ABSTRACT
ABSTRACT A variety of infectious public health problems are prevailing in the world. Among these, epidemics of Severe Acute Respiratory Syndrome (SARS), H1N1 influenza and Middle East Respiratory Syndrome corona virus (MERS-Co V) emerged as very important issues during last three decades as these infections caused quite large number of human deaths worldwide. Coronaviruses are single-stranded positive sense RNA viruses which mainly in past were considered responsible for high percentage of (around 30%) of common cold/flu cases. Viruses causing SARS, MERS and COVID-19 are members of family Coronavirdae. World Health Organization (WHO) reported that the novel Cov-19 virus infection was first diagnosed in Wuhan, Hubei Province, China during December 2019. Initially the virus was named as nCoV-19 and later disease due to this virus was named as COVID-19, and recently named as Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses. This new coronavirus was found to have 86.9% homology to a bat corona virus and hence it was suspected to have been originated from bats. Till 15th January 2021, the COVID-19 infection has been reported from 219 countries. It has caused over 20 million deaths in humans around the globe. Countries reporting very high death/infection rates include USA (393,948/23,617,815), Brazil (206,009/5,257,459), Mexico (136,917/1,571,901), India (153,000/10,596,442), UK (84,767/3,211,576), France (69,031/2,830,842), Russia (63,940/3,495,816) and Italy (80,326/2,319,036). Worldwide a total of over 96,750,700 COVID-19 cases have so far been reported. As reported earlier this pandemic has hit almost every country worldwide causing exceptionally high morbidity and mortality. Amongst the South Asian countries India is worst hit by this deadly COVID-19. Pakistan's neighboring Iran is also very badly infected and reported 57,057 deaths of 1,348,316 infected people. In Pakistan 52,411,930 confirm cases of COVID-19 and around 11,000 deaths are reported in various region of the country.
ABSTRACT
Emergency admissions due to acute metabolic crisis in patients with diabetes remain some of the most common and challenging conditions. DKA (Diabetic Ketoacidosis), HHS (Hyperglycaemic Hyperosmolar State) and recently focused EDKA (Euglycaemic Diabetic Ketoacidosis) are life-threatening different entities. DKA and HHS have distinctly different pathophysiology but basic management protocols are the same. EDKA is just like DKA but without hyperglycaemia. T1D, particularly children are vulnerable to DKA and T2D, particularly elderly with comorbidities are vulnerable to HHS. But these are not always the rule, these acute conditions are often occur in different age groups with diabetes. It is essential to have a coordinated care from the multidisciplinary team to ensure the timely delivery of right treatment. DKA and HHS, in many instances can present as a mixed entity as well. Mortality rate is higher for HHS than DKA but incidences of DKA are much higher than HHS. The prevalence of HHS in children and young adults are increasing due to exponential growth of obesity and increasing T2D cases in this age group. Following introduction of SGLT2i (Sodium-GLucose co-Transporter-2 inhibitor) for T2D and off-label use in T1D, some incidences of EDKA has been reported. Healthcare professionals should be more vigilant during acute illness in diabetes patients on SGLT2i without hyperglycaemia to rule out EDKA. Middle aged, mildly obese and antibody negative patients who apparently resemble as T2D without any precipitating causes sometime end up with DKA which is classified as KPD (Ketosis-prone diabetes). Many cases can be prevented by following 'Sick day rules'. Better access to medical care, structured diabetes education to patients and caregivers are key measures to prevent acute metabolic crisis.