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
Who knows tomorrow?
Recently a friend posted a sad news on his Facebook page, announcing the death of a school mate who had passed away, suddenly. The report had it that he was on his way to the airport to take a flight to Ghana.
I am sure this man had already informed the wife or a friend or a work colleague at work that he was returning home but he was not to return as a human being but as a dead body.
Such is life and so we need to be circumspect in how we go about things in life. The Bible reminds us that we are like grass which at one point in time looks elegant and the next moment becomes withered according to Psalm 90:5 and 6. It is for this reason that we need to guard our hearts with the word of God so that we shall be motivated to do the right thing, at all times.
This will enable us live on this planet, free from all sorts of troubles in our personal lives, even if we ignore the question of Heaven and Hell. Living a disciplined life delivers us from any kind of trouble as the Bible declares in Galatians 5:23 that against such there is no law.
The uncertainty surrounding our lives on earth is the more reason why people should commit their lives into the hands of the one who created it, in the first place unless you believe that the world created itself and that it appeared from nowhere.
Otherwise, the logical thing to do is to recognize the authority of the creator and surrender to his Lordship. Heaven is real and Hell is real, so for us who know the truth and have received Jesus as our Lord and Saviour, the onus lies on us to encourage our relations who have not believed and received Jesus into their lives, to do so.
We are a couple of days from another Easter Resurrection celebration and an opportunity to reflect on our lives in relation to the significance of Easter. In the Bible, the only occasion Jesus, Saviour of the world commands us to celebrate is his death and resurrection.
He never commanded his followers to celebrate his birth but like everything else, we chose to ignore Jesus’s instructions and decided to do what pleases us, just like our forefather and mother in the Garden of Eden.
Let us deliberately choose to do things differently as Christians this Easter, so we can really benefit from all the blessings that the celebration of the death and birth of Jesus, has on offer. Doing the same thing over and over and expecting a different result is definitely insanity.
I choose to be different this Easter and I am believing God for a newness of life so God’s glory would be revealed in me to draw the unsaved to him. It is only when people especially the unsaved, see the character of Christ in us, that they can be convinced about the authenticity of Jesus, as Saviour of the world, who can bring transformation in their lives too.
This is what would motivate them to surrender their lives to Jesus Christ. Let us make this Easter a memorable one that will be cherished for a long time. It is also a period for reconciliation and it would be great if in the spirit of Easter, we would try to reach out to those who have wronged us or have a grudge against us.
This would demonstrate that we have indeed accepted Jesus and that our religious posture is not a sham. May the good Lord grant us the grace to love our neighbours as ourselves, demonstrating the love of God in the process.
Those who have lost their loved ones and Easter brings sad memories, may the good Lord comfort and strengthen you. God bless.
.NB: ‘CHANGE KOTOKA INTERNATIONAL AIRPORT TO KOFI BAAKO INTERNATIONAL AIRPORT’
Features
Cosmetic deformities
COSMETIC deformities refer to physical imperfections or abnormalities that affect an individual’s appearance, often causing emotional distress and impacting their quality of life.
These deformities can be congenital, acquired, or result from various medical conditions or treatments. This article provides an in-depth exploration of cosmetic deformities, their types, causes, effects, and treatment options.
Types of cosmetic deformities
Cosmetic deformities can affect various parts of the body, including the face, skin, hair, nails, and teeth. Some common types of cosmetic deformities include:
1. Facial deformities: Congenital or acquired abnormalities affecting the shape, structure, or appearance of the face, such as cleft lip and palate, facial paralysis, or facial asymmetry.
2. Skin deformities: Conditions affecting the skin’s texture, tone, or appearance, such as acne, scars, birthmarks, or skin discoloration.
3. Hair deformities: Abnormalities affecting the hair’s growth, texture, or appearance, such as alopecia, hirsutism, or hair loss due to medical conditions or treatments.
4. Nail deformities: Conditions affecting the shape, size, or appearance of the nails, such as nail fungus, nail psoriasis, or nail trauma.
5. Dental deformities: Abnormalities affecting the shape, size, or appearance of the teeth, such as tooth decay, tooth loss, or malocclusion.
Causes of cosmetic deformities
Cosmetic deformities can result from various factors, including:
1. Genetics: Congenital conditions or inherited traits can cause cosmetic deformities.
2. Trauma: Injuries or accidents can result in cosmetic deformities, such as scars or facial trauma.
3. Medical conditions: Certain medical conditions, such as acne, psoriasis, or eczema, can cause cosmetic deformities.
4. Treatments and procedures: Medical treatments, such as chemotherapy, radiation therapy, or surgery, can result in cosmetic deformities.
5. Aging and environmental factors: Aging, sun exposure, and environmental factors can contribute to cosmetic deformities, such as wrinkles, fine lines, or age spots.
Effects of cosmetic deformities
Cosmetic deformities can have significant emotional and psychological effects on individuals, including:
1. Low self-esteem: Cosmetic deformities can lead to feelings of insecurity, self-consciousness, and low self-esteem.
2. Social anxiety: Individuals with cosmetic deformities may experience social anxiety, avoiding social interactions or feeling embarrassed in public.
3. Emotional distress: Cosmetic deformities can cause emotional distress, including depression, anxiety, or stress.
4. Impact on quality of life: Cosmetic deformities can affect an individual’s quality of life, impacting their relationships, career, or overall well-being.
Treatment options for cosmetic deformities
Various treatment options are available to address cosmetic deformities, including:
1. Surgical procedures: Surgical procedures, such as reconstructive surgery, cosmetic surgery, or dermatological surgery, can correct or improve cosmetic deformities.
2. Non-surgical treatments: Non-surgical treatments, such as laser therapy, chemical peels, or microdermabrasion, can address cosmetic concerns, such as skin texture, tone, or appearance.
3. Medical treatments: Medical treatments, such as topical creams, oral medications, or injectable treatments, can address cosmetic concerns, such as acne, hair loss, or nail deformities.
4. Prosthetic and orthotic devices: Prosthetic and orthotic devices, such as wigs, hairpieces, or dental prosthetics, can help individuals with cosmetic deformities.
5. Counselling and therapy: Counselling and therapy, such as cognitive-behavioral therapy or psychotherapy, can help individuals cope with the emotional and psychological effects of cosmetic deformities.
Conclusion
Cosmetic deformities can have significant emotional and psychological effects on individuals, impacting their quality of life and overall well-being.
Understanding the types, causes, and effects of cosmetic deformities is crucial in addressing these concerns.
Various treatment options are available, ranging from surgical procedures to non-surgical treatments, medical treatments, prosthetic and orthotic devices, and counselling and therapy.
By seeking professional help and support, individuals with cosmetic deformities can improve their appearance, boost their self-esteem, and enhance their overall quality of life.
Reference
1. “Cosmetic Deformities” by the American Society of Plastic Surgeons
