Features
DIABETES AND COVID-19
It came from a student in health care training. I have diabetes increases the severity of COVID-19. I have a strong family history of diabetes. Kindly throw more light on the subject. In responding to this, I found a fine paper by Singh et al titled “Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practicalConsiderations and published in Diabetes& Metabolic Syndrome: Clinical Research & Reviews (2020).
The disease burden of coronavirus infectious disease 2019 (COVID-19) caused by
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) has been
Increasing continuously with more than five million confirmed patients and more than 350,000 deaths globally. With a high prevalence of diabetes, it is important to
understand the special aspects of COVID-19 infection in people with diabetes.
This becomes even more important, as most parts of the world introduced
restrictions on mobility of patients in order to contain the pandemic even though they are being eased in some countries.
Diabetes and associated complications can increase the risk of morbidity and
mortality during acute infections due to suppressed immune
functions. The levels of glycated haemoglobin (HbA1c) greater than 9% have been linked to a60% increased risk of hospitalization and pneumonia-related severity duringbacterial infection. Past viral pandemics have witnessed the association of
diabetes to increased morbidity and mortality. Diabetes was considered as
independent risk factor for complications and death during 2002-2003 outbreak of
Severe Acute Respiratory Syndrome (SARS-CoV-1). Similarly, the presence
of diabetes tripled the risk of hospitalization and quadrupled the risk of intensive
care unit (ICU) admission during Influenza A (H1N1) infection outbreak in 2009.During the 2012 outbreak of Middle East Respiratory Syndrome Coronavirus
(MERS-CoV), diabetes was prevalent in nearly 50% of population. Mortality rate in patients with MERSwho had diabetes was 35%.
Emerging data suggests that COVID-19 is common in patients with diabetes,hypertension, and cardiovascular disease (CVD). Evolving data also suggest that patients of COVID-19 with diabetes are more oftenassociated with severe or critical disease varying from 14-32% in different studies. SARS CoV-2, like SARS CoV utilises angiotensin converting enzyme 2 (ACE-2) as receptor for entry into cell.ACE2 is expressed not only in the type I and II alveolar epithelial cells in the lungsand upper respiratory tract, but also several other locations like heart, endothelium,renal tubular epithelium, intestinal epithelium, and pancreas.
S-glycoprotein on thesurface of SARS CoV2 binds to ACE-2 and causes conformational changes in the ACE-2 receptors are expressed in pancreatic islets. Infection with SARSCoV has been seen to cause hyperglycaemia in people without pre-existingdiabetes.
Hyperglycaemia was seen to persist for 3 years after recovery fromSARS indicating a transient damage to beta cells.
Metformin, a common medication used in diabetes, was significantly
associated with a decreased risk of mortality in patients with chronic lower
respiratory diseases. In a study of 4321 patients with a follow up of 2-
year period, metformin users had a significantly lower risk ofdeath compared with non-metformin users. Patients with coexistent chronic obstructive pulmonary disease and diabetes.
Glycaemic control is important in any patient who has COVID-19. Though data is still evolving, data from other infections like SARS and influenza H1N1
has shown that patients with poor glycaemic control have increased risk of
complications and death. Most patients with mild infection and with
normal oral intake can continue the usual antihyperglycaemic medications.
However, it is advisable to discontinue sodium glucose transporters (SGLT-2) inhibitors because of the risk ofdehydration and euglycaemic ketosis. Metformin may also need to be stopped ifthere is vomiting or poor oral intake. Doses of other antihyperglycemic drugs likesulfonylureas and insulin may have to be altered depending upon the blood glucoselevels.
Blood glucose monitoring poses a special challenge in COVID-19 as it necessitates frequentvisits to patient’s bedside, especially if the patient is critically ill and receiving insulin.
There are several studies about the protective effect of statins in pneumonia.
Statins are known to increase ACE-2 levels and may protect against viral entry of
SARS CoV2. Also, statins are known to inhibit Nuclear factor kappa B
(NFκB) activation and might help in blunting the cytokine storm- a causative factor in COVID-19 complications.
Calcium channel blockers (CCB) have been shown to reduce severity of disease
and mortality in patients with pneumonia, presumably by inhibiting calcium influx
into the cell. It is therefore safe to continue these drugs for control of blood pressurein hypertensive patients. Since CCB has no effect on ACE2 expression, someresearchers have proposed its preferable use in patients with COVID-19 and
hypertension.
So to recap high prevalence of diabetes is seen in patients with SARS-CoV-2 (COVID-19)and the presence of diabetes is a determinant of severity and mortality. Diabetes might facilitate infection by COVID-19 due to increased viral entryinto cell and impaired immune response.Blood glucose control is important for all patients who have diabetes andCOVID-19 infection.Telemedicine can be very useful for the management of patients with diabetes inpresent times with limited access to healthcare facilities.
Once again, make sure you regularly/daily consume polyphenol-rich cocoa to among others reduce your blood glucose, reduce your blood pressure and strengthen your immune system.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
Features
A call to prayer for Ghana
When you hear of a call to prayer, the people you will least expect to find on the list will be pastors. Surprisingly, these are the group which currently need prayers the most due to recent actions and behaviours associated with them.
I keep saying that when a cart pusher or a carpenter or the ordinary guy on the street, goes to ‘Ashawo’ line at say Circle and is noticed, coming out of that ghetto, it is no news. In fact no reporter worth his sort, will write about it.
However, if one of these known men of God was to be noticed coming out of such ghettos, it is certainly news worthy because he is not supposed to be associated with such behaviour.
In similar manner, the lens through which the actions of a carpenter’s son and I am not demeaning the profession, will be viewed, will not be the same as the lens through which a son of a member parliament, or a son of a public figure will be viewed.
There is a saying that, to whom much is given, much is required and so people in leadership positions must understand this and therefore should take steps to protect their hard won reputation.
Recently, an incident involving the crashing of an over speeding car resulting in the death of two people has become the topic for discussion across the media landscape.
People have expressed diverse opinions, some harsh criticisms, some condemnations and some sympathetic ones. Those who have condemned the pastor for the wrongs of his son has to do with a certain video showing him make certain declarations.
It is alleged that he declared that He drives without any policeman stopping him in Ghana due to his fame or the influence he has.
When such declarations are attributed to you then you can be sure that heavy criticism will come your way, when your son acts in a manner that seems to reflect this re-emphasise this reckless living perception that people have of you.
Then to add salt into injury, church members of the pastor attacks some journalists and the criticisms flies through the roof. The manner, videos apparently showing a pattern of reckless driving by his son started surfacing also infuriated people.
Parenting has become a serious business and people should really consider it as such and seek all the assistance they need to make it a success. The children of this dispensation are exposed to a lot of crazy ideas through television and easy access to the internet.
What they watch is difficult to regulate and that is the danger confronting parents now. There is an urgent need for prayers for the youth of Ghana, so their behaviour will reflect the culture and values of this dear country.
When pastors who should be examples of good parents are woefully failing, then it is time indeed for a call to prayer.
Lessons learnt for all of us has to do with being a bit more curious about the activities of our children when we are not around. We should maintain a certain cordial relations with our neighbours such that they can report to us certain actions or behaviours of our children they feel must be brought to our attention.
A lady shared a story on social media as to why she was being sympathetic to wards the pastor whose son has created this whole buzz. She said she was at her shop, when she had from one of her tenants that her son has taken her vehicle out of the house.
She informed her to quickly organise a taxi and chase after them to stop them. When they were stopped and she asked her son as to why he took the vehicle, he confessed that his friend was going to teach him how to drive.
She said something quite remarkable that, if something terrible had happened, guess what people would have said, given her pedigree in society.
Features
The Dawn Preachers
The dawn of each day marks the transition of darkness into daylight. And according to my friend Weddeye, it is a period when good (light) gradually overcomes bad (darkness).
He adds that this transcient period is of much significance to many people either as a time of sorrow or a time of joy.
Normally, the dawn of every day is the period when most people enjoy their sleep best and snore like thunder. The cool morning air that caresses the body has a soothing effect on the mind and the soul is transported, the nose becomes charged and snoring becomes rather rhythmical but hazardous.
To some, the dawn is the most romantic period of the night when they are inseparably close to their lovers. When daylight sets in they must mandatorily separate. That is a law nature. The dawn is also a period when most people think clearly and rationally except when one is experiencing a hangover. Thinking at dawn normally centres on the payment of school fees, rent, and perhaps, how best to advise Saddam Hussein to stop being a “problem child.”
The social significance of the dawn is well known to most people, especially those who owe sums of money. If you are one of such people, creditors are most likely to attack you at dawn, unless you are clever enough to anticipate the commando-type movement, to escape well before dawn sets in.
But assuming you were sleeping cozy when the creditor arrived and knocked your door. “Who are you,” you are likely to bark. “I am coming to collect my money with interest. No need to mention my name. Immediately I mention it you will develop hernia because the pressure will be too much to bear.”
At this point of time, your first instincts will be to hide under the bed and start reciting the Lord’s Prayer, or to silently open the window and stylishly fly through it and show a very clean pair of heels.
But that would not be politic enough. The creditor may shout after you “thief! thief!” and that is not a very good compliment. I should think that it is always better to confront your creditor and explain matters with all the hope that he’ll give you some breathing space.
Parents are more inclined to rebuke or advise their wards at dawn and it is also a time when wives are likely to confront their husbands over extra-marital improprieties. And lest I forget, convicted criminals are most often executed at dawn. Is it because most criminals are allergic to daylight? They operate under the cover of darkness and must face the bullet under the cover of darkness, armed robbers, especially.
Born again Christians also make good use of the dawn for reasons best known to themselves. They preach the GOOD NEWS at this time of the night and some people consider it a nuisance. A Muslim for instance would not enjoy being disturbed by a doctrine quite alien to his circumstances.
And others who are not Christians and do not intend to be one in the foreseeable future will naturally be angered. And naturally most Christians would enjoy this dawn session tremendously and pray that it becomes a regular feature.
It was at Legon that I realised how these Christian enterprises were both loved and hated. The dawn preachers came mostly on Saturday mornings and the preacher was usually a baritone-voiced apostle who preached the gospel with vim and fervour.
And he was supposed to be a man capable of speaking in at least thirteen foreign languages without error in grammar, usage, vocabulary and phonetics. The preacher was also not supposed to have learnt any of these languages. They are special gifts by the Holy Spirit and he becomes more or less a multi-lingual secretary.
Anyhow, his preaching always touched many hearts and also annoyed many hearts as the message reverberated across the silent hall. And the message was specifically directed to fornicators.
Quite fortunately or unfortunately, Fridays were days when “external” girlfriends came to spend the night on campus. And the dawn of Saturday dangerously coincided with gospel time, a time when lovers were supposed to be inseparable. It was so very untimely and very undemocratic on the part or the preachers.
An aggrieved student often expressed his disaffection by hurling the following across like a projectile: “Hey born again, go and preach to your parents at home. They need Jesus more than we do. Don’t waste our ears”.
I quite remember that in response to a similar remark one dawn, the deep-throated preacher shouted back “Be gone, Satan!”
Today, preachers of the good news minister the word in mummy trucks, buses, lorry parks and residential areas where the dawn is the most suitable period.
Their message is almost always the same. “For God so loved the world that he gave His only begotten Son, that whosoever believeth in Him should not perish but have everlasting life. John 3:16”
You have to confess your sins, repent, accept Jesus Christ, fellowship with the assembly of saints and the way to heaven is opened to you. If you do not, you go to hell. The choice is yours.
I realise that barring any prejudices that might be harboured against the Christian doctrine, the apostles of Christ are doing a good job because they do not preach anything bad. To me, the Christian religion is credible and worth following since it is a sure way of reforming bad morals and keeping righteous.
But I also realise that the dawn preachers only focus on the spiritual side of man and ignore the numerous social problems afflicting him. It is not enough to pave the golden way to heaven. For the time being, man must also see to his earthly problems, alongside.
I have, always expected the dawn preachers for example to talk a little on advisıng people to steer clear of drug abuse and sloth, respect for one another, prevention of AIDS and teenage pregnancies.
The preachers must realise that preaching against fornication alone will not help stop the spread of AIDS for instance because people are always going to mate, anyway. So after preaching against fornication, the preachers could go on to educate their hearers on the deadliness of AIDS, how it is spread, and what pre-cautionary measures to take, e.g. the use of condoms. There is nothing sacrilegious in preaching practical ways of preventing the spread of the disease.
This information will not be useful to Christians alone but to everyone. When Christ came, he ministered, not only to the spiritual needs of the people but to their physical needs as well. The fact that he fed five thousand people with five loaves and two fishes means that he perfectly understood the physical needs of man as well.
Let our dawn preachers do more than merely telling us to repent and go to heaven. Repent we shall.
But do we need to die of AIDS for instance before we repent?
This article was first published on Saturday, December 15, 1990.
MerariAlomele’s
Merari Alomele’s
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I realise that barring any prejudices that might be harboured against the Christian doctrine, the apostles of Christ are doing a good job because they do not preach anything bad. To me, the Christian religion is credible and worth following since it is a sure way of reforming bad morals and keeping righteous.
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