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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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The eye is indeed the lamp of the body

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There is a scripture that is found in Matthew 6:22 which says that the lamp of the body is the eye and therefore the eye must see well to enable the body to get to its destination.  

What most people do not know is that behind the scenes, there is a strong interaction between the eyes and the brain before a picture becomes clear.  The state of mind therefore is crucial to the eye seeing clearly to enable the body to process accurately the information the eyes are feeding it for proper identification of what the eyes see. 

This is similar to how a person behaves i.e. what informs the decisions that forms in the mind that results in the actions that a person performs.  The actions of a person does not therefore just happen but is as a result of things that went on in the mind, which in most cases resulted from information passed on to it by the eyes either consciously or unconsciously.

There are so many issues that affect our society which makes one wonder, whether the people who displayed such acts were created by someone or something other than God. 

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How can a person see a beach created by God with beautiful beaches and fresh air blowing all around, decides to defecate at such places, and therefore desecrate the environment?  lt is simply mind boggling? 

When other people in other countries who dwell on the coast are using their beaches for tourist attraction purposes as a means of livelihood and also to promote environmental health, some people living around our beaches, have turned them into rubbish dumping sites and toilets. 

It is a very sad situation and the earlier we did something about it the better.  It is a national emergency that must engage the attention, first of the government and then the citizenry, where religious bodies and NGOs must play a critical role.

The things we focus on in this country, needs to be addressed.  Our minds which processes the info the eyes send to the brain, must be disciplined.  There are certain behaviours that a disciplined mind can ignore even when the eye has provided info to the brain.  One of the things a disciplined mind does, is the avoidance of a second look, which is critical for every person who wants to avoid adultery or fornication. 

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Once a person is not blind, he will see things.  The boobs, the ‘shankus’, the coca cola shapes, the light complexioned, the dark complexioned etc. the eyes will definitely see and report same to the brain.  What the brain or the mind decides to do or instructs the eye to do is the issue. 

It can decide to instruct the eye to take a second look and let the mind drool over it or say ignore it and that will be the end.

If the mind becomes trained to focus on environmental issues like clean environment, the eyes will automatically be reporting on insanitary conditions to the brain as and when it sees them.  The mind will pay attention to such data and begin to process them and to identify solutions to deal with the reported insanitary conditions. 

There is the need to encourage citizens to train the mind to focus on the right thing so that in tandem with the eyes, focus will be maintained.  When the mind is so trained, it communicates with the eye to also focus on hood things that helps in both are spiritual life and our secular lives, for indeed the eyes are the lamp of the body.  God bless.

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 Arming the Sikaman journalists to the teeth

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THE relationship between New Times Corporation (NTC) and African Concrete Productions (ACP) is based entirely on matters of the stomach. Each depends on the other in a dietary symbiosis, reinforced by the close proximity of each other

At lunchtime, you’d see a particular set of Times workers marching regimentally to ACP to face the wall. You’d think they are soldiers. It has long been declared that the company manufactures the best kokonte in the Greater Accra Region. ACP is, therefore, a culinary haven for those NTC kokonte fans, both male and female.

As the NTC kokonte warriors cross the border to ACP, you’d see some ACP banku fanatics dancing joyously to NTC. They are lucky folks because they do not have to obtain visa to enter into ‘Times’ to attack the balls of banku with precision and accuracy. They also claim that the lightsoup at ‘Times’ is arguably the best in West Africa.

So the relationship between the two entities was quite cordial and based practically on stomach palaver, until ACP workers staged an industrial revolution, whereupon the managing director, accountant and estate manager were allegedly stripped naked and locked up in a room. An insurgency had began in earnest.

An ACP worker came to ‘Times’, this time not to eat banku and okro. He had come to inform newsmen that juicy stuff awaited them at ACP. It could make a front page lead story.

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A camerawoman and a female reporter were accordingly dispatched to go and bring back news, juicy news as juicy as kokonte and groundnut soup.

Sikaman Palava
Sikaman Palava

I was driving to work when I espied the familiar camerawoman clicking away outside the ACP premises. I didn’t see any ‘Times’ reporter but angry workers who were on the verge of getting violent. I slowed down and the driver behind blew his horn at me like a lunatic. I drove on.

Later, I heard the reporter and camerawoman were harassed and brutalised. The report came,. “The camerawoman, Mrs Salome Adonu-Agbottah and reporter Mrs Doreen Allotey, in an attempt to retrieve the camera which the workers had seized from them were severely beaten. They were manhandled and almost pushed into a big gutter opposite the company’s premises.

BRUISES

“….The camerawoman had bruises on her body, her hand bag was destroyed and the money in it stolen. Mrs Allotey’s watch was also snatched and her feet stamped on.”

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Luckily, it was not her nose that was trampled upon. She has a beautiful nose.

The bad news was received with extreme sorrow. If the victims had been men, it would not have seemed too bad. But to brutalise women is just unacceptable. The New Times Corporation has not stopped mourning the incident which has been condemned in many circles.

Some people keep asking me why Times sent females to cover a potentially violent demonstration. I tell them they might as well ask why CNN’s amazon, Christina Amanpour, is assigned to cover the carnage in Bosnia-Herzegovina and Rwanda. She is always on the frontline in jeans and jacket.

Journalism is a potentially hazardous profession, and once you accept to study and practise the trade, you might as well bone up to face any assignment as long as your superiors feel you are capable of handling it or you have demonstrated the capacity to handle it. Both males and females can be assigned anywhere, anytime just like policemen and women are assigned.

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The only difference between cops and pressmen is that the latter are armed only with a pen and the former with a gun. The question is should newsmen also arm themselves so that in any event of an assault they would not be found wanting in self-defence? They can’t adequately defend themselves with a pen and a jotter. A pen cannot even disfigure an opponent’s upper lip.

Photo-journalists have particularly suffered violence. Spectator ace-cameraman Vincent Dzatse was severely assaulted by AMA men when he attempted to take pictures of their indiscretions.

Sports cameraman, P. K. Arthur has been beaten more than once at the sports stadium when riots errupted and he wanted to capture it on his lenses.

Some sports journalists have been banned from entering the Accra Sports Stadium by supporters because in their comments, they didn’t write “sense”. Some supporters once nearly lynched Christian Abbew, Spectator Sports Editor, near a courtroom. He was stoned like the biblical Stephen. He had gone to defend a contempt charge.

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I think it is time journalists met and discussed how best to defend themselves in any event of an attack by individuals or mobs. In the pursuance of their duty, they must be free from harassment and assault.

Some journalists go to work and return home with a black-eye or a double fore-head. It is just not right. Something has to be done about it. I think journalists should be armed. But first we must be trained in the use of firearms so that our warning shot do not hit below the belt. What about training in Kung Fu?

This article was first published on Saturday, October 17, 1998.

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