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
In a country like ours in which we are aware of our challenges, all that is required is focusing on strengthening our institutional processes by making them more robust and transparent. In this regard, investment in digitilisation must be prioritised since the human element to cut corners is inherent in the psyche of some people and therefore cannot be trusted to do the right things out of their own volition.
Enforcement of existing laws and regulations must be reviewed to see what is working, which ones have to be tweaked to be able to address current challenges, and those that have become obsolete and must be discarded.
One issue that needs to be given priority attention is remuneration. A former President is alleged to declare that we pretend to pay workers and they also pretend to work. This indeed sums up the quandary facing government after government. Workers’ salaries are crucial in the fight against corruption. A realistic living wage must be given to workers; otherwise, they will seek avenues to address their personal budget deficit.
On day one, what should engage the attention of government is Energy, making it available and affordable. The industrialisation agenda cannot be successfully executed without power that is readily available, reliable, and affordable. Solar energy must be factored in the quest for affordable and reliable power for industry.
The fuel sector issues must be urgently addressed so that it can impact positively on the transportation sector, which plays a key role in the supply of goods and services. The railway infrastructure plan linking places like Boankra Inland Port to prolong the lifespan of our roads and to fast track distribution of goods from the Capital City to the inland areas of the country should be a top priority item.
A well-structured system linking industry to academia must be quickly established to serve as a catalyst towards the industrialisation drive. Research findings from the universities must be channelled to captains of industry in a timely manner. Effective channels of communication should be established to facilitate shorter product-to-market times.
An effective mechanism for fishing out needy but talented children must be established, as well as a sponsorship package for talented individuals who are needed for certain critical areas of the economy — what I term critical investment in education.
Certain changes must be made in the constitution, particularly the appointment of the heads of certain constitutional bodies or institutions. This is to ensure that the Executive arm of government does not wield too much power to ensure accountability and checks and balances really work.
The Attorney General’s Office must be detached from the Executive arm of government. The Nolle Prosequi provision must also be amended to compel the Attorney General to give an explanation of why he or she is declining to prosecute a particular case or discontinue it. The provision that protects sitting Presidents from prosecution must also be reviewed.
The punishment for some of our laws needs a review. We must review the removal of CJ provision to ensure the independence of the Judiciary.
Above all, there must be a mindset of change, i.e., a paradigm shift from inability to capability. Inferiority complex must give way to a pacesetters mentality, and all will be well. God bless.
NB: KOTOKA INTERNATIONAL AIRPORT TO KOFI BAAKO INTERNATIONAL AIRPORT
BY LAUD KISSI-MENSAH
Join our WhatsApp Channel now!
https://whatsapp.com/channel/0029VbBElzjInlqHhl1aTU27
Features
The impact of emotional surgery and emotional elysium on neurological and neurosurgical procedures
Abstract
THIS comprehensive review aims to explore the impact of emotional surgery and emotional elysium on neurological and neurosurgical procedures. We examine the scientific literature on these approaches, including their definitions, theoretical frameworks, and applications. Our analysis highlights the potential benefits and risks of these approaches and discusses their implications for practice.
Introduction
Neurological and neurosurgical procedures are complex and delicate, requiring precision and accuracy to achieve optimal outcomes. Emotional surgery and emotional elysium are two innovative approaches that have the potential to enhance the success of these procedures. Emotional surgery involves the use of art and other creative techniques to promote relaxation and reduce stress, while emotional elysium focuses on cultivating positive emotions and promoting emotional well-being.
The Role of Emotional Surgery in Neurological and Neurosurgical Procedures
Emotional surgery has been shown to be effective in reducing anxiety and stress in patients undergoing neurological and neurosurgical procedures. By promoting relaxation and reducing stress, emotional surgery can help patients prepare for procedures, leading to improved outcomes and faster recovery times.
The Role of Emotional Elysium in Neurological and Neurosurgical Procedures
Emotional elysium has been shown to be effective in promoting emotional balance and resilience in patients undergoing neurological and neurosurgical procedures. By cultivating positive emotions and promoting emotional well-being, emotional elysium can help patients cope with the stress and trauma associated with these procedures, leading to improved outcomes and enhanced quality of life.
Benefits of Emotional Surgery and Emotional Elysium
The benefits of emotional surgery and emotional elysium in neurological and neurosurgical procedures are numerous. These approaches can:
- Reduce anxiety and stress: Emotional surgery and emotional elysium can help patients manage anxiety and stress, leading to improved outcomes and faster recovery times.
- Improve emotional regulation: Emotional surgery and emotional elysium can help patients regulate their emotions, leading to improved mental health and well-being.
- Enhance patient experience: Emotional surgery and emotional elysium can improve the patient experience, leading to increased satisfaction and improved outcomes.
Conclusion
In conclusion, emotional surgery and emotional elysium are two innovative approaches that have the potential to enhance the success of neurological and neurosurgical procedures. By reducing anxiety and stress, promoting emotional balance and resilience, and improving patient experience, these approaches can lead to improved outcomes and enhanced quality of life for patients undergoing these procedures.
Recommendations
- Further research is needed: More research is needed to fully understand the benefits and risks of emotional surgery and emotional elysium in neurological and neurosurgical procedures.
- Integration into practice: Emotional surgery and emotional elysium should be considered for integration into practice, as they may offer a valuable tool in the treatment of a range of neurological and neurosurgical conditions.
By exploring innovative approaches like emotional surgery and emotional elysium, we can improve patient outcomes and enhance the quality of life for individuals undergoing neurological and neurosurgical procedures.
BY ROBERT EKOW GRIMMOND-THOMPSON
