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
Conflict at work is more common than you might think. According to 2022 research by The Myers-Briggs Company, more than a third of the workforce reports dealing with conflict often, very often, or all the time in the workplace. The same report found that managers spend an average of four hours per week dealing with conflict, and nearly 25 per cent of people think their managers handle conflict poorly or very poorly.
Addressing a dispute might feel tense or awkward, but resolving the conflict is typically well worth it in the long run. Whether you’re trying to mediate conflict between colleagues or are directly involved, here are seven steps you can take to manage workplace conflict.
1. Don’t put it off
Facing conflict head-on is hard. However, waiting too long to address it can negatively impact your emotional well-being, focus, and the entire office environment. If you’re feeling angry, letting that emotion fester can also escalate it over time. This can make you less responsive to other points of view and make it harder to resolve the issue.
The sooner you can address the conflict, the better it will be for you, the person you disagree with, and your entire team.
2. Learn all you can about the problem
It’s important to determine the type of conflict you’re dealing with. Begin by considering the cause of the conflict. For example, ask yourself whether someone said something that upset you or if you have emotions of anger and resentment that stemmed from something that happened.
Then try to identify if it’s a task, relationship, value, or team conflict. Once you know what type of conflict it is, you can work to resolve it with specific tactics for that situation.
If you skip this step, you may waste time or escalate the situation further by trying to address issues irrelevant to the real conflict.
3. Actively listen
Listen attentively when people share their side of the story. Active listening is one of the most valuable professional skills you can possess. This type of listening involves not only hearing what the other person is saying but also listening to understand their point of view.
No matter your role in conflict, it’s easy to begin sharing your opinion with little regard for the other people involved. However, it’s important to learn about all sides of a disagreement to make well-informed decisions before drawing conclusions.
To reach a resolution, you must step back and prioritize listening over talking. Ultimately, that will encourage the other person to do the same when it’s your turn to speak. –source: betterup.com
Today, I focus on the Temple Of Praise Ministries International (TOP Church) in Helsinki, as I continue my description of personalities or institutions and their accomplishments as members of the Ghanaian Diaspora in Finland.
The TOP Church in Finland has seen significant strides and accomplishments that must be made known to the public. 
Some history
The Church was established in Finland in September 2016. Since its inception, it has steadily grown both spiritually and numerically, by the grace of God, as disclosed to me by Mr Matthew Anini Twumasi, the Presiding Elder of TOP’s branch in Finland. The TOP Church has other branches across Africa, Europe, and America.
The Church in Finland was founded with a vision to create a welcoming and dynamic community where people could experience God’s love and grace (see, www.topchurchfinland.org). According to Presiding Elder Matthew, the TOP Church operates within a unique environment where Christianity coexists with what is seen as a largely secular society.
Despite this, he submits, there are significant opportunities for outreach, unity, and demonstrating the love of Christ through service and community engagement.
Activities
Church services at the TOP Church are typically held on Sundays for the main worship. In addition, there are mid-week prayer sessions, Saturday prayer services, and a half-night service held on the last Friday of every month. “We also organise quarterly programs”, Elder Matthew added.
His impression of the Church so far has been positive. “It is a vibrant and welcoming community where members are committed to worship, fellowship, and supporting one another in faith”, he stated.
In sum, Elder Matthew said the Church continues to grow by God’s grace. “We remain hopeful and committed to spreading the Gospel, strengthening the faith of our members, and making a positive impact in society”, he continued.
Achievements
The TOP Church has a number of achievements and achievements. Some of the strengths include strong community bonds, cultural diversity, and deep commitment to spiritual growth.
I also remember that during the COVID-19 period, I heard that the TOP Church was one such bodies that hugely supported its members and others to cope with the situation.
According to Elder Matthew, the challenges facing the church include “adapting to cultural differences, engaging the younger generation, expanding outreach in a secular society, and securing a permanent place of worship”.
Role in the Ghanaian community in Finland
The TOP Church plays a prominent role as a religious group that serves Ghanaian migrants and others in the Finnish society.
Thus, the TOP Church is a religious body for Ghanaian migrants in Finland and other nationalities who want to worship with them for diversity and better intercultural and multicultural understanding.
The Church also has mechanisms in place to support its members who are bereaved as a way to commiserate with them in times of death and funerals.
The Ghanaian community has played a vital role in the growth of the Church. Their strong sense of fellowship, dedication to worship, and active participation have helped build a solid foundation and attract others to the ministry, according to Elder Matthew.
Integration
By its activities, the TOP Church is helping to ensure integration of its members well into the Finish society.
This is important since social interaction and citizens’ well-being are an important part of the integration process.
The role of migrant associations and groups such as TOP Church acting as bridge-builders for the integration and inclusion of migrants through participation in the decision making process and by acting as a representative voice is highly appreciated in Finland. Thank you!
GHANA MATTERS column appears fortnightly. Written in simple, layman’s terms, it concentrates on matters about Ghana and beyond. It focuses on everyday life issues relating to the social, cultural, economic, religious, political, health, sports, youth, gender, etc. It strives to remind us all that Ghana comes first. The column also takes a candid look at the meanings and repercussions of our actions, especially those things we take for granted or even ignore. There are key Ghanaian values we should uphold rather than disregard with impunity. We should not overlook the obvious. We need to search for the hidden or deeply embedded values and try to project them.
With Dr Perpetual Crentsil
