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1.
Diabetes Metab Syndr Obes ; 15: 3403-3413, 2022.
Article in English | MEDLINE | ID: covidwho-2109471

ABSTRACT

Introduction: The COVID-19 pandemic has brought major changes not only at the economic and social level but especially in the medical system. Objective: To evaluate the impact of COVID-19 lockdown on the quality of glycemic control in Romanian patients with type 1 diabetes mellitus (T1DM). Material and Method: Our study group included 102 Romanian volunteers' patients with T1DM from both urban and rural areas. Data were collected during an interview, based on a structured questionnaire with multiple-choice questions about diabetes management during lockdown, how they interact with their diabetologist, how they accessed the treatment and what other factors influenced their diabetes management during the lockdown. Results: Blood glucose levels were significantly higher in the MDII group as a consequence of delayed administration of insulin corrections due to inadequate insulin dosing (60% vs 31.81%; χ 2 = 5.51, p = 0.018). In addition, insulin pump users had improved response to stress and anxiety (ie, additional therapeutic safety being provided by use of insulin pump; in some devices, blood glucose being continuously monitored, leading to premature detection of important blood glucose excursions) compared to insulin pen users (χ 2 = 5.09, p = 0.024). In the context of hypoglycemia, we observed that in the pen MDII group, more users have administered an excess of insulin, compared with the pump users (80% vs 45.45%; χ 2 = 10.34; p = 0.001). Conclusion: A lower impact of COVID-19 lockdown on glycemic control was observed in patients with T1DM treated using insulin pumps compared to patients with T1DM who administered their insulin using insulin pens. Telemedicine and online consultations have brought significant improvements in diseases management. Stress, emotions, and anxiety were among the main reasons that led to increases in blood sugar levels, suggesting that the psychological impact may have long-term complications.

2.
Telemed J E Health ; 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2107326

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has rapidly transformed health care delivery into telehealth visits. Attending regular medical appointments are critical to prevent or delay diabetes-related complications. Although telehealth visits have addressed some barriers to in-person visits, appointment no-shows are still noted in the telehealth setting. It is not completely clear how the predictors of appointment no-shows differ between in-person and telehealth visits in diabetes care. Objective: This retrospective study examined if predictors of appointment no-shows differ (1) between pre-COVID (January 1, 2019-March 22, 2020) and COVID (March 23, 2020-December 31, 2020) periods and (2) by health care delivery modes (in-person or telehealth visits) during COVID among adults with type 2 diabetes mellitus (T2DM). Methods: We used electronic health records between January 1, 2019 and December 31, 2020 across four diabetes clinics in a tertiary academic hospital in Baltimore, Maryland. Appointments marked as completed or no-show by established adults with T2DM were included in the analyses. Results: Among 7,276 appointments made by 2,235 patients, overall appointment no-show was 14.99%. Being older and White were protective against appointment no-shows in both unadjusted and adjusted models during both time periods. The interaction terms of COVID periods (i.e., pre-COVID vs. COVID) were significant for when glycated hemoglobin drawn before this visit and for missing body mass index. Telehealth visits during COVID decreased more half of the odds of appointment no-shows. Conclusions: In the context of diabetes care, the implementation of telehealth reduced appointment no-shows. Future studies are needed to address social determinants of health, including access to internet access, to further reduce health disparities among adults with T2DM.

3.
Klin Lab Diagn ; 67(10): 561-569, 2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2101091

ABSTRACT

The study of the characteristics and dynamics of laboratory biomarkers in patients with cardiovascular diseases (CVD) with type 2 diabetes mellitus who underwent COVID-19-associated pneumonia is of great clinical importance for preventing the risk of adverse events. IN the study we used data from 65 patients in the present work. Patients were divided into 2 groups: group 1 included patients with CVD: arterial hypertension (AH) in combination with coronary artery disease (CAD) without DM2 (n=45), group 2 included patients with CVD and DM2 (n=20). Patients were examined at baseline in the infectious disease hospital and 3 months after discharge. During laboratory examination of blood biosamples we evaluated parameters of general blood test; biochemical and immunologicai parameters; elastic properties of the vascular wall. The analyzed leukocyte parameters and their index coefficients - increase in NLR ratio (neutrophils/lymphocytes) and decrease in LYM/CRP ratio (lymphocytes/CRP) were more significantly changed in DM2 group. Patients in both groups had a significant excess of baseline max CRP concentrations with decrease in parameters after 3 months, but with persistent excess values in group 2. Three months after discharge patients with DM2 had levels of hs-CRP, IL-1ß and TNFa and NT-proBNP, that exceeded both the reference values and those in group 1, which reflected the presence of more pronounced vascular inflammatory potential for possible adverse events in this group of patients in post-COVID period. The method of multiple regression showed that DM2 is an independent risk factor for increased stiffness of the vascular wall. Thus, dynamic control of laboratory parameters has prognostic value in assessing the nature of the course of COVID-19 associated pneumonia in patients with CVD and DM2 developing an algorithm for personalized monitoring of patients in the post-COVID period with the aim of timely prevention of unwanted vascular complications.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/complications , Prospective Studies , COVID-19/complications , Follow-Up Studies , Biomarkers
4.
Cureus ; 14(9): e28830, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2100363

ABSTRACT

Studies show a low progression rate of prediabetes to Type 2 diabetes mellitus (DM) that we commonly seek to reverse, but we don't associate prediabetes as a lead-up to the first presentation of ketosis. We present a prediabetic who, in less than a year, converted to GAD65 antibody-positive diabetes mellitus with a diabetic ketoacidosis presentation. A 69-year-old male presented with three weeks of fatigue, polyuria, polydipsia, abdominal pain, and weight loss. Vital signs and physical exam were normal except for abdominal tenderness and dry oral mucosa. Complete blood count (CBC) was normal; blood glucose was severely elevated with mild corrected hyponatremia; elevated anion gap metabolic acidosis with glucosuria and ketonuria. He received an insulin drip, normal saline, and potassium in the intensive care unit. His anion gap closed overnight and was switched to basal-bolus insulin. Hemoglobin A1c (HbA1c) came out to be higher than expected as compared to last year of low prediabetic value, decreased c-peptide levels, and positive anti-GAD65 antibody. His first abnormal HbA1c was 5.8% a year ago and no autoimmune marker was checked before. He was vaccinated with the messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccine a year ago with an mRNA vaccine booster two months earlier. He was not COVID-19 infected. We discharged him with a basal-bolus insulin regimen. Type I DM passes from autoimmunity-positive normoglycemia to dysglycemia to the symptomatic stage, typically progressing more rapidly in children than in older adults. A new Type I or dysglycemia in Type II DM is increasingly reported after COVID-19 vaccines/infection. Mechanisms could be cytokine-mediated beta-cell damage or autoimmunity after mRNA vaccines or as a part of autoimmune syndrome induced by vaccine adjuvants. This case reports the rapid progression of prediabetes to Type 1 rather than Type 2 DM and highlights the possibility of dysglycemia after COVID-19 vaccines and calls for measures to prevent or early management of these side effects.

5.
World J Diabetes ; 13(10): 802-808, 2022 Oct 15.
Article in English | MEDLINE | ID: covidwho-2100070

ABSTRACT

Diabetes mellitus (DM) is an independent risk factor for admission to intensive care unit and death in patients with coronavirus disease 2019 (COVID-19). On the other hand, medications used in the management of COVID-19 are potentially associated with increases in blood glucose levels and a higher incidence of infections. Accordingly, care of patients with DM and acute COVID-19 requires careful consideration of both diseases. Hyperglycemia and hypoglycemia are associated with adverse outcomes and therefore frequent measurement of blood glucose levels and a basal-bolus insulin regimen are required in most patients. Regarding the management of COVID-19, dexamethasone increases blood glucose levels and might also increase the risk for infections. On the other hand, limited data suggest that antiviral and immunomodulatory agents used in COVID-19 are not strongly associated with higher incidence of infections in this population. As knowledge evolves in this field, optimization of the management of both DM and COVID-19 will hopefully improve the outcome of these patients.

6.
Indian J Community Med ; 47(3): 400-404, 2022.
Article in English | MEDLINE | ID: covidwho-2100015

ABSTRACT

Context: Adult population visiting COVID vaccination center is a potential teachable moment for screening and preventive advice on non-communicable diseases. Objectives: The objective of this study was to assess the proportion of vaccinees volunteering for screening and to know the proportion of newly detected hypertensives and diabetics among the screened vaccinees at COVID-19 vaccination center. Setting and Design: This descriptive, cross-sectional, operational research study was carried out at the COVID vaccination center at a medical college in central Gujarat from July to September 2021. Methods: After receiving the vaccine, the vaccinee was offered screening through a community-based assessment checklist for risk factors of non-communicable diseases, blood pressure, and blood sugar measurement. Those volunteering for this screening received a slip mentioning their risk score, blood pressure and blood sugar reading, and relevant health information and disease prevention advice. The study variables were acceptability (proportion of vaccinees volunteering for screening) and yield (newly detected hypertensives and diabetics among those screened). Results: Among vaccinees, 27.7% volunteered for risk scoring and blood pressure measurement, whereas 8.3% volunteered for blood sugar measurement. Around 15.5% of vaccinees had high-risk scores as per the community-based assessment checklist. The yield of freshly detected high blood pressure and high blood sugar was 19.3% and 10.5%, respectively. The yield was similar even among vaccinees under 30 years of age. Conclusions: Vaccinees demonstrated interest in undergoing screening for non-communicable diseases. Yield indicates that such screening is worth the effort.

7.
Pharmaceuticals (Basel) ; 15(11)2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2099704

ABSTRACT

Type 2 diabetes mellitus (T2DM) is a potential risk factor for the development of COVID-19 and is associated with higher severity and mortality rates. T2DM patients are commonly treated with metformin monotherapy or metformin plus sitagliptin. In the present case-control, single-center cohort study, a total number of 112 T2DM patients suffering from COVID-19 and aged 44-62 years old were compared with 78 T2DM patients without COVID-19 and aged 42-56 years old. Both the patient group and the control group were allocated into four groups. Group A: T2DM patients with COVID-19 on metformin treatments plus standard therapy (n = 60); group B: T2DM patients with COVID-19 on metformin plus sitagliptin plus standard therapy (n = 52); group C: T2DM patients without COVID-19 on metformin treatments (n = 40); and group D: T2DM patients without COVID-19 on metformin plus sitagliptin (n = 38). The investigation duration was 2-3 weeks. Anthropometric measurements, serological and biochemical investigations, pulmonary radiological findings, and clinical outcomes were evaluated. Only 101 T2DM patients with COVID-19 continued the study, 71 (70.29%) with mild-moderate COVID-19 and 30 (29.7%) with severe COVID-19 were compared with 78 T2DM patients as a control. Inflammatory biomarkers (C reactive protein, ferritin, and procalcitonin), a lung injury biomarker (lactate dehydrogenase), and a coagulopathy biomarker (D-dimer) were elevated in severe COVID-19 patients compared with mild-moderate COVID-19 (p < 0.05) and T2DM patients (p < 0.05). However, metformin plus sitagliptin was more effective than metformin monotherapy in T2DM patients with COVID-19, as evidenced by the mitigation of oxidative stress, CT scan score, and clinical outcomes. The present study confirmed the protective effects of this combination against the development of COVID-19 severity, as most T2DM COVID-19 patients develop mild-moderate forms. Herein, the combination of metformin and sitagliptin may lead to more beneficial effects than metformin monotherapy.

8.
Nutricion Clinica Y Dietetica Hospitalaria ; 42(3):152-159, 2022.
Article in English | Web of Science | ID: covidwho-2100424

ABSTRACT

Introduction: Skipping meals has been associated with cardiometabolic risk factors such as overweight and insulin re-sistance. Despite this, data on the frequency of meals and the influence on the nutritional and metabolic status of individu-als with type 2 Diabetes Mellitus (DM2) are scarce.Objective: To investigate the correlation between missed meals, body mass index (BMI) and metabolic profile of DM2 patients during the COVID-19 pandemic.Methodology: Cross-sectional study with 107 individuals followed at a Nutrition outpatient clinic of a reference hospi-tal in Fortaleza, Ceara. Socioeconomic, clinical, anthropomet-ric and biochemical data were collected. Meal omission was verified using a 24-hour dietary recall. The correlation be-tween the variables was verified by the Spearman and Chi -Square test, considering p<0.05 as significant.Results: The mean age of participants was 62 +/- 11.34 years, where most were women (57.9%). The mean BMI was 28.67 +/- 5.13 kg/m2 and most were overweight (68%). Participants ate an average of 5 +/- 0.94 meals per day. The median number of meals skipped was 1 (0 -3) and 60.7% skipped at least 1 meal. The most missed meals were supper (41%) and a morning snack (38%). There was a significant positive correlation between the number of skipped meals with BMI and weight.Conclusion: The number of skipped meals is directly cor-related with the nutritional status of older adults and elderly people with DM2.

9.
JMIR Form Res ; 6(11): e38862, 2022 Nov 16.
Article in English | MEDLINE | ID: covidwho-2098994

ABSTRACT

BACKGROUND: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. OBJECTIVE: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. METHODS: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. RESULTS: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. CONCLUSIONS: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective.

10.
Diabetol Metab Syndr ; 14(1): 164, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2098446

ABSTRACT

BACKGROUND: During pandemic period, a single fast glycemia value (≥ 92 mg/dl) performed within the recommended time window for the risk level defined by the Italian guidelines, was considered an acceptable surrogate for GDM diagnosis following Italian Diabetes Association recomendations. METHODS: All pregnant women who performed an OGTT following Italian Guidelines from march 2020 to september 2021 and then delivered at our University Hospital were prospectively enrolled in this study. Primary outcome of the study was the number of women diagnosed with GDM with only the FPG value (≥ 92 mg/dl), following Italian Diabetes Societies recommendations for COVID 19 pandemic period. At the same time, the data of women who became diabetic according to the 1999 WHO criteria was collected too. The secondary outcome was the comparison of risk factors of women undergoing OGTT according to IADPSG and WHO'99 criteria for the diagnosis of GDM and associated clinical outcomes. RESULTS: The number of women with a diagnosis of GDM following Italian guidelines in the 18-month period considered was 161. Only 109 (67.7%) had a fast glucose value ≥ 92 mg/dl. No differences between IADPSG and WHO'99 groups in relation to risk factors, with the exception for overweight and obesity, and clinical outcomes. CONCLUSION: Recommendations of Italian Diabetes Societis for COVID 19 pandemic failed to recognize one third of GDM diagnosis. Clinical Trial Registration ClinicalTrials.gov, www. CLINICALTRIALS: gov , NCT05026840, August 30, 2021, 'retrospectively registered'.

11.
Int J Environ Res Public Health ; 19(21)2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2090170

ABSTRACT

(1) Background: to examine the effect of an online supervised exercise program during pregnancy on the prevention of GDM, and on maternal and childbirth outcomes. (2) Methods: we conducted a randomized clinical trial (NCT04563065) in 260 pregnant women without obstetric contraindications who were randomized into two study groups: intervention group (IG, N = 130) or control group (CG, N = 130). An online supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. (3) Results: no significant differences were found at baseline in maternal characteristics; nevertheless, certain outcomes showed a favorable trend towards the IG. A lower number and percentage of GDM cases were found in the IG compared to the CG (N = 5/4.9% vs. N = 17/16.8%, p = 0.006). Similarly, fewer cases of excessive maternal weight gain (N = 12/11.8% vs. N = 31/30.7%, p = 0.001) were found in the IG, and a lower percentage of instrumental deliveries (N = 8/11.3% vs. N = 13/15.1%) and c-sections (N = 7/9.9% vs. N = 20/23.3%, p = 0.046). (4) Conclusions: an online supervised exercise program can be a preventative tool for GDM in healthy pregnant women.


Subject(s)
COVID-19 , Diabetes, Gestational , Humans , Pregnancy , Female , Diabetes, Gestational/prevention & control , Diabetes, Gestational/epidemiology , Pregnant Women , COVID-19/prevention & control , Pandemics , Exercise , Weight Gain
12.
Journal of Istanbul Faculty of Medicine / &Iacute ; stanbul Tıp Fakültesi Dergisi; 0(0):0-0, 2022.
Article in English | Web of Science | ID: covidwho-2091520

ABSTRACT

Objective: Diabetes mellitus is a chronic, complex disease with many components that must be managed. Treatment success depends on excellent treatment compliance. In this study, we aimed to evaluate the treatment adherence of diabetic patients during the COVID-19 (Coronavirus Disease) pandemic and the factors affecting this condition. Material and Methods: The study was carried out on 474 diabetic patients with a questionnaire consisting of questions based on The Medication Compliance Questionnaire (MCQ) and the World Health Organization (WHO) 2003 compliance guideline. Results: The rate of non-compliance with the treatment based on the MCQ scale was 82.3%. Non-compliance with treatment was significantly associated with oral antidiabetic (OAD) drug use, smoking status, glycosylated hemoglobin (HbA1c) <7%, and patient comments of "I don't have regular doctor follow-up," "I can't communicate well with my doctor," "My blood glucose is not at the target value," and "My medications are not comfort-able enough for use"(p=0.011;0.010;0.014;0.011;0.002;0.019;0.001). Patients under insulin treatment or with an HbA1c value of >= 7% were found to be more compliant with the treatment. Conclusion: Unlike the classical results, the incompatibility of di-abetic patients with HbA1c <7% and under OADs with the treat-ment was emphasized. Patients using insulin and with advanced duration of diabetes were more compliant with the treatment in the stressful period of the COVID-19 pandemic. Lack of fol-low-up by the doctor and low patient effort to communicate with the doctor have been decisive factors in the non-compliance.

13.
Diabet Med ; : e14986, 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2088169

ABSTRACT

AIMS: This cohort study, based on Danish health registers, examined the post-acute consequences of hospitalization for COVID-19 in patients with diabetes. METHODS: The study population comprised all Danish citizens (≥18 years old) who had diabetes when the pandemic started. A patient was exposed if he/she had a hospitalization with COVID-19 after 1 March 2020. A patient was unexposed when he/she was not hospitalized with COVID-19 between 1 March 2020 and the end of follow-up (4 January 2022), or the first registered event of interest. The outcomes included post-COVID-19 hospitalizations and death. We used a Cox proportional hazards model with time varying exposure estimating the hazards ratio (HR) to analyze if the hazard for an outcome of interest was impacted by being hospitalized with COVID-19. RESULTS: In patients with type 1 diabetes, 101 were hospitalized with COVID-19, and 25,459 were not. We did not have sufficient statistical power to identify differences in risk for those with type 1 diabetes. In type 2 diabetes, 1515 were hospitalized with COVID-19, and 95,887 were not. The adjusted HRs of post-acute hospitalization for respiratory diseases and infections were 1.71 (95% CI 1.45-2.03) and 1.87 (95% CI 1.61-2.18), respectively. The HR of death was 2.05 (95% CI 1.73-2.43). Patients with uncertain type had results similar to those with type 2 diabetes. CONCLUSIONS/INTERPRETATION: In type 2 diabetes and diabetes of uncertain type, hospitalization with COVID-19 was associated with an increased risk of post-acute hospitalization for respiratory diseases, infections and death.

14.
Indian J Tuberc ; 69 Suppl 2: S264-S266, 2022.
Article in English | MEDLINE | ID: covidwho-2086306

ABSTRACT

Diabetes mellitus (DM) and tuberculosis (TB) are worldwide health burdens post-COVID-19. TB is the second-leading cause of death by a single infectious microbe. There is much evidence around the world about the responsibility of TB-DM co-morbidity. Both TB and DM prevalence is high in low- and middle-income countries. Especially the elderly with diabetes are more prone to TB infection due to compromised immune systems. Diabetic patients are three times as likely to develop tuberculosis as non-diabetic patients. DM interferes with the status of TB and leads to undesirable outcomes in the treatment of TB. This may later lead to the development of multidrug-resistant tuberculosis (MDR-TB). The coexistence of TB and DM leads to a high mortality rate and therefore becomes an enormous challenge for the medical field. This viewpoint includes the most current information about TB and DM, disease complications, treatment strategies, challenges to be faced in disease management and the importance of TB-DM bidirectional screening in older adults, which helps in early detection and better treatment programme.


Subject(s)
COVID-19 , Diabetes Mellitus , Tuberculosis, Multidrug-Resistant , Tuberculosis , Humans , Aged , COVID-19/complications , COVID-19/epidemiology , Tuberculosis/complications , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Diabetes Mellitus/epidemiology , Tuberculosis, Multidrug-Resistant/complications , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , Comorbidity
15.
Hormones (Athens) ; 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2085800

ABSTRACT

AIM: To compare the kinetics of neutralizing antibodies (NΑbs) against SARS-CoV-2 after vaccination with the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech) between patients with T2DM and healthy controls. METHODS: NAb levels after the BNT162b2 mRNA vaccine were compared between 50 patients with non-insulin treated T2DM and 50 age-, gender-, and BMI-matched healthy controls up to 3 months after the second dose. The median age of both groups was 70 years. RESULTS: On day 1, mean NAbs of the control and T2DM groups were 14.64% (standard error, SE = 2.30) and 14.04% (SE = 2.14), respectively (p value = 0.926). Three weeks later, the mean NAb values were 39.98% (SE = 3.53) in the control group and 40.97% (SE = 3.99) in participants with T2DM (p value = 0.698). One month after the second vaccination, mean NAb values increased to 87.13% (SE = 2.94) in the control group and 89.00% (SE = 2.18) in the T2DM group. Three months after the second vaccine dose, the mean inhibitory titers decreased to 83.49% (SE = 3.82) (control group) and 76.36% (SE = 3.33) (T2DM group). On all occasions, no significant difference was found between the two groups (all p values > 0.05). CONCLUSIONS: Patients with T2DM present similar immunological response to COVID-19 BNT162b2 mRNA vaccine to that of healthy subjects.

16.
Clin Case Rep ; 10(10): e6352, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2084997

ABSTRACT

Mucormycosis is an opportunistic infection that has become a serious concern as a result of the immunosuppressive drugs used during COVID-19. In this report, we describe two cases of rhino-orbital-cerebral mucormycosis with neurological presentation and ophthalmologic problems accompanied by a history of COVID-19 and diabetes.

17.
Journal of Research in Medical and Dental Science ; 10(8):128-+, 2022.
Article in English | Web of Science | ID: covidwho-2081720

ABSTRACT

The world is facing COVID 19 pandemic which has created a chaos among the mankind. It has created a huge burden in the health care facilities. COVID 19 disease is caused by emerging mutants of Severe acute respiratory syndrome corona virus 2(SARS CoV-2). The virus is highly contagious and infects through the respiratory route. It invades the respiratory tract mainly the lungs causing pneumonia. Patient usually presents with fever, nonproductive cough, breathlessness, myalgia and fatigue. Severe cases can rapidly progress to acute respiratory distress syndrome and multi organ failure, death may occur due to complication. Furthermore early identification and diagnosis of high risk cases like hypertension and diabetes and prevention of the serious complication in them help in decreasing the burden on the intensive healthcare facilities. As we know the doctor to patient ratio in a developing country like India is very low, thus it becomes very important for the doctor to know the impending risk in his/her patients. So we have made an effort to understand the pathophysiology involved, the treatment protocols followed in patient of type 2 diabetes mellitus with COVID 19 infection. Regular monitoring of the blood sugar levels during the hospital stay becomes important to detect the red flags of complication. Assessment of the severity of the disease and prognosis in type 2 diabetes mellitus patient and non-diabetics has been contrasted. This might help provide better intensive care management for all the patients at early stage and decrease the morbidity and mortality in the COVID 19 patients. We have tried to unfold the relationship between two hyper inflammatory diseases that is type 2 diabetes mellitus which is chronic inflammatory condition and SARS CoV 2 which causes acute inflammation. It should be noted that both the diseases have tendency to cause multi organ dysfunction and failure.

18.
European Review for Medical and Pharmacological Sciences ; 26(16):5963-5970, 2022.
Article in English | Web of Science | ID: covidwho-2081709

ABSTRACT

OBJECTIVE: SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung al-veoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the meta-bolic and immune systems. The hematological ef-fects of COVID-19 and the relationship of lympho-penia with the severity of the disease have been reported previously. The parameter of percent-age of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardi-ac diseases, solid tumors, and sepsis. The pres-ent study aimed to evaluate whether the parame-ters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Asso-ciations with disease severity were also sought.MATERIALS AND METHODS: In our retro-spective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records.RESULTS: When diabetic patients were com-pared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs. 5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53 +/- 12.3 vs. 64.08 +/- 13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively).CONCLUSIONS: We determined that LUC counts and NLR values in COVID-19-positive pa-tients with diabetes were statistically significant-ly higher compared to nondiabetic patients.

19.
European Review for Medical and Pharmacological Sciences ; 26(15):5587-5595, 2022.
Article in English | Web of Science | ID: covidwho-2081698

ABSTRACT

- OBJECTIVE: The Coronavirus dis-ease 2019 (COVID-19) infection is associated with autonomic dysfunction. Data on the long-term re-lationship between COVID-19 infection, heart rate recovery (HRR), and exaggerated blood pressure response to exercise (EBPR) are very limited. In our study, we aimed at investigating the long-term association between COVID-19, HRR, EBPR, metabolic, and echocardiographic parameters.PATIENTS AND METHODS: The study includ-ed 65 patients in the study group (33 female, median age 46) and 57 in the control group (30 female, 39 median age) between 1 April 2020 and 1 January 2021. Office blood pressure mea-surement, 24-hour ambulatory blood pressure monitoring, treadmill test, echocardiography, and metabolic parameters were evaluated.RESULTS: The frequency of blunted HRR (25 subjects, 38.5%, p < 0.001) and EBPR (7 subjects, 10.8%, p = 0.014) were significantly higher in study group. The study group had higher levels of white blood cell (p = 0.002), neutrophil, c -reac-tive protein, and uric acid (p < 0.001). Diameters of left atrium, aortic root, and ascending aorta were significantly higher in study group (p < 0.05). Age adjusted multiple logistic regression analysis showed that neutrophil levels (odds ra-tio (OR), 9.21;95% confidence interval (CI), 1.52-55.75, p = 0.016), glomerular filtration rate (OR, 1.34;95% CI, 1.13-1.59, p = 0.001), basal heart rate (OR, 1.58;95% CI, 1.17-2.12, p = 0.003), and mean heart rate (OR, 1.22;95% CI, 1.03-1.45, p = 0.0021) were independently associated with COVID-19 infection.CONCLUSIONS: The frequency of blunted HRR and EBPR, and uric acid levels were significant-ly higher in the study group compared to the control group, suggesting autonomic dysfunc-tion as the possible sequelae of the COVID-19 infection and increased risk of cardiovascular events in the future.

20.
Healthcare (Basel) ; 10(10)2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-2081965

ABSTRACT

The joint effect of diabetes mellitus and hypertension on COVID-19 has rarely been evaluated but had potential as a major risk factor. This study aims to investigate the joint effect between diabetes mellitus and hypertension on in-hospital mortality among COVID-19 patients in Yogyakarta stratified by age groups and other comorbidities status. Methods: This cohort retrospective study collected data from two major hospitals in the Sleman district and a total of 2779 hospitalized COVID-19 patients were included in this study. The study outcome was COVID-19 in-hospital mortality (deceased or discharged alive) and the main risk factors were diabetes mellitus (DM) and hypertension (HT). The multiple logistic regression model was utilized to estimate adjusted odds ratio (AOR) and calculate the joint effect. Results: COVID-19 patients who have both DM and hypertension were three times (AOR: 3.21; 95% CI: 2.45-4.19) more likely to have in-hospital mortality than those without both comorbidities. The highest risk of in-hospital mortality was found in COVID-19 patients without other comorbidities (other than DM and HT) and younger age (age 0-40 years), with AOR equal to 22.40 (95% CI: 6.61-75.99). Conclusions: This study identified a joint effect between diabetes mellitus and hypertension which increases the risk of in-hospital mortality among COVID-19 patients. Targeted public health, clinical, and health education intervention should be carried out on individuals with diabetes mellitus and/or hypertension.

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