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Frail populations burdened with chronic diseases can get more severe forms of coronavirus disease-2019 (COVID-19) and have a higher mortality rate.
To test the efficacy of a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) containment protocol in patients with endstage renal disease (ESRD) diabetes mellitus (DM) requiring dialysis, who are a typical example of the above category.
The protocol included: (i) daily telephone COVID-19 related triage for patients and their general practitioners (GPs); (ii) social distancing; (iii) environment sanitization, including ambulances, transfer vans, medical equipment, patient/health personnel clothing, and individual protection devices; (iv) adoption of quota systems for patients allowed to the dialysis room, and increased time lags among dialysis shifts. Eight hundred twenty-five (825) patients on dialysis (315 with and 510 without DM), and 381 healthcare providers (HCPs) were monitored continuously from the start of the pandemic until the end of the lockdown.
No HCPs were infected, while only two patients on dialysis were positive for SARS-CoV-2: one with DM, who died in intensive care, and one without DM, who recovered at home. The adopted contagion containment protocol proved to be effective for both HCPs and patients.
Therefore, we propose it as a useful model for any internal medicine or ESRD specialized units dealing with patients on dialysisoriented with or without DM.
COVID-19, Dialysis, Diabetes, Prevention, Contagion.
After the official coronavirus (severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)) pandemic declaration by the World Health Organization (WHO), Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our National Health Service (NHS) again.
To assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium dialysis centers (DCs) as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors.
381 HCP members underwent regular monitoring on April 1 and November 13, 2020. Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean±SD:853±30 per month; range 825 to 873) vs (11.8% in April, and 14.8% in November vs. a pre-coronavirus disease-2019 (COVID-19) 12.0% rate in January).
More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic’s two periods
showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD).
The previously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The author, discuss possible reasons and put forward further suggestions for the best handling of any future infection waves.
COVID-19; Dialysis; Diabetes; Prevention; Contagion; COVID second round.
Mechanisms by which some plants with antihyperglycemic effects reduce postprandial hyperglycemiaare not fully elucidated. This study was designed to investigate some action mechanisms of extracts from stem bark of Citrus sinensis, seeds of Persea americana and bulbs of Allium sativum including in vitro inhibition of α-amylase and invertase; glucophagic capacity, absorption capacity on yeast cells and psoas tissues.
Recently, elder patients tend to have neuropathic pain such as lower back and joints pain, stiff shoulders, besides diabetic neuropathy. Typical peripheral neuropathic pain includes diabetic peripheral neuropathic pain (DPNP), postherpetic neuralgia (PHN) and chronic pain due to herniated disc. Three analgesic agents are described. Pregabalin (Lyrica®) has been prevalent worldwide. However, it has been provided for several diseases for off-label administration, which has been one of the clinical problems.Mirogabalin (Tarlige®) has revealed efficacy for DPNP in a dose-dependent manner. Duloxetine hydrochloride (Cymbalta®) has efficacy for pain and also depression as serotonin and noradrenaline reuptake inhibitor (SNRI).
Neuropathic pain; Pregabalin; Mirogabalin; Duloxetine hydrochloride; Diabetic peripheral neuropathic pain (DPNP).
DPNP: Diabetic peripheral neuropathic pain; PHN: Postherpetic neuralgia; CRPS: Complex regional pain syndrome; FDA: Food and Drug Administration.
The case was 52-year-old female with type 2 diabetes mellitus (T2DM) for 10-years. She complained of the decreased sensation of right lower foot, and revealed diabetic foot infection (DFI) and/or diabetic foot osteomyelitis (DFO) at right 1st proximal phalanx. Various data included body mass index (BMI) 33.3 kg/m2, HbA1c 11.4%, blood glucose 430 mg/dL, WBC 12100 /μL, C-reactive Protein (CRP) 13.5 mg/dL. On admission (day 1), she was started by 4 times of injection (Aspart and Glargin) with glucose profile 200-500 mg/dL. Surgical amputation of the right toe was performed between 1st metatarsal and proximal phalanx (day 17). Then, blood glucose profile decreased moderately. After discharge of the hospital, super-Low Carbohydrate Diet (LCD) was started without Aspart (day 37). Consequently, glucose profile was normalized with HbA1c 6.3% on (day 77). Consequently, LCD was evaluated to be effective for glucose variability in this case and some related discussion was described.
Diabetic foot infection (DFI); Diabetic foot osteomyelitis (DFO); Low Carbohydrate Diet (LCD); Japanese LCD promotion association (JLCDPA); International Working Group on the Diabetic Foot (IWGDF).
DFI: Diabetic foot infection; DFO: Diabetic foot osteomyelitis; LCD: Low carbohydrate diet; JLCDPA: Japanese LCD promotion association; IWGDF: International Working Group on the Diabetic Foot.
Deep venous thrombosis (DVT) in an amputated stump is potentially life-threatening but rarely diagnosed and there are limited data in sub-Saharan Africa. This is aimed at demonstrating an additional vascular risk in patients with lower limb amputation and diabetes. A 74-year-old man who had a right above knee amputation done on account of grade 5 right diabetic foot with post-operative prophylactic anticoagulation. Doppler ultrasound done before the surgery showed bilateral multiple lower limb arteries atherosclerosis but no evidence of deep venous thrombosis. He was discharged home on Zimmer frame. Three months after, he was noticed to have differential swelling of the right amputation stump. Thigh circumference measured at 15 cm below the anterior superior iliac spine was 55 cm and 50 cm on the right and left respectively there was but no differential warmth or tenderness. The vital signs were relatively stable. Doppler ultrasound scan of the lower limbs showed an echogenic thrombus in the right deep femoral vein. He was commenced on therapeutic dose of subcutaneous enoxaparin. DVT in an amputated stump is uncommonly encountered. It may not have classical clinical findings. Poor mobility and pooling of venous blood in the amputated stump are some of the risk factors that have been reported. DVT in an amputated stump in a patient with diabetes is rare and may not present classically. It may be one of the potential reasons for the increased mortality after lower limb amputation.
Deep venous thrombosis (DVT); Amputated stump; Diabetes patient.
Menopause is a critical time in a woman’s life which heralds the cessation of reproductive competence. There is body fat redistribution which increases the risk of type 2 diabetes mellitus (T2DM). There is a complex interrelationship between menopause and T2DM; several variables like the timing of the menopause, the type of menopause and the symptomatology impact this relationship. The treatment of vasomotor symptoms with hormone replacement therapy may also impact glycemia both in women with and without pre-existing T2DM. We tried to examine this relationship based on current scientific evidence. We also suggested strategies
to reduce the burden of T2DM in menopausal women.
Menopause; T2DM; Hormone replacement therapy.
Life Science Promotion Foundation
25-3-1004, Daikyo-cho, Shinjuku-ku
Tokyo 160-0005, Japan
Chief Executive Officer
Chief Scientific Officer
Prometheon Pharma, LLC
Sid Martin Biotechnology Incubator
University of Florida
10285 Research Drive
Alachua, FL 32615, USA
Department of Endocrinology and Diabetes Mellitus
School of Medicine
7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan