

Trump was prescribed the drug in concert with other medicine — supplemental oxygen, a monoclonal antibody cocktail and a five-day course of the intravenous antiviral remdesivir.


Study: 7 in 10 appendicitis patients treated with antibiotics avoid surgery

Oct. 5 (UPI) — Antibiotics and surgery are both good options for treating appendicitis, according to a study published Monday in the New England Journal of Medicine that found 7 in 10 patients treated with the drugs ultimately avoid surgery.

“About three in 10 patients in the antibiotic group ultimately underwent an appendectomy within 90 days,” study co-principal investigator Dr. David Flum said in a statement.

“There were advantages and disadvantages to each treatment, and patients will value these differently based on their unique characteristics, concerns, and perspectives,” said Flum, professor and associated chair of surgery at the University of Washington School of Medicine.

The Comparison of the Outcomes of antibiotic Drugs and Appendectomy is the largest study to date comparing antibiotics for appendicitis to appendectomy, which is a surgery to remove the appendix, researchers said.

The goal of the study is to help nearly 300,000 people who visit the hospital each year for appendicitis-related issues choose the treatment that would be best for them with support from the evidence in the study.

Inflammation of the appendix, usually occurring in the teens or 20s, is the most common cause of acute abdominal pain requiring surgery though some mild cases are treated with antibiotics alone.

The study involved 1,552 participants from 25 sites across 14 states, researchers said. One month after treatment, participants rated their general health as about the same in both groups.

In the antibiotics group, about 71% did not have surgery within three months, and participants in the antibiotic group missed missed about 3 1/2 fewer days of work.

However, more participants in the antibiotics group needed to visit an emergency room or urgent care clinic within three months, 9%, compared with the surgery group, at 4%.

When surgery is successful, the appendix is fully removed, but with the antibiotics, appendicitis can come back and researchers said they will determine how often that happens in follow-up reports.

For every 100 participants in the antibiotics group, there were about eight unexpected problems. By comparison, in the surgery group, there were about four such problems.

The higher rate of problems in the antibiotics group was related to participants with an appendicolith, which is a calcified deposit within the appendix. These participants had a higher rate of having surgery within three months at 41% compared to the overall group rate for participants using antibiotics of 29%.

Source Article

As Trump is treated for coronavirus, the press can’t lose sight of the nationwide story

A version of this article first appeared in the “Reliable Sources” newsletter. You can sign up for free right here.

a bus that is sitting on the side of a car: President Donald Trump wears a protective mask while giving a thumbs up as he is driven in a motorcade past supporters outside of Walter Reed National Military Medical Center in Bethesda, Maryland, U.S., on Sunday, Oct. 4, 2020. Trump briefly left his hospital in a car to greet supporters gathered outside, after posting a video on Twitter saying he was about to make a surprise visit. Photographer: Graeme Sloan/Bloomberg via Getty Images

© Graeme Sloan/Bloomberg via Getty Images
President Donald Trump wears a protective mask while giving a thumbs up as he is driven in a motorcade past supporters outside of Walter Reed National Military Medical Center in Bethesda, Maryland, U.S., on Sunday, Oct. 4, 2020. Trump briefly left his hospital in a car to greet supporters gathered outside, after posting a video on Twitter saying he was about to make a surprise visit. Photographer: Graeme Sloan/Bloomberg via Getty Images

The president’s health crisis is undoubtedly the biggest single story in the United States right now. But it should not blot out the broader coronavirus story.

Along with the cooler temperatures that drive people indoors, there are worrying trends across the US. “In many states, local and state leaders are reporting worrying milestones,” CNN’s Christina Maxouris and Jason Hanna reported over the weekend.

Wisconsin is emerging as a hotspot: The state reported 2,892 new cases on Saturday, “a record number.” In Kentucky, the governor said his state “shattered” the previous case record. In New York City, the mayor said he wanted to lock down certain hot spots in the city.

Overall, “in the past five days of reporting nationwide, there have been a total of 232,657 cases of coronavirus reported, according to data from Johns Hopkins University. That is the most cases in a five day period reported since mid-August,” per CNN’s Chuck Johnston.

The daily new-case count surpassed 50,000 on Friday. And on Saturday, there were 49,994 new cases reported nationwide, according to JHU. The virus is tightening its grip on many parts of the continental US. And the fall is just beginning, so expect that grip to get even tighter. The president’s diagnosis should be reported in that context…

>> Big picture: More than 7.3 million people have been infected nationwide, according to Johns Hopkins data. More than 209,000 people have died.

Trump said “the end of the pandemic is in sight”

That’s what he said in a pre-recorded video on Thursday for the Al Smith Dinner. Based on what we know about the timeline of his illness, he was already infected when he made the faulty claim.

In a new video, posted to Twitter on Sunday evening, Trump said “I learned a lot about Covid” by getting sick. He went on to say “I get it, and I understand it, and it’s a very interesting thing, and I’m going to be letting you know about it.” Right after he recorded that comment, he went for a ride…

The “double take”

Ana Cabrera was anchoring on CNN, interviewing James Clapper and David Gergen, when there was a surprise convoy of vehicles on the live camera shot from outside Walter Reed. Cabrera told me she did a “double take” as she saw the president waving to his supporters from his armored SUV. “Hey, you guys,” she said as she interrupted

How Trump Is Being Treated in the Hospital

During the press conference today, Conley said that Trump was “doing very well,” but added that he had been experiencing symptoms as far back as Thursday, including a fever and a cough. They were severe enough that Trump inquired as to whether he should be lying on his stomach in a prone position (which has shown to help some COVID-19 patients breathe more easily). In response to questions, Conley declined to comment on when the president had been infected, or when he’d last tested negative. And in three separate exchanges with reporters, Conley dodged the question of whether Trump had ever required supplemental oxygen—which would be a sign of early stages of respiratory failure—emphasizing only that he does not require oxygen at the moment.

By the few available objective measures, Trump was not himself on Friday. He went almost an entire day without tweeting; one of the few such days in his presidency. As he exited the White House and boarded Marine One for the trip to the hospital, he gave only a meager thumbs-up to the press. He climbed the stairs into the helicopter unassisted, but used both handrails. The White House has indicated that he “will be working from the presidential offices at Walter Reed” out of “an abundance of caution.” Today, his doctors confirmed that he was an admitted patient.

The disease is known to take sudden turns for the worse, within a matter of hours. So being monitored in a hospital is not an unreasonable move, especially for a person in a high-risk demographic, like Trump. It would be unsurprising to learn later today that Trump requires oxygen, or to learn tomorrow that he has moved to the intensive-care-unit bed in his presidential suite. But it would be equally unsurprising to learn that he is indeed working from the hospital and will be home on Monday, and back on the campaign trail within the week.

By midnight yesterday, Conley had reported that the president had received yet another experimental drug, the antiviral remdesivir. The news that Trump had received these two drugs does not give any meaningful clue as to how sick he is. Often when a person receives experimental therapies, it suggests that their condition is at least more than a mild cold. But Trump is inclined to try out novel medicinal approaches. He said that he was taking hydroxychloroquine and azithromycin in May, despite a lack of evidence that these would have any bearing on whether he would contract the coronavirus. That same mentality could lead him to request antibodies and antivirals like remdesivir at the first sign of illness. Both have shown mixed results in trials so far, but both seem unlikely to make a person worse off.

What would be meaningfully objective news is if Trump starts requiring oxygen regularly, or if imaging studies suggest that he’s developing pneumonia. It is crucial that there be transparency and honesty when reporting such basic

President Donald Trump treated with remdesivir at Walter Reed, doctor says

A pedestrian walks past a bar established in 1933 after Los Angeles County officials closed it for the second time following a spike in COVID-19 cases in Los Angeles on August 10. Photo by Jim Ruymen/UPI | License Photo