Hypoglycemia at the time of Covid-19 pandemic

BackgroundHypoglycemia is the limiting factor in the glycemic management of diabetes, which need to be addressed critically to avoid complications. Lockdown because of new coronavirus strain (COVID-19) pandemic has further complicated the issue of hypoglycemia due to limitations in access to food, outpatient clinics, pathological services and medicines.AimTo assess the factors associated with the risk of hypoglycemia during April–May 2020 lockdown in people with type 2 diabetes mellitus.MethodologyWe analyzed the data retrospectively from 146 patients of type 2 diabetes mellitus (T2DM) reporting to the emergency department (ED) during lockdown period with symptoms suggestive of hypoglycemia.ResultsThe majority of patients were male (90/146) with a mean age of 59.88 ± 10.09 years and a mean random blood glucose level of 57.67 ± 9.00 mg/dL. Two-third of patients (70.83%) had level 1 hypoglycemia, while level 2 hypoglycemia was reported in 29.16% of patients. A combination of Metformin and Sulfonylureas (SU) was most commonly associated with the risk of hypoglycemia (65.75%) followed by insulin (33.56%). Subjects who received insulin reported a lower blood glucose value (50.75 ± 8.20 mg/dL) as compared to those receiving a combination of metformin and SU (60.95 ± 7.10 mg/dl). 330.56% of patients who had received prophylaxis hydroxychloroquine (HCQ) 400 mg twice a day along with the routine anti-hyperglycemic agents without their dose adjustment reported hypoglycemia. Patients with hypertension, micro-vascular, macro-vascular complications, and coexistent with each other had a higher propensity to the risk of hypoglycemia (46.58%, 33.56%, 23.29%, and 32.88%) respectively.ConclusionThe COVID-19 lockdown has shown to influence the risk of hypoglycemia in patients with T2DM, especially those receiving SU, insulin, HCQ especially in patients with associated co-morbidities. Patient education, support, and telemedicine plays a pivotal role to prevent hypoglycemia.     

The perspectives of dialysis patients about the Covid-19 pandemic and differences between the modalities

The novel coronavirus disease was declared as a pandemic and CKD is an important risk factor for morbidity and mortality. Dialysis has additional contributions on transmission risk so prompt preventive strategies were implemented for dialysis patients. We aimed to evaluate pandemic-related perceptions and concerns of dialysis patients and differences between dialysis modalities. An anonymous survey for assessing concerns, knowledge, and attitudes about the pandemic was sent online to a total of 339 patients on maintenance dialysis at four tertiary dialysis centers in Turkey. A total of 309 patients (54.9 ± 15.1 years, 51.6% females, 55.7% in-center HD, 44.3% peritoneal dialysis) enrolled. The anonymous online survey was conducted at the end of April 2020. HD patients were more concerned about transmission risk (p = 0.002) and risks associated with the dialysis treatment environment and the transport methods (p < 0.001). The total concern score was significantly higher in the HD group (2.60 ± 0.93 vs. 1.65 ± 0.54, p < 0.001). The knowledge about the pandemic and prevention methods and the attitudes of prevention were similar between the groups (p = 0.161 and 0.418, respectively). The compliance rate of personal preventive strategies was 98.1%. Considering changing the current dialysis modality due to the pandemic was higher in the HD group (p < 0.001). Although the preventive strategies were performed properly in the HD centers, HD patients were more concerned about the Covid-19 outbreak compared with PD. Our results support home dialysis treatments for modality decisions with patients' positive perspective of PD over HD during the pandemic.     

Guidelines for the management of diabetes in care homes during the Covid-19 pandemic

The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.     

Nutrition and the Covid-19 pandemic: Three factors with high impact on community health

AimsIn the course of the COVID-19 pandemic, multiple suggestions have been delivered through websites and social media referring to natural substances and various kinds of supplements with thaumaturgical properties in preventing and/or fighting the coronavirus infection. Indeed, there is no clinical trial evidence that a dietary or pharmacological supplementation of any particular substance will increase the effectiveness of the immune defences. There are however three nutritional issues that deserve special attention under the present circumstances, namely vitamin D deficiency, excess salt intake and inappropriate alcohol consumption. Here is a short review of the current knowledge about the possible role of these factors in the immunity defence system and their potential impact on the modulation of the immune response to SARS-COV2 infection.Data synthesisFor all of these factors there is convincing evidence of an impact on the immune defence structure and function. In the absence of RCT demonstration that increased ingestion of any given substance may confer protection against the new enemy, special attention to correction of these three nutritional criticisms is certainly warranted at the time of COVID pandemic.ConclusionsWe propose that the inappropriate intake of salt and alcohol and the risk of inadequate vitamin D status should be object of screening, in particular in subjects at high mortality risk from SARS-COV 2 infection, such as institutionalised elderly subjects and all those affected by predisposing conditions.     

3D-printed protected face shields for health care workers in Covid-19 pandemic

The coronavirus pandemic resulted in a shortage of protective equipment. To meet the request of eye-protecting devices, an interdisciplinary consortium involving practitioners, researchers, engineers and technicians developed and manufactured thousands of inexpensive 3D-printed face shields, inside hospital setting. This action leads to the concept of “concurrent, agile, and rapid engineering”.     

Data mining and analysis of scientific research data records on Covid-19 mortality,immunity, and vaccine development - In the first wave of the Covid-19 pandemic

Background and aimsCovid-19 is a global pandemic that requires a global and integrated response of all national medical and healthcare systems. Covid-19 exposed the need for timely response and data sharing on fast spreading global pandemics. In this study, we investigate the scientific research response from the early stages of the pandemic, and we review key findings on how the early warning systems developed in previous epidemics responded to contain the virus.MethodsWe conducted data mining of scientific literature records from the Web of Science Core Collection, using the topics Covid-19, mortality, immunity, and vaccine. The individual records are analysed in isolation, and the analysis is compared with records on all Covid-19 research topics combined. The data records are analysed with commutable statistical methods, including R Studio’s Bibliometrix package, and the Web of Science data mining tool.ResultsFrom historical analysis of scientific data records on viruses, pandemics and mortality, we identified that Chinese universities have not been leading on these topics historically. However, during the early stages of the Covid-19 pandemic, the Chinese universities are strongly dominating the research on these topics. Despite the current political and trade disputes, we found strong collaboration in Covid-19 research between the US and China. From the analysis on Covid-19 and immunity, we wanted to identify the relationship between different risk factors discussed in the news media. We identified a few clusters, containing references to exercise, inflammation, smoking, obesity and many additional factors. From the analysis on Covid-19 and vaccine, we discovered that although the USA is leading in volume of scientific research on Covid-19 vaccine, the leading 3 research institutions (Fudan, Melbourne, Oxford) are not based in the USA. Hence, it is difficult to predict which country would be first to produce a Covid-19 vaccine.ConclusionsWe analysed the conceptual structure maps with factorial analysis and multiple correspondence analysis (MCA), and identified multiple relationships between keywords, synonyms and concepts, related to Covid-19 mortality, immunity, and vaccine development. We present integrated and corelated knowledge from 276 records on Covid-19 and mortality, 71 records on Covid-19 and immunity, and 189 records on Covid-19 vaccine.     

Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic

Introduction and objectivesDuring the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training.MethodsTwelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage.ResultsUsing a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions.ConclusionsProfessionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.     

Covid-19 and the digestive system

The novel coronavirus disease is currently causing a major pandemic. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Betacoronavirus genus that also includes the SARS-CoV and Middle East respiratory syndrome coronavirus. While patients typically present with fever and a respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin converting enzyme 2 was found to be highly expressed in gastrointestinal epithelial cells. These suggest that SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract. This has important implications to the disease management, transmission, and infection control. In this article, we review the important gastrointestinal aspects of the disease.     

Worrisome trends of ST-elevation myocardial infarction during the Covid-19 pandemic: Data from Portuguese centers

IntroductionDuring the Covid-19 pandemic there has been a general belief that hospital admissions for non-infectious causes, especially cardiovascular diseases, have fallen.ObjectivesTo assess the impact of the pandemic on admissions for ST-elevation myocardial infarction (STEMI) during the first pandemic wave.MethodsWe performed a multicenter retrospective analysis of consecutive patients presenting with STEMI in two Portuguese hospital centers in two sequential periods – P1 (March 1 to April 30) and P2 (May 1 to June 30). Patient's clinical data and hospital outcomes were compared between the years 2017 to 2019 and 2020 for both periods.ResultsDuring P1 in 2020, a reduction in the number of STEMI patients was observed in comparison with previous years (26.0±4.2 vs. 16.5±4.9 cases per month; p=0.033), as well as an increase in the number of mechanical complications (0.0% vs. 3.0%; p=0.029). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs. 9.1%; p=0.033). An overall trend for longer delays in key timings of STEMI care bundles was noted. Mortality was higher during P1 compared to previous years (1.9% vs. 12.1%; p=0.005).ConclusionsDuring the first Covid-19 wave fewer patients presented with STEMI at the catheterization laboratory for percutaneous coronary intervention. These patients presented more mechanical complications and higher mortality.     

Self- management of diabetes mellitus during the Covid-19 pandemic: Recommendations for a resource limited setting

Background and aimsThe COVID-19 pandemic has challenged both institutional and self-management of diabetes. The ongoing social distancing and lock downs have negatively impacted to access to care and self-management.MethodsThis is a narrative review of diabetes management in a resource limited setting during the ongoing COVID-19 pandemic. Electronic databases, namely; Pubmed, CINAHL, EMBASE and Google Scholar were searched for literature. Search terms were “corona virus”, “COVID-19”, “diabetes self-care”, “diabetes self-management education”, “DSME”, “diabetes self-management”, “diabetes self-care in low income countries” and “diabetes management in Zimbabwe”.ResultsThis paper suggests a culturally tailored educational plan on diabetes self-management of diabetes in a limited resource country, Zimbabwe, amid the ongoing COVID-19 pandemic. Components of health education comprised general preventive measures, medications, diet, physical activity, self-monitoring of blood glucose, stress management, foot care, smoking and drinking and preventing complications of diabetes mellitus.ConclusionsWe have reemphasized the need for self-care, social support and a collaborative, patient-centered approach to care amid the ongoing COVID-19 pandemic.     

Drastic decrease of urgent endoscopies outside regular working hours during the Covid-19 pandemic in the paris area

Background and Study AimsThe coronavirus 2019 (COVID-19) pandemic has significantly affected medical care. We surmise that the number of urgent endoscopies outside regular working hours in the Paris area decreased as a result. The objective of this study was to describe the observed number of acts during the 2020 mandatory period of home isolation, compared to the values in prior years and the expected value for 2020.Material and methodsWe performed a multicenter cohort study to investigate the practice of urgent endoscopy acts, outside regular working hours, in Paris and its surrounding suburbs, in the setting of the COVID-19 pandemic. We collected the number of endoscopies performed between January 17th and April 17th 2018, 2019 and 2020. We then collected clinical, endoscopic and outcome variables from the patients of years 2019 and 2020.ResultsFrom March 17th to April 17th (during home isolation), the number of acts was respectively of 147 in 2018, 137 in 2019, and 79 in 2020, lower that the expected number of 142 (-44.0%). In 2020, the number of endoscopies for suspected gastrointestinal bleeding (GIB), and findings of variceal and non-variceal bleeding decreased by 52.1%, 69.2% and 43.1% respectively, after a month of home isolation. In-hospital death rate were similar.ConclusionsThis study confirms that the urgent endoscopy caseload outside regular hours decreased nearly by half during the pandemic. Our results suggest a decreased number of endoscopies for suspected gastrointestinal bleeding, and findings of variceal and non-variceal bleeding.     

Top 50 cited articles on Covid-19 after the first year of the pandemic: A bibliometric analysis

Background & aimsIt has been just over a year since the Covid-19 pandemic started. The top 50 cited articles on this subject would help identify trends and focus on the research efforts.MethodsWe utilised e-utilities in PubMed to find publications on Covid-19 until the date of search on 7/2/21. The iCite website was used to find the top 50 citations of the output from the search strategy. We looked into their full text for the editorial dates, type of study, level of evidence, focus of the article and country of origin. We also counted the errata and comments on each of them.ResultsThe total number of citations of all 50 articles was 123,960, the highest being 10, 754 for a single article. Huang C was the most cited first author. They were published from week 4–17, with February being the month with most citations. Lancet was the most cited journal, having published 9 of the 50 articles. Majority belonged to level 3 of the evidence ladder and were retrospective studies. Thirty percent of them had an errata published and an average of 7 comments per article.ConclusionThe top 50 most cited articles identify the most impactful studies on Covid-19, providing a resource to educators while identifying trends to guide research and publishing efforts. There has been an explosion of publications and an unprecedented rate and number of citations within the first year for any single condition in the literature.