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
Prostitution in Sikaman -1
Men come from in-between the thighs of women and spend the rest of their lives trying to get back.
Apart from money-based church business and armed robbery, prostitution must be the next most lucrative private enterprise in Sikaman. It is normally organised as a sole proprietorship and not as a limited liability company.
In some cases, it is a partnership between a prostitute and a pimp who knows he is destined for hell, anyway.
‘Sikaman Palava’ investigations have lots to reveal about the flesh trade. Contrary to opinions that the business is dying out, it is rather booming and mobile phones and E- mail services are making it more pliable.
It all points to the fact that some prostitutes are in a class of their own. The clients are top shots and expatriates who have ‘dough’, executives who want the service in style, with all the champagne airs, a little perversity here, a bit of sadism there to intensify sexual gratification.
The fact is that some of the big guns are tired of having sex with their wives. Some claim the women are not what they used to be. After one or two children, they simply bloat, develop flabby breasts, and lose the shape that used to turn their husbands crazy. So there must be a search for new cargo. But the big man cannot go after ‘meat’ in the streets. He must distinguish himself in the sinful venture, and if that means going to hell, so be it.
It has come to the realisation of some high profile prostitutes that their peculiar brand of prostitution is in high demand by high paying clients. So they make themselves available on ‘mobile. The client only has to dial a number and she is booked.
“You can’t get me before 9pm. I’ll fix you for 9:30 pm till thy kingdom come. I’ve got a new style to outdoor tonight I hope you don’t get a heart attack. As you know, it can be quite hectic sometimes.”
“See you at 9:30 then. I’m already getting a hard-on.”
CANDLELIGHT
Some prostitutes indeed deliver in style. They can cook the best of meals and serve in the glow of candlelight, light music floating from the back ground. The romantic atmosphere is quite irresistible and the client is delighted. He laughs like a fool.
In a more elaborate setting, he must submit to a lather bath and massage with health-oils. When he is through, he is relaxed. A glass of champagne loosens his appetite. Two tots of Alomo heightens his libido, but he must be patient. In the hands of an experienced prostitute, you indeed must be patient, lest you stumble and fall.
The sex act itself can vary depending on the taste of the client, his orientation, his occupation, level of intelligence or stupidity. Everything counts. Other factors to consider is the weirdness of the character of the particular client. Is he perverse? What about unnatural sex; sodomy? Fellatio and cunninlingus? Very frightening terms. Sadism or masochism?
A whole successful businessman worth millions of dollars is seen naked with a chain around his neck like a licensed dog.
He is dragged about in a room by a lousy prostitute who gives him orders to bark “Wow! Wow! Wow!”
It is all part of the sexual gimmick. Sometimes, the man is flogged with a belt; that’s the only way he can become aroused. And when he is through after satisfying himself sexually, he pants for breath. “Jesus Christ! Deliver me!”
The bill is outrageously high. A quick cheque settles it though and the client is led to his car. At home, he tells his wife, “The meeting today was very hectic. They just wouldn’t understand my point of view, I had to leave panting at the end of it.’
EXPERIENCE
A prostitute who handles high-profile clients are normally trained overseas where they also gain experience. When they are getting older, they come back home and set up. They are still attractive, curvy, not too bad vital statistics.
They have their own houses, cars and a houseboy who knows how to shut his beak. Occasionally, he is given a sexual treat by Madam and he wonders whether heaven is not right here on earth.
The next class of prostitutes are the freelancers. They may look gaudy, boosy and wandering. They may target motorists. After a lift and a nice chat, they can offer to give the wealthy-looking driver some manipulation of his organ while he is still driving, quite a dangerous undertaking.
If the driver doesn’t end up in a ditch or hits an electric pole when climaxing, then he is likely to wind up in the sea. Often, nothing happens, though. The lady is dropped off, the man gets home and realises that his wallet full of foreign currency and cedis is nowhere to be found. It is a lesson to be learnt the hard way.
This kind of prostitute may even take a client to a hotel. She chats and drinks with the wealthy client who wants to go and ‘wee wee’. In his absence the prostitute drops a little something in his drink. He is back, takes a long one down his throat. In 15 minutes, he can be seen lying prostrate, snoring powerfully.
The prostitute dresses up quickly, takes the loot from the man’s brief- case and exits. Thousands of dollars and pound sterling together with travellers’ cheques gone for good. These types are in town. Get wary of them, till we meet next week for the sequel.
Features
The Prophet part 4
Antobam woke up with a terrible headache. He checked the time on his mobile phone, 2:30 am. “What! Where is the money?” He asked aloud. “Where are those girls? Why did I drink so much of that whisky? What were those two girls up to?” He sat up on the bed and noticed a bulge close to the pillow.
He lifted the mattress and picked up the newspaper wrappers with the neatly arranged notes. He saw the neatly written record of the value of the notes. No, those girls are not thieves.
“It was my mistake. If I hadn’t drank myself to sleep they would be here in bed with me, giving me the time of my life. Pretty girls, those two. And so loyal and honest. Tomorrow will be different.”
“I will not drink any whisky, and I will show them that I am a real man. Just then he heard the whispers. Very soon it will be time, they seemed to be saying. This is an important day.”
The gold dealer will bring lots of money. Give him some of the liquid to drink, and we will prepare him. He will do very big business, and he will give you anything you ask for. There will be more miracles and testimonies today.
Antobam smiled to himself. “I am going to be a very rich man in only a few days man. Money, power, and women. Wow! Antobam got to the grounds at 5, but there were quite a number of people waiting.
Mr Kwame Dofu was among them. He greeted them all, and they came around to shake his hand. “My brothers and sisters, I assure you that whatever your problem is, you will not go home without a solution.” Shouts of “Amen” “thank” you Osofo and “you are a true man of God” responded.
“Please take your seats, and start talking to the great one about whatever bothers you. Before the service is over, there will be a solution.” He waved Mr Dofu over, and went with him to the wooden structure that serves as a temporary office.
“My brother, I have done quite a lot of work on the issue you came to see me about. I have prepared a special, powerful package for you. Take this, drink it, and go back to your business. I want to see you in two weeks.”
Beaming with smiles, Mr Dofu drank the foul smelling liquid in two gulps, said a big thank you to Antobam and took his leave. “I believe you, Papa Osofo. And I assure you that I will reward you, big time.”
Just when Osofo Antubam finished with Mr Dofu, Mary and Suzzie went over to him. “Good Morning ladies. I am very sorry about yesterday. I drank too much of the stuff you gave me. Today will be different, I assure you.”
“Don’t worry, Osofo. Since you are now setting things up, our main concern now is to help you to put things in place, and to make you comfortable. We are always there to serve you. This morning, Osofo, we want to go and clean up your place, and prepare something nice for you when you close.
And before coming to church, we will pass by the bank and collect the forms. After you have signed them, the account will be open. You can check the payments anytime and, of course, issue cheques whenever you need money.”
“Suzzie and Mary, I am happy I picked the two of you from the very start. Listen, I will take good care of you, okay? Here is some money. Buy whatever you need for the errands you have mentioned.
And here is the key. Please come back as early as you can. You know I need you here.” The service was very lively. The lively singing of praise songs was followed by one and a half hours of testimonies.
Most of them related to money – big sales, new jobs and overdue debts paid. But there were also testimonies about healing. Barren women had taken seed, and, of course, several men who had lost their bedroom authority had regained them, to the delight of their partners.
As he had promised, Antobam preached for only 30 minutes, exhorting the congregation to attend church regularly, pay their tithes and offerings, and strictly follow his ‘directions’ for securing solutions to their problems.
After another round of praises during which the congregation danced to the floor to drop their offering, he closed the service, grabbed the big bowl which was full to the brim with money, and moved to his desk. A long queue was quickly formed at the desk.
Meanwhile, Mary and Suzzie had gone to give Antobam’s place quite a decent look. A new bedsheet and pillows, a secondhand carpet and four plastic chairs placed in the verandah had done the trick.
They also prepared two fish and chicken stews. After all these, they rushed to the National Savings Bank and collected application forms for opening current and savings accounts.
They joined the service a few minutes before the main session closed. Antobam looked round and saw, to his relief, Mary and Suzzie moving towards him. “Hello ladies. What have you been up to?” “Quite a bit, Osofo. We’ve just collected your drink. Here you are. We’ve made a few changes at your place. I think you will like it. You will also have something nice to eat. Now, here are the forms for the savings and current accounts.
If you will sign them, the bank will open the account. From today, we can pay all monies direct into the account.” ‘How can I thank you, ladies?” “You don’t need to thank us,” Suzzie said. “It is our duty to help a man of God succeed.” “Okay, my ladies, please take the offerings and count them as you did yesterday.
You can add the payments made after the consultations. Will it be possible to pay them into the account today?” “Yes,” Mary said. “The bank closes at four. If we leave here at three, we would be there just in time.”
The two friends started counting, as Osofo Antobam gave his clients his directions for solving their problems. On quite a few occasions he closed his eyes as if he was receiving direction from above on what to do.
But as the fetish priest at the Nana Kofi Broni shrine and the dwarfs had assured him, the solutions would certainly be provided. Having heard the huge testimonies earlier in the day, the clients parted with substantial sums of money in expectation.
By Ekow de Heer