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Extreme Medicine
SCIENTIFIC AND PRACTICAL REVIEWED JOURNAL OF FMBA OF RUSSIA
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DOI: 10.47183/mes.2022.009
Liver damage in patients with COVID-19
Vologzhanin DA1,2, Golota AS1, Kamilova TA1, Makarenko SV1,2, Scherbak SG1,2
1 City Clinical Hospital No. 40 of the Kurortny District, Saint Petersburg, Russia
2 Saint Petersburg State University, St Petersburg, Russia
Correspondence should be addressed: Aleksandr S. Golota
Borisova, 9, lit. B, 197706, Saint Petersburg, Russia; moc.oohay@aatolog
About paper
Author contribution: Golota AS, Kamilova TA — data search and analysis, manuscript writing; Vologzhanin DA, Makarenko SV, Sсherbak SG — manuscript discussion and editing.
Received: 2022-03-14 Accepted: 2022-03-27 Published online: 2022-03-31
SARS-CoV-2 coronavirus is a respiratory pathogen causing COVID-19. Complications of COVID-19 affect almost all organs, including liver. Direct virus cytotoxicity, dysregulated immune responses, microcirculatory disorders and thrombosis contribute to the systemic toxicity in COVID-19. The diversity of the COVID-19 manifestations is associated with the broad organotropism of SARS-CoV-2.
SARS-CoV-2 infects cells by means of the multifunctional cellular receptor, ACE2 (angiotensin-converting enzyme-2), which is found on the cell membranes in all organs, including liver, and makes the tissue vulnerable to the coronavirus invasion. Cellular serine protease TMPRSS2 (transmembrane protease serine 2) is involved in the SARS-CoV-2 invasion, contributing to the virus internalization into target cells [1]. ACE2 and TMPRSS2 are expressed in the cells of many tissues, including gastric glandular cells, enterocytes, hepatocytes, cholangiocytes, and endothelial cells [2, 3]. Elevated ACE2 expression in hepatocytes has been revealed in patients with liver fibrosis/cirrhosis [2, 4]. This finding is very important: concomitant liver disease may increase the SARS-CoV-2 liver tropism.
Hepatic dysfunction may influence the multisystem manifestations of COVID-19, such as acute respiratory distress syndrome (ARDS), coagulopathy, and multiple organ failure. Liver is the main human organ involved in metabolism and detoxification, that is why even a moderate decline in liver function can alter the safety profiles and therapeutic efficacy of antiviral drugs metabolized in the liver [4].
Epidemiological data on liver injury in patients with COVID-19
The prevalence of liver injury in patients with severe COVID-19 (74.4%) is higher than in patients with the mild course of the disease (43.0%). Patients with severe COVID-19 admitted to an intensive care unit (ICU) had a more severe hepatic disfunction compared to patients with the milder disease. The prevalence of elevated hepatic transaminase plasma levels in patients with COVID-19, which are particularly high in severe cases, reached 53% in survivors [5, 6] and 78% in the deceased [5]. Elevated serum levels of aspartate transaminase (AST) were observed in almost 18% of patients with mild COVID-19 and 56% of patients with severe disease; elevated levels of alanine aminotransferase (ALT) were found in almost 20% of patients with mild COVID-19 and 28% of patients with the severe disease. Elevated levels of cholestatic enzymes, alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT), were observed in 6.1 and 21.1% of patients with COVID-19, respectively [7].
Elevated levels of transaminases and bilirubin and the reduced albumin concentration in patients with COVID-19 correlate with the length of hospital stay, risk of admission to ICU and 30-day mortality. In the majority of patients, transaminase levels are back to normal after recovery. The patients with persistently elevated transaminase levels are severely ill or have a chronic liver disease (CLD). Elevated levels of GGT and ALP in patients with COVID-19 are indicative of damage to the bile duct cells in the liver. Liver injury could be secondary to the bile duct cell damage, since there are no viral inclusions in the biopsy specimens taken from some patients, and the pathological changes manifest themselves in the form of microvascular steatosis and moderate lobular and portal inflammation. Furthermore, the extent of liver injury positively correlates with the infection severity [8].
According to systematic review with meta-analysis of 11 studies (793 patients), abnormally low serum albumin levels were found in 79% (40–99%) of patients [9]. When performing meta-analysis, only the baseline laboratory data obtained at admission were taken into account.
In general, hepatic dysfunction is typical for 76.3% of patients, and liver injury is typical for 21.5% of patients [10].
Mechanisms underlying liver damage in COVID-19
Pathogenesis of liver injury caused by COVID-19 have not been properly clarified, since the available data are scarce and contradictory. The mechanisms of hepatocellular injury are multifactorial and include direct viral damage, immunemediated injury, hypoxia-ischemia, thrombosis, and druginduced hepatotoxicity [8, 10].
Direct viral damage to the liver
Infection of hepatocytes with SARS-CoV-2, mediated by the ACE2 cellular receptor, results in the acute cytopathic liver injury and is associated with the high mortality [3]. Foci of periportal and centrilobular necrosis without significant inflammation are reported [11].
In addition to hepatocellular pattern of the liver enzyme level elevation, COVID-19-associated liver injury can manifest itself in the form of cholestatic pattern. ACE2 expression on the biliary epithelial cells results in the direct viral infection. Swelling of endothelium of the hepatic artery branches in the portal tract together with luminal narrowing are observed, endophlebitis of the portal vein, endotheliitis, and blood clots in the branches of the portal vein emerge [12].
ACE2 expression on the majority of cholangiocytes (59.7% of cells) and a relatively weak expression on hepatocytes (2.6%; the average expression levels are 20 times lower than in cholangiocytes) suggest that SARS-CoV-2 contributes to liver injury, causing cholangiocyte dysfunction. SARS-CoV-2 infection decreased cell-cell tight junction between cholangiocytes and reduces their barrier function. Assessment of liver biopsy specimens in fatal cases has revealed coronavirus in the cytoplasm of hepatocytes. Considerable hepatocyte apoptosis in combination with the presence of the CD4 and CD8 T cells in the lobular and portal tracts is indicative of the direct liver infection with SARS-CoV-2. These data demonstrate the SARS-CoV-2 ability to infect hepatocytes, despite low ACE2 expression [10].
Immune-mediated liver injury
In the course of the SARS-CoV-2 infection, 80% of immune cells entering liver are represented by CD8 T cells. CD4 T cell infiltration correlates with B cell activation, and the levels of neutralizing antibodies against SARS-CoV-2 and proinflammatory cytokines (IL1β, IL6 and TNFα), as well as the SARS-CoV-2 hepatic clearance [8]. IL6 is a factor of acute liver injury in patients with COVID-19, which induces liver sinusoidal endotheliopathy with neutrophil infiltration and a hypercoagulable phenotype [13]. The hypercoagulable and inflammatory phenotypes of the liver sinusoidal endothelial cells are considered the marker of endothelial damage and mortality predictor in patients with liver cirrhosis and COVID-19 [14].
Sudden deterioration of liver function at the advanced stage of the disease is associated with systemic inflammatory response, which can damage multiple organs, including liver. Moreover, patients with lymphocytopenia more often suffer from liver dysfunction [15]. Inflammatory changes, such as hepatocyte swelling and steatosis, liver sinus cell proliferation, Kupffer cell hyperplasia, and immune cell infiltration are found in liver cells of patients with severe COVID-19 [16].
Post-mortem examination of some patients with COVID-19 revealed cholestatic features, such as bile duct proliferation, portal inflammatory infiltrates, and, in a number of cases, canalicular/ ductular bile plugs [17]. Cytokine storm typical for the SARSCoV-2-associated viral sepsis could be the main contributing factor, since inflammatory cytokines IL6, TNFα and IL1β could cause hepatocellular cholestasis. Persistent systemic IL6 signaling induced by the SARS-CoV-2 infection inhibits albumin synthesis. Hypoalbuminemia associated with the cytokine storm and cholestasis resulting from inhibition of hepatobiliary excretion could be considered part of the COVID-19 acute phase. IL6 provides strong mitogenic stimulation of cholangiocytes, which induce proliferative and pro-inflammatory phenotypes [4].
In those infected with SARS-CoV-2, elevated C-reactive protein (CRP) levels and lymphopenia are considered independent risk factors for liver injury [18]. Taking into account the fact that histopathological examination has revealed no signs of severe inflammatory liver injury [19], alterations in the levels of hepatic enzymes in patients with SARS-CoV-2 could be due to hepatitis being the secondary response to the SARSCoV-2-induced systemic inflammation [10].
Hypoxic hepatitis
Hepatic sinus endothelial cells contribute to perfusion disorders, responding to inflammatory signals. Ischemia–reperfusion injury in the liver could result in inflammation due to activation of Kupffer cells, neutrophils, and platelets. In the conditions of ischemia and hypoxia, inhibition of the cell survival signaling pathway in hepatocytes results in hepatocyte necrosis. In patients with ARDS, hypoxia induces oxidative stress, persistent elevation of the levels of reactive oxygen species, and secretion of proinflammatory substances that cause hepatocyte damage and necrosis [8].
Hypoxia is a typical sign of severe COVID-19 and the main regulator of hepatocellular ACE2 expression. This may explain the fact that extrapulmonary dissemination of SARS-CoV-2 is observed mainly in patients with ARDS and other hypoxic conditions. Gene expression analysis has shown that primary hepatocytes infected with SARS-CoV-2 are characterized by overexpression of pro-inflammatory cytokines together with inhibition of key metabolic processes. These data illustrate the comprehensive nature of liver injury in patients with COVID-19 and the mutual influence of multiple SARS-CoV-2-activated molecular pathways involved. Biliary ducts of patients with COVID-19 are subject to hypoxia due to respiratory failure (exacerbated by the peribiliary arterial plexus obliteration resulting from vasculitis/thrombogenesis). Thus, poor blood circulation and hypoxia, as well as continuous inflammatory stimulation, are the main triggers of damage to the bile duct epithelium in patients with severe COVID-19 [4].
Coagulation and thrombosis
Elevated levels of hypercoagulability markers, D-dimer, fibrinogen and factor FVIII, were found in 100, 74 and 100% of patients with the extremely severe COVID-19. Microvascular thrombosis may result in the end-stage liver disease. Autopsy has revealed infiltration of lymphocytes and monocytes in the portal area with sinus thrombosis and congestion; hepatocyte degeneration and lobular necrosis have been found in the liver [16]. These data show that in patients with COVID-19 hypercoagulation is one of the causes of liver damage. Coronavirus therapy-induced hepatotoxicity
Drug-induced liver injury results in varying degree liver damage, observed in patients with COVID-19. Antiviral drugs (oseltamivir, abidor, lopinavir, and ritonavir), antibiotics, steroids and hormones which have side effects, including liver damage, are widely used in treatment of COVID-19. In particular, the use of lopinavir/ritonavir increases the likelyhood of liver injury by 4 times. Liver metabolizes the majority of drugs for SARS-CoV-2. Elevated levels of ALT, ALP, bilirubin, and GGT, were observed in individuals infected with SARS-CoV-2, who were treated with lopinavir, ritonavir, and remdesivir [20].
Liver damage was more likely in patients who received medications of several types, and high-dose hormones. Liver injury disrupts metabolism and drug excretion and increases the antiviral drug toxicity. That is why great importance should be attached to the liver function monitoring, although in the majority of COVID-19 cases mild liver injury is observed, which is of a temporary nature and returns to normal without any specific treatment. Patients with severe liver injury need targeted hepatoprotective therapy. Treatment of the COVID-19-associated liver damage is based on inhibition of inflammation and correction of hypoxemia aimed at preventing the multiple organ dysfunction syndrome, as well as on one or two hepatoprotective drugs depending on the patient's liver dysfunction [15].
Hepatotoxic therapeutic agents include antiviral drugs that target the virus itself (remdesivir), IL6 and its effector signaling pathways (tocilizumab and baricitinib), and systemic inflammation (dexamethasone) together with antibiotics and steroids.
The randomized clinical trials have shown that the combination of remdesivir, the antiviral drug used in treatment of SARS-CoV-2 infection, with baricitinib, the JAK protein kinase inhibitor, improve the COVID-19 outcomes compared with the use of remdesivir only [21].
Coformulated drug lopinavir/ritonavir can cause liver necrosis and suppress hepatocyte proliferation. The drug induces inflammation and exacerbates liver injury due to increased oxidative stress. Lopinavir/ritonavir administration results in 7-fold increase in the hepatic enzyme levels [20].
Dexamethasone reduces the levels of biomarkers of endothelial damage (angiopoietin-2, intercellular adhesion molecules ICAM-1 and sRAGE) and inflammation (CRP) [22].
The use of endogenous cytokines, interferons, released by cells in response to viral infection (including SARS-CoV-2), in treatment of COVID-19 in order to inhibit replication of the pathogen resulted in leukopenia, lymphopenia, hepatocyte injury, autoimmune hepatitis, and other severe side effects [8].
Baricitinib, the JAK-STAT signaling pathway inhibitor, affects hyperinflammatory status arising from the SARS-CoV-2 infection, and is capable of preventing endocytosis and viral infection. However, the drug increases the risk of thrombosis and leads to liver injury. The increasing number of the reported cases of liver damage, cholestasis and hepatitis developing in the considerable number of patients who received JAK inhibitors to treat COVID-19, attracts attention [23].
Tocilizumab, anti-IL-6 receptor monoclonal antibody, is used as part of combination therapy in severe COVID-19 cases. Tocilizumab therapy must be discontinued if the levels of hepatic enzymes exceed the upper limit of normal more than three times [8].
These data indicate that it is necessary to regularly monitor the hepatic enzyme levels during treatment of patients with COVID-19 in order to minimize the risk of complications [24].
Taking into account the increased risk of death from COVID-19 in patients with CLD, European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD), and Belgian Liver and Intestine Advisory Committee (BeLIAC) have recommended to give priority to vaccination against COVID-19 to patients with CLD and liver transplant recipients [25].
COVID-19-associated liver damage in patients with no concomitant chronic liver disease
Liver injury (predominantly hepatocellular rather than cholestatic) observed at admission correlates with clinical outcomes (ICU admission, mechanical ventilation, death). Patients having normal AST levels at admission and patients with abnormal levels of AST, ALT and ALP at peak hospitalization are at higher risk of mechanical ventilation [26]. Analysis of biopsy specimens has shown that the coronavirus-induced liver damage is the main cause of liver dysfunction in COVID-19 patients with no CLD. SARS-CoV-2 causes hepatic cytopathy with massive apoptosis and the presence of binuclear (less mature) hepatocytes being the predominant histological features [18, 27].
Among 900 COVID-19 patients, 28% had elevated levels of at least one hepatic enzyme [24]. Liver examination in patients with COVID-19 revealed endotheliitis [28] and fibrin microthrombi in hepatic sinusoids [29]. Liver study performed during autopsy revealed the dilated portal vein and the increased number of the portal vein branches, partial thrombosis or complete obstruction of the portal and sinusoidal vessels, portal tract fibrosis, and microthrombi in hepatic sinusoids. None of these patients had CLD before or at admission to hospital. All liver specimens showed minimum signs of inflammation. Histopathological findings indicate a secondary nature of intrahepatic vasculature abnormalities to systemic changes caused by the virus [30].
Microvesicular steatosis is considered the main COVID19-associated hepatocellular alteration. However, signs of liver damage, such as ground glass hepatocytes, fibrin aggregates in the sinusoidal lumen, sinusoidal dilatation and hepatocyte atrophy, dilated Disse spaces, and intrasinusoidal deposition of fibrin and red blood cells are also found in patients with no steatosis. Sinusoidal dilatation and Kupffer cell activation are the signs of thrombotic sinusoiditis. Intrahepatic vasculature abnormalities, including sinusoidal microthrombi, were found in the liver of 15% of patients who died from COVID-19: this was a marker of liver desease caused by SARS-CoV-2. A body of observations allows us to consider severe thrombotic sinusoiditis as a negative prognostic factor in patients with COVID-19 [17]. Liver injury can be also associated with the interaction between the intrahepatic cytotoxic T cells and Kupffer cells. Hypoxia and shock can cause ARDS, hypoxia/reperfusion-induced dysfunction, and hepatic ishemia. Indirect damage to the liver sinusoidal endothelium could result from systemic inflammation or iatrogenic causes (mechanic ventilation) [4].
Autopsy of the deceased COVID-19 patients' liver also revealed portal fibrosis accompanied by considerable pericyte activation. Liver autopsy performed in patients with COVID-19 revealed SARS-CoV-2 RNA in blood vessel lumens and endothelial cells of portal veins [30]. Inflammation mediated by endothelium is a possible mechanism of sustained liver injury, since endotheliopathy persists in patients with long COVID-19 [31].
Micro- and macrovesicular steatosis was observed when performing liver autopsy in patients with COVID-19, for whom SARS-CoV-2 infection was the only factor of liver damage. Microvesicular steatosis usually results from the genetic or acquired disorders of mitochondrial β-oxidation. In patients with COVID-19, SARS-CoV-2 affects mitochondrial activity and causes mitochondrial cristae abnormalities, thus worsening the liver metabolic status [18].
COVID-19-associated ARDS could be accompanied by the right ventricular dysfunction resulting in congestive hepatopathy due to elevated central venous pressure. In cases of sustained hemodynamic and/or respiratory failure hypoxia leads to hepatocyte death, defined as the centrilobular necrosis when performing histopatological examination. Furthermore, acute right-sided heart failure and the resulting hepatic congestion in patients with COVID-19 could be caused by hypercoagulation [4]. However, in the majority of cases, SARS-CoV-2-associated liver injury was mild and failed to meet the diagnostic criteria for hypoxic hepatitis even in patients admitted to ICU [7].
Coagulopathy characterized by elevated levels of D-dimer and fibrinogen is one of the features of COVID-19. Elevated levels of D-dimer are associated with severe COVID-19 and high mortality. High levels of D-dimer were found in almost all patients (96%) who died from severe COVID-19; elevated ALT levels were found in the majority of patients (62%), which pointed to the link between liver injury, hepatic vein thrombosis and coagulopathy. None of the patients had a history of CLD or portal hypertension [30]. Autopsy revealed the platelet-fibrin microthrombi in hepatic sinusoids and platelet aggregation in the portal vein in at least 50% of patients [30, 32].
In 86% of cases, autopsy of patients who died from severe COVID-19-associated pneumonia revealed moderate centrilobular necrosis associated with minimum portal or lobular inflammation; steatosis and cholestasis were found in 57% of cases, and in 36% of cases discrete proliferation of bile ducts was observed. Although most of patients were treated with drugs having low hepatotoxicity, hypoxia resulting from severe lung injury could reduce the tolerance of hepatocytes to toxic damage. The combination of hypoxia caused by severe pneumonia and drug toxicity was the most likely cause of liver injury in the deceased patients with COVID-19 [19].
The correlation between liver injury and COVID-19 severity has been confirmed [33]. Abnormal liver function test results at admission to hospital increase the risk of severe COVID-19associated pneumonia [20]. The COVID-19 severity correlates with the AST and ALT levels, particularly in patients admitted to ICU [24]. In patients admitted with liver diseases, the risk of death correlates with the grade of liver damage: the risk is 1.4 times higher in patients with grade I liver injury, and 2.8 times higher in patients with grade II liver damage [34]. Thus, liver damage is an independent prognostic factor of mortality in patients infected with SARS-CoV-2.
COVID-19 in patients with concomitant liver disease
According to meta-analysis of epidemiological studies, the overall prevalence of CLD in patients with COVID-19 is 3%. SARS-CoV2 infection in patients with CLD is associated with higher mortality compared to other etiologies [13]. In case of liver disease diagnosed before the COVID-19 infection, coronavirus affects the emergence, severity, prognosis of COVID-19, as well as the treatment success [8]. Individuals with CLD are more likely to be infected with SARS-CoV-2 due to weak immune response. Half of the patients with abnormal liver function test results have CLD, including non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, and chronic hepatitis B [20]. NAFLD is the most common dysmetabolic liver disease in the world being an independent risk factor of the COVID-19 progression (OR 6.4). The disorder is associated with the higher risk of liver dysfunction and the longer viral clearance period. Moreover, it increases the risk of severe COVID-19 progression related to metabolic dysfunction [35].
The study of patients within the Yale-New Haven Health System (USA) confirmed that the patients with abnormal liver tests were at high risk of severe disease. Liver injury was predominantly hepatocellular rather than cholestatic. In these patients, liver abnormalities increased at peak hospitalization. Multivariate analysis made it possible to reveal the relationship between the liver function indicators and clinical outcomes (admission to ICU, mechanical ventilation, and death) [26]. In COVID-19 with elevated serum transaminase levels, it is necessary to take into account the SARS-CoV-2-associated reactivation of the existing liver diseases, including autoimmune disorders.
Pro-inflammatory environment occurring in patients with hepatocellular and cholangiocellular COVID-19-associated injury contributes to activation of hepatic stellate cells, and, as a result, to fibrosis induction in patients with CLD [4]. Activation and proliferation of Kupffer cells resulting from systemic inflammation are often observed, particularly in the liver specimens obtained from the deceased patients with COVID-19 [8].
Chronic liver damage determines immunosuppression, which signficantly increases patient mortality, as it has been shown in the observational study of 17,425,445 patients with COVID-19 [36].
Patients with liver cancer are also at high risk of coronavirus infection, especially those undergoing chemotherapy or immunotherapy in the hospital [37]. Cancer patients infected with SARS-CoV-2 have a poorer prognosis compared to COVID-19 patients having no cancer; in such patients, mortality reaches 20% [38].
The risk of infection and severe course of COVID-19 during the perioperative and the early post-transplant period is higher because of the high levels of immunosuppression [39]. At the same time, hyperactive response of innate immunity can cause liver damage and multiple organ failure; immunosuppression reduces the risk of hyperinflammation and cytokine storm in the liver transplant recipients [15].
The registry of patients with COVID-19 and CLD contains the data of 1588 patients with CLD and no cirrhosis, 772 patients with cirrhosis, and 280 liver transplant recipients [40]. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, while 21% of them had no respiratory symptoms. In patients with acutely decompensated liver disease, mortality is two times higher than in patients with compensated cirrhosis (44% vs. 22%; p < 0.001) [41].
Pathogenic gut–liver axis in COVID–19
Since the beginning of the pandemic, gastrointestinal (GI) symptoms were reported as the distinctive features of COVID-19 along with the respiratory and hepatic symptoms. According to meta-analysis of 60 studies involving 4,243 patients with COVID-19, the prevalence of GI symptoms is 17.6% [42]. GI symptoms can appear before or even in the absence of respiratory symptoms [43].
SARS-CoV-2 identification in fecal samples and the combination of GI and liver symptoms are indicative of the gut–liver axis dysregulation in these patients. High expression of ACE2 receptor in the gastrointestinal epithelium (100 times higher than on hepatocytes) allows SARS-CoV2 to enter the cells of biliary ducts and suppress liver function [8]. The COVID-19induced bowel infection can disrupt the intestinal epithelial barrier and gut vascular barrier leading to the viral translocation into liver through the portal vein. Subsequently, SARS-CoV-2 virions released by the infected hepatocytes, enter the bile [44]. Biliary tract provides the direct link between the liver and the gut, that is why SARS-CoV-2 can reach the gut and infect the gut through bile, causing reinfection. Thus, the prospective hepatobiliary mechanism can create a vicious cycle explaining the worst outcome in patients with the symptoms of liver disease and GI symptoms [4, 45].
When comparing the deceased patients with the critically ill survivors, immunomodulatory and tissue proteins associated with the COVID-19 survival were identified in blood plasma [46]. Comparison of the organ-specific "death signitures" revealed the significant correlation between the liver signature and the levels of ALT and AST. Proteins associated with the COVID-19 severity included THBS2 (thrombospondin 2), ACTA2 (actin alpha 2), HGF (hepatocyte growth factor), PDGFRA (platelet-derived growth factor receptor А) of Kupffer cells, TACSTD2 (tumor-associated calcium signal transducer 2) of cholangiocytes, CA2 (carbonic anhydrase 2), and BLVRB (biliverdin reductase B) of erythroid cells of the liver. Thus, blood plasma proteome could be used as the liquid biopsy for studying the potential therapeutic targets, and the diagnosis and stratification of patients at high risk being the candidates for personalized therapy [46].
SARS-CoV-2 coronavirus mainly affects respiratory tract. However, it shows tropism to the liver and bile ducts. That is why hepatologists are increasingly involved in combating the novel coronavirus infection. Medical practitioners predict the increasing prevalence of liver diseases in the months and years ahead, since SARS-CoV-2 is capable of directly infecting and causing damage to the liver tissue.
The course and outcome of COVID-19 depend largely on the patient's health and concomitant diseases. NAFLD, hepatitis B and C, liver cirrhosis, hepatic cancer, and taking immunosuppressants after the liver transplant result in immunodeficiency. Complications occur earlier and to a greater extent in patients with systemic immunodeficiency.
With the spread of the pandemic and publishing the new data on the effects of coronaviruses on the infected body it has become possible to define the risk factors for hepatic complications in patients infected with SARS-CoV-2. Studying the clinical data of patients with COVID-19 and liver diseases is important for identification of hepatic complications, prediction of the response to treatment, creation of the hepatic complication risk models, and development of the guidelines for patients with liver diseases and coronavirus infection.
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REVIEW Liver damage in patients with COVID-19
Vologzhanin DA, Golota AS, Kamilova TA, Makarenko SV, Scherbak SG
Published in "Bulletin of RSMU" 1, 2022
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Vologzhanin DA, Golota AS, Kamilova TA, Makarenko SV, Scherbak SG. Liver damage in patients with COVID-19. Extreme Medicine. 2022; (1): 12–9. DOI: 10.47183/mes.2022.009
Vologzhanin, D. A., Golota, A. S., Kamilova, T. A., Makarenko, S. V. and Scherbak, S. G. (2022), "Liver damage in patients with COVID-19", Extreme Medicine, no. 1, p. 12–19. DOI: 10.47183/mes.2022.009
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Subject: In talk.c, what is a thumbnail?
In talk.c, what is a thumbnail?
thumbnail". I didn't know about anything but voice. What's a thumbnail?
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text:
Q: Save items to different childs in firebase How can I save data to different childs in a firebase?
I push items to a firebase using onclick function and if/else statements for creating different categories.

Example

Button1 click -> push data from inputform to child1 in firebase,

Button2 click -> push data from inputform to child2 in firebase....
Problem

The item is pushed to one child only (e.g. ref0).
Everytime I push further items into the firebase, there appended to the ref0 child and not assigned to a new child (e.g. ref1).
Unfortunately I can´t find specific information for solving this issue.
Would be great if you can support me.
Check my Code for more specific information.

//create firebase reference
var dbRef = new Firebase('https://firebaseurl.firebaseio.com/');
var ref0 = dbRef.child('ref0');
var ref1 = dbRef.child('ref1');
var ref2 = dbRef.child('ref2');
var ref3 = dbRef.child('ref3');

var showAllRefs = ref0, ref1, ref2, ref3;

//load all contacts (limited to last 5 items)
showAllRefs.limitToLast(5).on("child_added", function(snap) {
  snap.forEach(function(childSnapshot) {
  var key = childSnapshot.key();
  var childData = childSnapshot.val();

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  var card = document.createElement('div');
  card.setAttribute('class', 'linkprev');
  $('#content').prepend($(card));

  var cardtitle = document.createElement('div');
  cardtitle.setAttribute('class', 'cardtitle');
  cardtitle.innerHTML = childData;
  card.appendChild(cardtitle);
  });
  $(document).ready(function(){
  document.guteUrls.execute('linkprev');
});
});

//save contact
  //save in database contacts
  var elements = $('.f');
  //console.log(elements);

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  var buttonPressed = function( event ) {
    event.preventDefault();

    //url validation from inputfield using Regex
    var valpattern = new RegExp('^(http|https)://'+ // protocol
    '((([a-z\\d]([a-z\\d-]*[a-z\\d])*)\\.?)+[a-z]{2,}|'+ // domain name
    '((\\d{1,3}\\.){3}\\d{1,3}))'+ // OR ip (v4) address
    '(\\:\\d+)?(\\/[-a-z\\d%_.~+]*)*'+ // port and path
    '(\\?[;&a-z\\d%_.~+=-]*)?'+ // query string
    '(\\#[-a-z\\d_]*)?$','i'); // fragment locator
    var valselect = document.getElementById('url');
    var val = valpattern.test(valselect.value);

    //save in database to different childs on buttonclick
    if(val && document.querySelector(".f1")){ref0.push({name: document.querySelector('#url').value})
      contactForm.reset();}
    else if(val && document.querySelector(".g1")){ref1.push({name: document.querySelector('#url').value})
      contactForm.reset();}
    else if(val && document.querySelector(".h1")){ref2.push({name: document.querySelector('#url').value})
      contactForm.reset();}
    else if(val && document.querySelector(".i1")){ref3.push({name: document.querySelector('#url').value})
      contactForm.reset();}
    else {
    alert('Oops');}
};

for (var i = 0; i < elements.length; i++) {elements[i].addEventListener("click", buttonPressed, false);}

Thanks in advance

Ben

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text:
Hudlin Entertainment Forum
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General Discussion (Moderator: Marvelous) »
The Racial Politics of Regressive Storytelling
Author Topic: The Racial Politics of Regressive Storytelling (Read 8976 times)
Vic Vega
Honorary Wakandan
Re: The Racial Politics of Regressive Storytelling
Yet again D.C. walks back a commitment to youth and racial diversity to appease a bunch of 40 year old fanboys.
Ray Palmer hasn't had a solo title since the freaking early 90's.
This is so ill-concieved its embarassing.
They have no idea how to get new fans so they do stuff like this.
How much longer can they milk nostaligic 30-40 somethings?
I am pretty much the target market for this sort of thing but I just find it embarrassing.
I may drop DC books altogether.
They don't want people like me as fans.
KIP LEWIS
Something I've noticed about this "return to the silver age". Unlike the previous "next generation", the modern day versions aren't signicantly different than their Silver Age counterparts. Compared to the Golden Age, the revamps were more tangible. The Golden Age Atom was completely different than the Silver Age Atom, but the modern era Atom was basically the same character, power and costume. Or no one would ever confuse the Golden Age Flash for the Silver Age Flash, but visually Wally and Barry are interchangable. John Stewart, Kyle, and whatshisface are identical to Hal in power and sometimes in costume, but there is sufficient differences between Alan Scott and Hal.
Or think about Hawkman; while his storyline changes from the golden age to the silver age, visually he didn't change. Then the Modern Age Hawkman had a new costume, but the same storyline and ultimately DC ended up merging all versions of Hawkman into one.
But compare them to Blue Beetle, each version is radically different than the previous in costume and power; even though his title was canceled, the Modern Day Blue Beetle remains.
Or take a look at Marvel, most of their next gen versions of heroes end up with new costumes and names.
Perhaps rather than creating a new Atom who has the same powers and visually looks the same, they should have created a new Atom with new powers or at least a easily recongizable costume, so when anyone sees him, they know he's not Ray Palmer.
i know yall are talking DC but check this.....
Twitter Campaign Wants 'Community' Actor to Be First Non-White Spider-Man
Could the movies soon have the first African American Spider-Man?
If thousands of Twitter users get their way, the star of Sony's upcoming reboot of the franchise will be Donald Glover, best known from his role on NBC's "Community." This weekend the Twitter hashtag "donald4spiderman" became the #3 trending topic in the U.S., and the campaign is still gaining steam.
The origins of this latest attempt by social media users to influence casting decisions occurred last week. After surveying the five mostly unknown white actors said to be vying for the role, Marc Bernadin, a writer for the sci-fi site io9.com, called the choices "bland" and asked, "In this day and age, why does Spidey have to be a white guy?" In response, commenters threw out Donald Glover's name as a possible contender, and a Twitter campaign was born.
A unique aspect of this latest fan campaign is its wholehearted support by the subject in question. Glover seems to like the idea (though he makes it clear on his Twitter page that he's interested in auditioning, not just being handed the role without first having to prove his worthiness). While he had nothing to do with its inception, Glover himself has been promoting the campaign, instructing fans to tweet the #donald4spiderman hash tag at strategic times to keep it trending.
In years past, an Internet petition of this kind might not be given much credence, but given the overwhelming success of the recent social-media uprising to get Betty White a hosting gig on "Saturday Night Live," this could be Glover's ticket to director Marc Webb's tryout room. He and his fans will have to act fast, though: The Hollywood Reporter is already forecasting the five most likely contenders for the role, and Glover is not on the list
Glover, a comedian and former writer for "30 Rock," has starred in only one movie so far: "Mystery Team," a comedy he co-created with his sketch comedy team, Derrick Comedy, which came out in 2009.
One hurdle Glover's fans will have is in his presumed bankability as a movie star: "Mystery Team" brought in a meager $89.4 thousand in domestic box-office sales
You gots to have vision, Willie!
Wow...if that happened, 80% of current comic buyers would either, have heart attacks, stroke out or commit suicide. It would be like Scarlet Witch uttering "No More Geeks!"
M.A.X. Commander
Quote from: Cookiehead Jenkins - The Return on June 01, 2010, 06:18:24 pm
It would be like Scarlet Witch uttering "No More Geeks!"
Which would have a probability of a 99.9999999% chance of happening!
Rockscissorspaper
Quote from: KIP LEWIS on May 13, 2010, 02:05:21 pm
Asian? I thought he was Hispanic, but I admit, never really bothered with the dude knowing he was nothing but a place holder. Ray Palmer wasn't even dead; just on a sabbatical.
He was Korean.
HEY KIDS, (BUY MY) COMICS!! https://www.mythworldemedia.com/comics
DC COMICS SENIOR STORY EDITOR IAN SATTLER ON "GREEN, PINK, AND BLUE" HEROES
Regarding the recent death of minority characters like Ryan Choi:
It's so hard for me to be on the other side because it's not our intention. There is a reason behind it all. We don't see it that way and strive very hard to have a diverse DCU. I mean, we have green, pink and blue characters. We have the Great Ten out there and I have counter statistics, but I won't get into that. It's not how we perceived it. We get the same thing about how we treat our female characters. - as quoted in Newsarama, June 6.
Reginald Hudlin
Quote from: Kristopher on June 07, 2010, 07:31:46 am
I have heard the "green" argument from senior DC management before. It's so sad. At this point they are not capable of change. There's isn't a financial incentive to do so. Their job is to keep old IP alive until they make a movie or TV show out of it, and Hollywood will always reinforce racist presumptions of the audience desires.
I thought it was bizarre he gives the green argument then remembers the Big Ten. It's almost like, reflex comment then he remembers, I have a reargument for diversity.
Of course the Big Ten run the villain-hero route. Heroes when it suits the story, or villains when it suits a different story. They were introduced fighting GL and the rest.
Edit previous comment--that was supposed to say "real argument" not reargument. (Can't edit on my BlackBerry).
Yeah, I can see bizarre being the word here. It was like he went the "pink, green and blue" route then all of a sudden remembered the Great Ten. DC won't ever change. They figure, they've given us Mr. Terrific and that's enough. John Stewart fades back into the background and the Milestone Heroes would have been better off left in limbo until DMcD could have found a better home for them. Instead of Brightest Day they should have named it Whitest Day.

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Summary: This interview is of a Koli woman – Devyani Chanur. She lives in Khar Danda, buys fish at the Crawford market or Bhaucha Dhakka jetty and sells at the Kalina market. That makes her daily routine something like this – get up at 4am and travel 25 km to the wholesale market, buy fish and travel again the same distance to the retail market to sell till 12 noon, go home again by traveling in public transport to attend to household chores and have lunch, then back again at the retail market at 6 in the evening and work till 9.30pm. Her daily routine compliments that of the wholesale sellers. We have documented the daily cycle of the fisher women in wholesale market in the events titled 'Koli Women: Livelihood Practice 1 & 2' on the same site. Seen and read together these three events will make a complete picture of the work pattern of the Koli women.
Devyani Laxman Chamur is a typical Koli woman – confident, articulate, independent. Years of self-reliance and experience of dealing with the outside world have made these fisher women distinct and distinguished. The élan and the precision in their gait, attires, language is a race characteristic. In that sense the articulation and the communicative skill that Devyani displays in this interview is not a matter of the personality of an individual. The division of labour in Koli community goes like this: for the affluent men go to the deep sea for fishing and women sell the fish in wholesale markets. In case of a poorer family, men work as wagers in other people's boats and women buy fish in the wholesale market and sell it in the retail market. Devyani falls in the second category.
Before the colonial rulers decided to make Bombay a city and an international port, it was a cluster of islands. Some islands were fishing hamlets and some others were not populated. The three centuries of urbanization has taken its toll and the originals today find themselves at the fringe of development.
Renu(R): Maushi, tell us your name.
R: Where are you from?
R: And where do you go to sell your fish?
DC: We go to Kalina market to sell fish. We get up at 5.am, go to Crawford market, Bhaucha Dhakka, and buy fish from there to sell here. We do not have a boat to call our own. So, we bring that fish and we sell it in the market here.
We sell that fish, but now there such an injustice being done to us, that we are unable to do business because of the vendors. We have been in this line of work for over 40 years and our parents have been doing it since even before that. We are citizens of Mumbai. We don't have a village or a native place (desh). Mumbai only is our village. Our parents were from here itself. So were our forefathers. Our maher (maternal home/Girl's parents' home) is also from here; what do you call it, 'maher' only, correct?
Our maher is here, so are the in-laws. Now we have daughters. Even the daughters have their maher and in-laws from here.
There is no one in our family who is from outside Mumbai.
All our affiars are based here and our traditions, from earlier. Our native place is here for 200 years.
Fish is a metaphor for the culinary culture of Maharshtra. The fisher folks call themselves 'children of the sea'. But fishing is also a livelihood. First came migrants from other parts of Maharshtra and took a bite of the market. Then came the male migrants from other states and took over a larger share of the market. Can any citizen be stopped from choosing any livelihood practice? Can a hereditary vocation be protected by stopping other people from getting in? The Koli people do the business legally and with dignity – sitting in formal market. Whereas the migrants carry their wares from door to door. It is also part of the era of service industry where home delivery is preferred than a trip to the bazaar. Bazaars belong to the era of neighbourhood. The atomization of people in big cities encourage either shopping malls or home delivery. Human interactions of Bazaars are passé.
R: These traditions that you speak of, why do you find it being threatened? What happened?
DC: See..We do this line of work. We pick up goods worth Rs.5000-10000. 4 crates- 5 crates.
They graduated, 15th, 12th or 10th standard. But they have no jobs.
So that house and its responsibilities have now fallen to us.
If we are unable to earn a living, then it's like an injustice being done to us. Our children do not have jobs. There are no jobs, despite being so educated. They are not working anywhere. So this is the situation we are currently in. It wasn't like this before. In olden times, of our parents, in-laws, and their in-laws in turn, there was no such causes to worry.
At that time, we'd get our 2-paise, our children would eat happily and our family would live happily.
That is not the situation we're in now.
DC: 8 times, 7 days, 6 days… now when we sell the whole lot, we get nothing in hand.
DC: People came from outer states, some Marathi women, some people came from the Ghats (people from the Sahaydri hill range). They picked up baskets and went to the bazaar, bought from the bazaar and roamed from door to door. They are able to do business. And we were left sitting in the bazaar itself.
Devyani understands the electoral politics very well – the politics which thrives on nurturing a problem than resolving it. But since she does not know how to counter the politicians she too falls for the argument of ethnicity. A economic issue inevitably becomes an ethnic issue and a fodder for electoral politics. In this context her natural pride in the culture of her community and her legitimate claim over the land appear pathetic and mean.
R: Women come from the Ghats too?
DC: Yes, they all come.
You can see them. In trains, on the roads, wearing the sari in whatever style, be it castipatal or wrapped around.
We are Koli and we dress this way, and this is the Koli way. The rest are not Koli. Nowadays, everyone has become Koli folk, including the Bhaiyyas.
But that is not Koli, Only we are Mumbai's original Koli citizens.
And Mumbai belonged to us Koli folks.
But now it no longer belongs to us. Such is the extent of the injustice on us.
DC:... There are quite a few Kolis in that group. They now make speeches; those big people are all from our fold.
But now what has happened is, if you go to the municipality, Biharis and Bhaiyyas are there.
There are Bhaiyyas in the Railways. A Master, or anyone in an important post, is a Bhaiyya.
These Bhaiyyas have pulled their own people up.
First, one bhaiyya came and brought 5 other Bhaiyyas. Now, those 5 Bhaiyyas went and brought 25 Bhaiyyas back with them.
25 Bhaiyyas went and brought back 200 more. This is how they have spoilt Mumbai.
R: Now you said that even the women from the Ghats have come.
DC: All those women from the Ghats who were selling onions and potatoes before, have now started selling fish.
DC: Lots…. what I mean is…. not in this area, but in Goregaon, Malad, Kandivali, Borivali, and Jogeshwari…that's where you will find more of these women present.
What I mean is, those people saw some profit in this fish trade, and as for the customer, if the fish is available at your door… your household chores get reduced and your market place comes at your doorstep. Then there is no need to go to the market. That's why we have no customer in the market.
The areas she mentions are the newly developed suburbs in the northern end of the city. The migrants have chosen those new areas to operate from.
Devyani, like any other person with a life well lived talks about the olden days, the shifting sand of development as a personal story. Her narrative style is that of a person in public life, her memories are not exclusively domestic – she is a professional. Her work is her identity.
DC: The women are there, but the Bhaiyyas are in larger numbers. What I mean to say is, there are thousands of Bhaiyyas who have come in. If the number of Bhaiyyas reduce just that little bit, then we will get some sort of return on our business.
There are way too many Bhaiyyas that have come in.
D: Meaning much more of them have come in, they have increased in numbers.
DC: If we go at 5 am early morning, then they're there sitting since 3 am to buy fish.
DC: And then, at dawn...in the morning the milkman comes Or the bread Walla, and right after him comes a Bhaiyya.
We sit in the bazaar after 9am. But by then your shopping is already done!
Where will our customers come from then?
R: Earlier, you were saying something about the Kalina market?
DC: Kalina market was earlier situated up ahead. You know the police chowkie? It was there. So from that market... it was a good marketplace. Our business was going well there. Customers from the Air India colony were nearby. The bazaar was directly off the road. It wasn't such a large market, it was a smaller one. It was open and airy. The customers could see the fish by just passing by outside. We could sit at the side and right in front was the road. If we looked from there, we'd get customers.
So, the municipality people, the BMC (Bombay municipal corporation) officials, moved us here as this is their land. They moved us there, and hence we are now here. And after coming here, this is the second market they have built.
The first market that they made, they kept us there, but then they demolished it and made a new market. Even that new one has not been made recently, it's been about 10-12 years .In my lifetime, I have seen these three markets.
But before me, my mother-in-law, father in-law or my mother. How many markets they must have seen?
DC: I started coming to the market from the age of 14. There was no such thing as education, no one was studying. Now education is given importance. Now we educate our children in schools. Earlier, our parents didn't give it that much importance, so we weren't educated, not that much. We studied, but just a little. Hence, at the age of 13 or 14, I came to the market. I got married at the age of 16. After marriage, I now have 4 children.
I got those 4 children married, and I now have 5 grandchildren. I have now spent over 40 ...38 years of my life have gone in this market.
R: You were saying, your children have been brought up well; educated too but they don't have jobs. What is the reason for that? What do you feel about that?
DC: I feel that they should get a job somewhere at least.
R: Why don't they get jobs?
DC: They refuse to give us jobs. They say we are Kolis. We are Kolis from here, and those that come from outside, they give them jobs. We don't have jobs, Ma'am.You go anywhere and see. Do our Koli folks have jobs anywhere?
DC: You don't find this Mahadev Koli Certificate anywhere.
So what should we do now, you only tell us.
What could this history be called – subaltern? Or working class? Indigenous people? 40 years of working within formal structure and yet afraid of starvation! She talks about her children and grandchildren and markets in the same breath. She is another version of Mother India.
In independent India there has been an elaborate system of facilitating the people from marginalized communities – it is called caste reservation. Though conceived as a socialist measure, it has developed various loopholes at the implementation stage. Specially the issue of identifying the deserving caste and people have always been much debated. Moreover it has created much scope for administrative corruption. The people here are talking about that problem as caste certificate.
D: Who do we call....?
R: Tell me one thing, as Mumbai expanded, your customers increased too. If you speak about outsiders in this manner, for example remove the Bhaiyyas ...but Mumbai has been built as a result of a lot of people coming together, no?
DC: Not many people, Mumbai first and foremost belongs to Kolis.
Dada: Before the Kolis can sell to their usual customers, these Bhaiyyas go and sell their wares to them, sell fish. Because of that, these people are left without customers. Once they get their fish, why would they bother. And not just one, there will be one Bhaiyya, then right after him another and a third... R: Tell me, you say that the women that come from the Ghats, the BMC has moved your marketplace, and so who do you think is truly responsible for your situation?
DC: BMC shifted the market meaning.... the market belongs to the BMC itself...no?
The market belongs to the municipality, not to us.
The market is not ours, it is the Municipality's and we pay daily rent. And since we sit there, it is our place.
Look here; if you go to some college somewhere to study, then that school becomes your school. Where do you go? To this school.... to this college.
The same way, where do you do business....? We do business in Kalina market.
There have been initiatives to evict the fish market as part of gentrification in certain areas in the city. These were sponsored by the wealthy Gujarati community who are fanatic vegetarian. Obviously the interviewer is trying to make Devyani speak about that. But she misses the point and insists on them being the ward or tenant of the BMC (Bombay municipal corporation).
DC: You understand the way I'm speaking?
DC: No, no... Nothing, nothing.
Now look, we sit in that market. We get facilities like water, electricity, sweepers, cleaners; they are all their employees.
R...what are those problems? This Bhaiyya issue is just 3-4 years old.
DC: Right from the start, ma'am, and say about 25-30 years, or rather 35 years ago....if some of these people had gotten jobs, no dada? If in the beginning itself, they had gotten those jobs.
And now after 25 years, everyone is still jobless.
Bring us a Mahadev Koli Certificate. We do not have any Mahadev Koli Certificate.
What they say is that Koli folk are moneyed people.
But what kind of wealthy people are we?
Whatever money we earn is from our own hard work. We did not rob anyone nor did we loot anyone.
They say that you Koli people are wealthy people.
But it is just our hard work.
If one of us has a boat at home; I don't have it personally, but if someone else has it, then in the morning at 7am to the bandar (jetty) to dry the fish...and come home at 6 in the evening. Sitting in the hot sun for the whole day, sweating it out, toiling, and earning some money by doing that.
But that money, you have no clue what I've done to earn it and what money that is. What is hard work? But no...Kolis are wealthy folk, that's all they think, but what kind of rich people are we? It comes from hard work.
This is the situation we're in since the past 25- 30 years.
Devyani suggests that if Koli people could be integrated in the mainstream by getting jobs the situation would have been better. But is that so? With the background of being the first generation to be schooled, they would have been at the lowest of social ladder. They would have lost their traditional livelihood and yet not earn substantial amount in the job market. This must be a romantic idea about the job market in the outside world. Devyani and her people are so threatened and scared that they cling on to any idea that comes their way as a possible solution to their problem. Gentrification, obviously, is one such idea.
First, 35 years ago, there were never so many legal formalities.
BMC never had any legalities or anything. Because of that, the people here… Dada, my elder brother, sister and some educated children have all stayed in those same jobs and that is all. And now in these times, in the past 25 years, there is nothing. All these kids have been educated ...if you see, we don't have any money, but we still educate our children.
Earlier, our father, he put us in a Marathi school, in a municipality run school. We learnt in a municipal school. I didn't study much, just till the 2nd Standard, but at that time… Now our daughters, they speak to their children in English and send them to English medium schools. So how will they manage things? But still somehow, we manage. We do something or the other, but we manage and we put our children through school. This is the situation we are in right now.
D: I alone am earning, and I put my kids through school, as my husband is jobless. He is at home only.
I go from here, sell fish and then come home, and then cook and then they eat. Again the cycle repeats from 5am and we return at 9 in the night. We get only three hours sleep and then we're back there at 5 am.
DC: It is very troublesome for us.
H: Who is responsible for you not getting a job?
R: She is asking, what is the reason for you not getting a job?
DC: You see, if we go to the BMC, they pay us no attention. If we go to Air India, they don't bother, if we go anywhere...to any bigger place, there no one pays any attention.
Now what should we do, you only tell me.
With urban developments and expansion of consumers' market traditional skills no more look like a viable qualification. Little bit of formal education may open up the door to the mainstream world. The fisherfolks long to become peons, doormen and Clarks. So they send their children to English Schools. English is no more a colonial legacy, it is the entry point to the global market. But when they would realize how fragile the job market is, possibly much more fragile than their present vocation, what will their reaction be?
DC: Why we are against Bhaiyyas, I'll tell you. The Bhaiyyas can do their business. You can sell milk, bananas, fruit anything. You do any sort of business. But you are not to sell fish.
DC: We are against that. We don't say 'no' to the Bhaiyyas being here. We don't say you leave Mumbai, don't work here. Work.... do what you want, just don't take our fish business and sell it door to door.
Hansa (in Hindi): But if the Govt is able to provide jobs for all of you, for you and for you...then there won't be any problem.
H: Bhaiyyas can also do that job.
DC: Yes, the Bhaiyyas can also do it.
H: Your kids can also do it, if they have jobs.
H: At first, what kinds of jobs were there?
If they got some odd job somewhere, they'd do it. But there was no fixed job.
DC: They call them for three months, four months.... then they send them back. So now they're at home.
Right now I have two children sitting at home. You tell me, at present I have two children at home. What do we do?
It is the poverty, loss of traditional livelihood, being ejected out in the process of urban development and also being ignored by the policy makers…. The problems keep mounting, yet only Bhaiyas can be countered on the face. Rest remains largely unaddressed. Unemployment, loss of livelihood etc. do not make news in this part of the world.
R: What jobs were your ancestors doing?
You know dried fish like bombil (Bombay duck), kardi, kolambi (prawns)? Drying those fish, we had dried ourselves out too. Then only that fish would dry. While drying the fish, if we'd put it in the morning, and go home in the evening, one of them would bring packed food for us. They'd come there while we were sitting in the sun, we'd dry up just like the fish.
D: Just see how many women work there.
DC: You can see our condition in Khar Danda.
If you want to know, what state we're in because of this fish business.....You come there in the morning, I'll show you everything. I'll let you shoot it properly. You can see the condition of our women there.
DC: Tell us what day, and I'll show you. Just come to Danda and see. You see the condition we are in, only then will you understand. If you run a boat, then there's no fish to catch, if you hire people, then there's no money to pay them with. Debt lies heavily on our heads, the price of diesel has increased, and hence we cannot afford to buy the fish anymore. That also increases the debt. How do we pay off our debts?
That is also there, no ma'am?
There is a grave injustice done on us from all four sides.
Now the time has come for us to starve.
D: How much we tried… pay this person money, he will get us jobs… we gave them fish, they said they'll get us jobs.
We've spent so much money, still nothing.
R: Have you had any losses due to the big trawlers?
DC: For the big trawlers, there were no loss before. But now there are losses even in that, why?? Because now if you see the big trawlers that have come from outside, they too give us a run for our money.
But this sea, it never belonged to anyone but us.
We Kolis are the children of the sea.
'Drying those fish, we had dried ourselves out too' – is an iconic statement of an indigenous woman. Each community whose livelihood depends on the nature's wealth across the globe would echo her concern. The nature has provided them with livelihood but it has also made them pay heavy price for it. In her magnificent articulation the fate of the fisherfolks appear like an epical tragedy. She makes a desperate plea to the outside world by inviting the shooting crew to her neighbourhood. Somewhere there is a faint hope that this exercise of documenting their crisis will bring some respite. There might also be a blurring of all upper class people into one single influential block - where the government, the political leaders, the documentary film crew look the same.
In recent years many multi-national companies have taken lease on the sea for big scale fishing. Though the permit to them not necessarily prevent the Koli people to do fishing, the powerful trawlers can chase the small fishing boats out of the fertile zones. ONGC is Oil & Natural Gas Commission. They have been excavating for oil in the Arabian sea. Their wells are marked as high security zones and the Koli boats are chased out of that area too. It is not a question of one problem or the other. The reality is that the traditional livelihood of fishing is getting erased under the pressure of urbanization and development. The Bhaiya phenomena in the retail market is sort of a last straw. Besides, Bhaiyas are individuals and thus they have faces. It is possible to resist them collectively. But the corporations are faceless giants. The Kolis have no idea how to resist them. Yet, the Govt. has no sustainable rehabilitation scheme for them.
R: Where do the outside trawlers come from?
DC: The ones that come from outside, they come for fisheries.
D: They don't give us pass.
We have several problems like this.
We have set up our family, raised our children, got them married, Let me tell you one thing - the children that these people have, What will they do?
D: That is the question I'm facing.
DC: Now I told you, didn't I? I have four children. Two boys and two girls. My four kids got married. I have 5 grandchildren.
R: When you were a child, you must have seen Danda village, Worli village (old fishing hamlets?
What changes have taken place now in those villages?
DC: A lot of change has taken place.
DC: About land, wait, let me tell you. This house is mine. Let me tell you about Dada. This house is mine, and I should build something, but I have no money. Suppose a builder comes, and we give him something. What does the builder say? Half for you and the other half for me.
However we choose to do it, or even if we choose to build it ourselves, the BMC people come and break it, they take money, they harass us, they don't let us build anything. So what do we do?
DC: Danda village was exactly like that.
We didn't have (cooking) gas connection. We used to be scared to light the gas. We used to be scared to light the stove in case we spilt kerosene.... and there would be a fire. If the gas leaked, there would be a fire. So we'd light a fire on logs of wood, cook food on that.
10 people, 12 people, 15 people.... 20 people.
We used to cook on that. By patting nonstop, we'd make bhakri (roti made of jawar grains). Our one bhakri is this big (motions), you won't be able to finish it. Such large rotis, even to this day we make them. We make them by patting them continuously. Now by using gas, etc, things have changed a bit.
Earlier it wasn't like that.
It is obvious that it is not the Koli who have priorities the issue of the Bhaiyas over the other problems. It is the electoral politics who have made this distinction. The Bhaiya issue involves people, voters – on both side of the Kolis and the Bhaiyas. So the political parties first instigate the Kolis to mobilize under their umbrella against the Bhaiyas which, in turn, ensures them about the Koli votes. As the Bhaiyas start feeling unsecured the political parties approach them with the promise of protection and thus collect the Bhaiya votes too. Obviously the Koli people know it all and still they cannot resist it.
R: Now you told us all this...tell me one thing, this movement against the Bhaiyyas. It is not one problem; there are a lot of problems. Then why only focus on this one problem.
DC: Why we are on this problem only is because if the Bhaiyyas are removed, then only can we progress a bit.
DC: What did they say earlier? If you sit in the market, we will give you a license. They said so earlier, didn't they? Now we've been doing this business for so many years and we don't have any license.
H: Do politicians say like this? That they will do this?
DC: They've said this now.
H: They had also said this in Dadar, for the onion and potato sellers; they promised to get them licenses. They say it but they don't do it.
D: The Onion/Potato vendors have licenses.
DC: First... don't speak in Hindi... The first time we protested was 6 months ago. At that time we were very vocal about it. We really protested strongly. We shut down the big market, wholesale market... Crawford market, Bhaucha Dhakka, Sasoon Dock, Malad, Bhayander, all these markets of ours; Dadar market.....fish market. We shut them all down. What happened was after a few days, voting took place.
Congress wanted the vote of the Bhaiyyas. We were unable to continue our protest.
H: Shivsena also did a similar meeting in Vakola with the Bhaiyyas promising that they would not harm them (Bhaiyas).
D: yes, So voting took place. So our protest got deflated. Otherwise something good would have come of it. Something or the other would have happened then.
DC: See, now what should one do?
Back to the issue of organised sector and unorganized sector. The mode of operandi for the Bhaiyas is very simple. They operate on minimum infrastructure – just a basket and enough money to buy fish at the wholesale market. They carry the modest ware on their heads and canvas door to door. As their expenses are little and they have no facility to store they sell at a comparatively cheap rate. For the customers Bhaiyas offer a lower price, fresh fish and a home delivery service. For the Koli women they are entangled in a complicated formal structure. They are part of the market and pay for the market infrastructure. They are traditionally skilled to do business from one spot in the market. They even inherit the spots from their ancestors. So the cost of the fish in the market goes higher than that of the Bhaiya vendors. As more and more people buy from the Bhaiyas the Koli women are forced to preserve their wares in ice, which too increases their expenses and reduces the quality of their wares. It is a vicious circle. It has the same pattern as the organised workshops and the unorganized sweatshops; as the factory workers and the wageworkers, the lease farmers and the landless farm hands. The conflicts between these two groups of people are carefully orchestrated and monitored by the people in power.
Yet in the middle of all these problems when our protagonist talks about her work place, Kalina market, her face lights up with obvious pride. This subtle diversions save her from the status of a pathetic victim. Her dignity and her pride make her an iconic citizen within the nation-state formation who foregrounds an argument and not only a plea.
H: See, now can't the situation be something like this, that the politicians in fact never say that they will do your work. They only say "Beat up the Bhaiyyas". By saying that, they don't have to do any hard work.
DC: They are men. We are women. Bhaiyas are strong and we are not. One push and we will fall down.
D: We are usually alone, so we are scared to say anything to them.
H: What I'm saying is, the politicians don't do your work.
H: It's easy for them to say, isn't it? Beat up the Bhaiyyas, do this, do that. But they should do their own work, no?
DC: So that's what we are saying now. Do something but solve this problem for us. Show us by doing something about it.
H: But what is the problem? Are Bhaiyyas the problem or is it something bigger?
D: No, it's a Bhaiyya problem.
H: What I'm saying is, you require protection for your boats from the Govt., ONGC should allow you into those waters… in that the Bhaiyya becomes a very small issue.
D: We don't have a problem with that, with the boats.
Just to get the form. Then they give a pass for 6 workers. So in that matter we have no problem.
H: Will targeting just Bhaiyyas solve anything?
DC: By just the Bhaiyyas leaving... when there were no Bhaiyyas, at that time everything was good, ma'am. Everything was peaceful. Everything. We could eat even a sparse meal peacefully, when the Bhaiyyas weren't there.
See this lot I have bought. It is worth 2000 rupees. I haven't even done business worth 200 rupees. 1800 rupees worth of goods are just sitting there. So we have to put ice. We put ice for 1 day, 2 days, 3 days.
How many days do we put ice?
Where do I get the money to pay my supplier?
When I finish my goods, I can pay the supplier. The supplier there says; give me my money. Where do I get the money from?
It never used to be like this before. None of this was there before.
Woman standing: When we would go to Grant Road Bazaar, on Wednesdays, Fridays, Saturdays and Sundays, we'd get so fed up to just get off and wait for customers. And now even on Sundays, the customers are so few, just one comes and another goes. So now even going on a Sunday seems like a waste. It's a huge problem for us.
They saw, they saw that day. On a Sunday in a market, there should be a rush. There should be so many customers. And our Kalina market, it is so neat and clean. Everyone would vouch for that. And now go to any other market and see.
The other markets are also nice. Bandra Market, Khar Market, there are a lot of markets. But they come nowhere close to our Kalina market. Even we have gone and seen ourselves many times. That is why we used to get lots of customers from Ghatkoper, Andheri, Kurla, Santacruz, Santacruz (W). We used to get customers from there. Now, they don't come.
By now the discussion has disintegrated into petty allegation – such as colouring the fish, using dirty water to wash them etc. But the fact is the Bhaiyas are migrant without any infrastructure, experience or good will. They only have their capacity and will to work hard and make it in this big city. They are young men without any tie ups in the city. They have just learnt the basics of the fish business and jumped on it. They have neither the traditional skill nor the sense of norms. They are the ruthless, desperate migrants. Whereas the Koli women are well settled, middle aged women. Their ties with the system of families, community, markets make them comparatively slow and static. They cannot work harder than they already do, nor can they gear up to desperation like the Bhaiyas. So they are loosing out. It is not only about organised sector and unorganized sector, but also between young footloose men and middle aged settled women.
DC: They get their fish at their doorstep. Whatever they want, they order on the phone.
Woman Standing: The Bhaiyyas even have mobile phones now.
D: We don't even have that.
Then who will come to the market? Customers don't come anymore, ma'am.
These are the kind of problems we're facing, lot of problems.
And now I've come here. And the fish is on ice.
Now what do we do, you only tell me. This is our state.
DC: By the kilo.....We buy by the kilo, and in that also, they doctor the scales.
Woman Standing: If you buy peas from a Bhaiyya, it will be 300 gms less than a kilo.
R: Tell me one thing, for the Bhaiyyas that have come, you've had this program you have organized, so you kept all the markets closed all across Maharashtra?
DC: There are so many women out there, don't you see? The entire market.
D: It was completely closed.
DC: All the way from Versova, Malad, and Goregaon; the womenfolk have all come.
D: Ghatkopar and also Goregaon. It's shut right from Turbhe.
R: And from outside Mumbai?
Poisar, Palghar, Dahanu etc. All of them.
R: The Bhaiyyas have landed up there also?
DC: If the fresh, wet fish sell less, they sell dried fish. If the dried fish sell less, they sell wet fish.
If they don't get big fish, they sell small ones. By hook or by crook, they manage to sell fish.
D: They come to sell onions, and they ask you. Do you want fish? Which one should I get it for you?
They ask us, sister why don't you come to the market?
If you see their fish closely and examine it. You will neither take it nor eat it.
You know the gutter water that flow through the drain? They wash it in that, keep it in their basket and they will bring it to you on their rounds.
We take our fish, buy ice and put ice worth about twenty to thirty rupees, or fifty rupees. We bring it to the market, wash it with clean water and place it on our boards, then pack that lot back into the ice.
While he brings you his lot after roaming continuously in the harsh sun with his basket on his head.
The Pomfret is not white enough, so he puts that in the fish, what do you call it.......?
DC: Gum... they put gum on the fish to make it look white.
DC: From inside, the pomfret is spoilt.
D: You should open the fish and see, the gills should be red.
DC: This is how it is. No, they put something on the red gills too.
R: But if everyone starts saying this, you can't take up our line of work. Vegetable vendors will say the same thing. You're saying don't get into our line of work.
DC: We are not against the Vegetable sellers.
R: No, I'm not saying that.
You're saying the Bhaiyyas can take up any line of work, just not ours.
R: If every person in Mumbai starts saying this, then how will Mumbai progress?
DC: Mumbai will progress. There are many people who are willing. In such a market, about 50-60 of us womenfolk sit. In the Grant Road market, close to about 1000- 2000 women sit. Grant Road market is so big. The largest market in Bombay is Grant Road.
I know this. There are 108 markets and out of those, Grant Road market is the biggest.
In our market, there are 50 of us. About 40- 50.
1000-2000 over there... There will always be business taking place, most definitely.
If I sit at home, I am now an old woman; and I can't manage because I have no strength; then my daughter will sit to work. If I don't have a daughter, then my daughter-in-law will sit. But we won't leave this line of work. I will keep the business running. That is our tradition. We are not one to shut our business and keep quiet. We will continue doing our business no matter what.
Woman standing: When my mother goes to sell fish, she buys 300-400 rupees worth of fish and sells fish only worth 10-20 rupees, and the rest is put in the freezer. If we are to bring the same fish back then how would this work? In the Sunday market, there is only one person coming and one person going. We are fed up.
DC: And Grant Road market opens at 5 am. Whether Hira Bai knows or not, but I will tell you. Our sisters, all our people go there, so I know.
Early morning at 5. So, at 6'o clock, after selling half her lot, that woman will go home. Then I go there with my lot. Then after that another woman will sit on that same spot. Once she finishes at about 11 or 12'o clock, then another woman comes. We're discussing the Grant road market, Dada (to somebody off frame).
At one spot, three or four women do business. That's how the market at Grant Road is.
D: Now even that market is nothing, it is finished.
DC: It is a very serious problem for us, a very serious one. What are we to do?
It is heartening to sea the woman's faith in her vocation. Fish business is like a faith for her. She talks about the magnificence of the Grant Road market with a kind of national pride. Though the younger women try to pitch in, they can never match the emotional texture of the old woman. She laments the death of scale, erosion of a dense culture and the resultant vulnerability. Whereas the younger women only complaints.


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With Cowboys' construction halfway done, Jones looks forward to future Frisco training camps
The Dallas Cowboys opened training camp with the high expectations that follow a division-winning year and active offseason, so July seems an odd time to be thinking about future camps.
But with what's going on in Frisco, Cowboys Chief Operating Officer Stephen Jones couldn't help himself.
"It's going to be very hard not to spend a majority of our time here," Jones said on Saturday as he joined community leaders in marking the halfway point of construction on the Dallas Cowboys headquarters and 12,000-foot indoor stadium-special events center the team will share with the city of Frisco and Frisco Independent School District.
Before speaking to journalists, Jones and others watched work on one of the 12 trusses that will span the 557,881-square-foot event center. Each truss spans approximately 400 feet and weighs 1,250 tons.
"It's going to be the finest high school stadium in the country, and I think it's going to be the finest professional football facility as well," Jones said.
The Cowboys left Valley Ranch this week to open camp in Oxnard, Calif. Next year when the team does that, it will be for the final time, Jones said.
By the time camp ends in California next year, the headquarters and new training facilities should be ready for the team's return to Texas, he said.
That doesn't mean the team's training camp travels will come to an end.
Jones still sees brand-building benefits of spending portions of training camp elsewhere such as Oxnard or San Antonio, but the Frisco facilities will be very conducive to training camp and the Dallas Cowboys will want to take advantage of the fan-connecting opportunities there, too, he said.
"There's a bunch of fans here in North Texas that don't make it to the games, and it's not economical for them," Jones said. "This will give them a chance to come out here and bring their families."
Opportunities for families will go beyond watching the Dallas Cowboys practice.
"The multi-use events center itself will be an unbelievable venue that will host many public events . . . creating unbelievable opportunities for our students, athletically and academically," Frisco Mayor Maher Maso said.
But those opportunities come with a dilemma for Frisco ISD Superintendent Jeremy Lyon: Which of Frisco's several high schools should get to host the first game?
Lyon's solution: "How about an all-day extravaganza where we have eight high school football teams in Frisco playing one another on that opening week?"
Jones said his family is excited about the way the new facilities, which include two outdoor fields as well as the one indoors, will bring Dallas Cowboys and high school players together.
"It really gives me goosebumps to think about what's going to happen when these kids are rubbing shoulders with the Dallas Cowboys when they come off the field and Tony Romo is walking on," Jones said.
Crews for Manhattan Construction Company broke ground on the projects in August 2014, and despite heavy rains this spring, the projects are still on schedule, Maso said.
As part of their partnership with the Dallas Cowboys, the city of Frisco and Frisco ISD are contributing $115 million toward the team's headquarters and the special events center. The team, which has a 25-year agreement to manage and operate the publicly-owned facilities, will cover whatever costs exceed that amount plus pay $100,000 annually to lease the facilities.
The Star in Frisco, as the new development is called, covers 91 acres, including 5 acres for the Cowboys headquarters, 20 for the special events center and the remainder for a mixed-use development. The $1 billion development at the northwest corner of Warren Parkway and the Dallas North Tollway will include a hotel as well as office, retail and restaurant space and is helping generate other activity in Frisco.
"The synergy surrounding this project is incredible," Maso said. "Since announcing our public-private partnership, development around this project has evolved into, what we're calling, Frisco's '$5 Billion Mile'."
© 2015 by Lisa Johnson. Proudly created by Comandante


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Arrow Season 4 Episode 12 Review: Unchained
Carissa Pavlica at February 3, 2016 10:13 pm . Updated at February 4, 2016 5:35 am .
That could have been much better.
From fan reactions online, I don't expect this to be the popular opinion. Which isn't a surprise. But as a storytelling device, Arrow Season 4 Episode 12 was all over the place.
It was an hour of moments rather than a truly good episode of television. And, yes, there were a lot of moments during "Unchained." Some of them very good, thankfully.
Arrow Photos from "Unchained"
Two characters returned to Star City, Curtis delivered a company saving technical feat for Palmer Tech, Felicity's father arrived in town via a villain of the week shtick and Thea is in a coma with a 3 on the Glasgow scale. Hint: That's not good.
But that's not even all the moments. Also thrown into the mix with very little fanfare? Ruve Adams (Mrs. Damien Darhk) tossed her hat into the ring for mayor. Katana was guarding the potion Nyssa brought to Star City to save Thea.
We learned Sara is whole, and I was right – Constantine could have cured Thea, but the dude left town without bothering. At least we know why Sara is so different over on DC's Legends of Tomorrow now.
Felicity was back at Palmer Tech, and even though Curtis came through with an amazing piece of technology, she was hardly confident. He essentially saved the company, but she felt less than in comparison to herself as OverWatch.
Holt had a pep talk for her that got her through, but after everything she went through with Goth Felicity, it seemed odd that her insecurity would have appeared at the office. She was never at a loss there before.
While it was cute that she got to know her father a bit via the banter they did over headsets, I didn't quite catch why Felicity had an open line to The Calculator. Did anyone else? Any other time, she would have hung up on the adversary immediately and shut them down.
While it worked to show how similar Felicity and The Calculator were to each other, it also felt as if they didn't trust us to recognize their similarities. Hello! He's related to Felicity! Can't you tell how similar they are by their banter?
She's a smart cookie, however. If it takes her more than a couple minutes to put together her father's return with the arrival of The Calculator, I'll be surprised. The better story would be to her grappling with a baddie as a daddy anyway, right?
Good vs Evil right in your own family, which is kind of what Thea has been going through all along. Thea needs to get well soon so Felicity will be able to ask her the tough questions.
I realize Roy was trying to keep a lid on his identity when he didn't help Thea as she was getting ready to plunge over the side of the roof, but did anybody laugh when he was running from Oliver later and breakdancing here and there as he bounded through the parking lot? Talk about giving yourself away!
There isn't another masked man in the universe that does those silly maneuvers like Roy Harper.
And how many people are going to say either "This is my life. It's my choice," or, "It's my choice. This is my life," before the season is over? And are each of them supposed to be nominees for the grave? Both Felicity and Laurel said it the day Felicity was shot and Thea and Roy both said it here, with Thea winding up in a coma.
The scene between Thea and Roy when they declared their love, wishing they had made different choices, leading to a future where they would have shared a family together was incredibly touching and brought closure to their relationship. Will this be the last time we see Roy?
And who would have guessed Malcolm Merlyn might be the voice of reason, if only for an instant? Of course Nyssa would show up asking Oliver to kill Malcolm in return for a bloodlust cure just as we didn't think he was a complete jackass. Plus, he also uttered the phrase.
After Arrow Season 4 Episode 11, which was so well done both with content and flow, this installment was a bit of a letdown. The pieces are there to set up some great stuff going forward, but this could have been so much better with less noise and more focus. That could have even been achieved if we had seen Nyssa's actions in a flashback down the road and not in real time here.
And, of course, if we had foregone Oliver's flashbacks altogether and cut any mention of the mayoral race. They just weren't necessary to an already packed hour.
Are you ready to talk about that touch between Felicity and Oliver? Why he's hallucinating Shado on the island to help combat his darkness? Or maybe you're just ready to think about the future. You can get a look at what lies ahead with the preview:
Arrow Season 4 Episode 12 Clip: Roy Harper Exposed?!
You can also watch Arrow online anytime via TV Fanatic, so don't hesitate to do so!
Unchained Review
Editor Rating: 3.25 / 5.0
Rating: 4.0 / 5.0 (117 Votes)
Carissa Pavlica is the managing editor and a staff writer for TV Fanatic. She's a member of the Critic's Choice Association, enjoys mentoring writers, cats, and passionately discussing the nuances of television and film. Follow her on Twitter and email her here at TV Fanatic.
Tags: Arrow, Reviews
Arrow Season 4 Episode 12 Quotes
I am the Demon's Head. I have my resources.
Permalink: I am the Demon's Head. I have my resources.
Oliver, sometimes the greatest act of love is no action at all. It's her life. It's her choice.
Permalink: Oliver, sometimes the greatest act of love is no action at all. It's her life. It's her choice.
Arrow Season 4 Episode 12
Arrow Round Table: Our Choice is More Roy Harper
Watch Arrow Online: Season 4 Episode 12
Arrow Season 4 Episode 12 Photos
Watch Arrow Season 4 Episode 12 Online
Arrow Review: Unchained


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