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DIABETES AND COVID-19

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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

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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

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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

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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%.

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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

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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

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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.

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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

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(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

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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

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CHIEF PHARMACIST

COCOA CLINIC

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This sanitation issue!

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Some things do not change in this country.  The rains shall fall in May, and June and even July.  That is out of our control.  It is an act of God and he decides how often and the intensity.  Who are we to question God? 

However, there is something man-made that is gradually becoming something that is also not changing and it is worrying.  A week ago the President initiated a national clean up campaign to address the issue of sanitation in the country, especially in Accra. 

Citizens enthusiastically got involved and engaged in cleaning their environment and other places but afterwards, the issue that is becoming a permanent feature resisting change, reared its ugly head again. 

The rubbish and the silt that were dug out of the drains, were heaped on the shoulders of the drains and left there.  Any little rain will render the whole effort futile because the rubbish and silt will be washed right back into the drains. 

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This is what is not changing in the country and the various assemblies must ensure that this issue is dealt with and must become a thing of the past.

There is the need to engage the citizenry across board, in connection with mindset change, as far as sanitation is concerned.  At this juncture, I must acknowledge the thoughtful initiative of the current crop of Abenfo (i.e. students both present and past) of SUTESCO of Suhum, with support of the school administration for decorating the area under the overpass on the Accra Kumasi highway, near the school, with fascinating paintings.  This is an example worthy of emulation and makes me proud as one of the Abenfo. 

An example not worthy of emulation is an eyesore currently existing behind a cemetery along the Atta Mills link as you branch left, off the main Accra-Cape Coast road at Old barrier and head towards the beach through Aplaku, Bortianor, Oshiyie, Korobite through to Tuba and beyond. 

The drain along the walls of the cemetery also lying astride the road, is choked with silt and rubbish.  This has created a problem near the end of the cemetery wall just before you enter Bortianor. 

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Water has accumulated at that point, creating potholes and also gradually creating a channel across the road, creating a nightmare for motorists using that route.  This route is the main link between parts of Kasoa and the Accra – Cape Coast road and whenever it rains and the Atala stretch of the road is blocked, that is the route most motorists from Kasoa uses.

It is also the route used by tourists going to the beaches along the sea of the towns stretching from Bortianor to Kokrobite and so it does not speak well of us, as a nation at all.

A few days ago, I had to pass through Tema Station, the place where a major clean up exercise was conducted just fews days ago and it was very shocking to see the level of wanton littering that had taken place. 

One begins to wonder if this whole exercise initiated by the President was worth it.  People just do not care and are not willing to change their attitude towards sanitation. 

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We cannot continue like this and to win this battle against insanitary conditions in our environment, the NCCE must be resourced to embark on a serious educational drive.  The MMDCEs must also be held accountable for sanitation lapses in their administrative areas, by making sanitation part of their KPIs among other innovative policies.  This is one of the surest ways to overcome this sanitation challenge confronting us. God bless.

By Laud Kissi-Mensah

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Disqualified — Part 1

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THE discussion lasted only ten minutes. Mr Philip Sampson, Eunice’s father, had asked to see him, and he was led to the sitting room for the first time. Mr Sampson indicated that he should sit down.

‘Yes, Kakraba. I know that you have been, er, friends with Eunice for some months now, and naturally, as her father, I thought it would be important to meet you, and to reach an understanding with you on, er, some basic issues. So, I hear you are a graduate in building technology. Now, tell me about what you do’.

‘Okay. I worked with the Electricity Company for two years after National Service. During that time I interacted with some lawyers and land surveyors on our project sites, so I suggested to some of them that we take some dilapidated buildings in some parts of Accra, rehabilitate them and find new owners. Soon after starting that I got a job as Project Manager with a group of development agencies who are executing projects in the Northern Region, so I have been balancing the two positions’.

‘I see. That sounds like a bold step. So is it going well, financially?’

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‘Well, sir, I absolutely enjoy what I’m doing now. Financially, I would only say that I am a work in progress. A lot of what I’m doing now involves some risk taking, as it involves trust issues with land and property owners.

I am partnering with prominent lawyers and land surveyors, so I am not taking any serious risks. So currently I am doing okay financially, but it will take me some time before I reach the level where I can say I am comfortable financially.’

‘Okay. Now tell me about your parents’.

‘My father was an Agricultural Extension Officer, so we spent some time at several locations with him. He is now enjoying his retirement. And my mother is a retired nurse. I have three elder sisters, all married’.

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‘So you live with your parents?’

‘Yes and no. My dad built his home on one acre at Pokuase, so he gave me one plot, and I have done a three-bedroom house, where I live’.

‘Okay, fine. Thanks for the answers. You see, in addition to my position socially, I spent many years in the diplomatic service, so I’m sure you will understand that I need to ensure that my kids, especially my daughters, maintain suitable relationships. For now I think it is fine that you and Eunice are friends. I’m sure you understand what I mean’.

‘Yes sir. I understand perfectly well.’

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‘Great, okay, that would be all.’

Kakraba stood up, bowed and said thank you to Mr Sampson, and walked to the garden where his girlfriend Eunice, her mother Mrs Elaine Sampson and her two elder sisters, Yvonne and Emma, were seated, busily discussing some dresses being offered for sale online.

‘So,’ Mrs Elaine asked him, ‘you and Daddy had a good discussion?’

‘Yes, Ma. We certainly did. I really appreciate Dad for the discussion. It was really good.’

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‘Great. Although he has met you here on quite a number of occasions, I think it is good that you have met for a chat.’

‘Yes indeed, Ma, and I really appreciate it. So Eunice, I will be on my way. I will call.’

Eunice led him to his car, and after driving off he exhaled and shook his head. Although he had long concluded that Eunice’s family were so snobbish that a future relationship with her would be problematic, this discussion, or was it interrogation, had virtually cancelled any likelihood.

Mr Sampson just told him, in no uncertain terms, that the Sampson family was so prominent and socially connected that a union between his daughter and him was undesirable.

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He had a good relationship with Eunice. They shared some beautiful moments together, and often went out to entertainment joints, often with her three friends Marian, Patricia and Amanda. But Kakraba was often uncomfortable with their preferences.

Eunice regularly spoke about her family’s experiences during her father’s postings in Europe and Asia, and her three friends were always discussing the latest fashion trends, always noting the importance of placing themselves among the best-dressed ladies in town.

Eunice, her mother and siblings had indicated in several ways that he did not quite fit into their social standing. They had only said a mild ‘thank you’ when he brought them a goat or sheep and a generous amount of foodstuffs from the north every month.

But Kakraba did not really take it to heart, because they were quite inexpensive up north. Moreover, he always went to the food market and arranged with the truck drivers for a big package which was picked up by his buddy Paa John and delivered to his family and a few others, including the Sampsons.

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By Ekow de Heer

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