HIV and Covid-19: retrospective analysis of hospitalized patients

Clinical results for PLHIV hospitalized for Covid-19 have shown mixed results. Data from the OpenSAFELY study shows that HIV patients have a 2.9-fold risk of death linked to Covid-19 and in the Isarik cohort, the authors find a hazard ratio of 1.49 in terms of mortality at J28. Via a retrospective multicenter analysis of matched cohorts in the United Kingdom, the aim of this study was to estimate the effect of HIV status on the outcome of hospitalized Covid-19 patients.

Index cases were HIV + patients Covid-19 PCR + hospitalized between 1 st  February and 31 May 2020. The negative patients were matched for PLHIV to a ratio of 3: 1 of 6 sites in England, site hospital, date of test ± 7 days, age ± 5 years, sex. The primary endpoint was patients achieving ≥ 2 points improvement on the WHO 7 point scale or discharge from hospital. Baseline characteristics and outcomes were analyzed by stratified Cox proportional hazards regression. The model was fitted for ethnicity, clinical frailty score, body mass index, baseline hypoxia, duration of symptoms, hypertension, diabetes, malignancy, heart, lung and kidney disease.

68 PLHIV and 181 HIV-negative patients were included out of 6,612 hospitalized patients over the period, in the different sites.

Patients since HIV diagnosis, CD4 at 352 / mm 3 , 97.1% have an undetectable viral load <200 copies / mL and 47.6% were on integrase inhibitors.

In terms of initial characteristics or comorbidities, PLHIV are, compared to subjects not infected with HIV, more frequently with end-stage renal impairment or on dialysis, with Child B or C hepatic impairment, with a higher frailty score, and more often black / other minority.

On the criterion “improvement ≥ 2 points on the WHO 7-point scale or discharge from the hospital”, the results are as follows:

PLHIV had a hazard ratio of 0.57 ( 95 CI  : 0.39-0.85; p = 0.005) of achieving a 2-point improvement or discharge from hospital compared to HIV-negative patients. HIV. On the other hand, no difference in mortality at D28 between the 2 groups.

The effect of HIV status is attenuated (aHR = 0.70; 95 CI  : 0.43-1.17; p = 0.18) after adjustment in the multivariate model with the frailty score (aHR = 0.79; CI 95  : 0.65-0.95; p = 0.011), have an active cancer (aHR = 0.37; CI 95  : 0.17-0.82; p = 0.01) or a BMI < 25 (aHR = 0.46; CI 95  : 0.21-0.99; p = 0.047) having a greater impact on the primary endpoint. In terms of secondary endpoints, there is no difference in death or use of mechanical ventilation or improvement in WHO criteria on D28.

Although PLHIV are less likely to achieve improvement or discharge from hospital, after adjustment, the effect of HIV status is lessened. Increased baseline fragility and active malignant tumors remain associated with poorer outcomes for Covid-19.

Abdoul (assumed name), a homeless and undocumented Moroccan in Spain, has survived since last November without his diabetes medication.

As soon as he came of age, Abdoul decided to leave Morocco to join Spain via the Canary Islands, in order to build a better future. Rescued on November 7 by the emergency services, he stayed for 28 days in the Arguineguín detention center, before being accommodated in a hotel where catering conditions were difficult.

After losing consciousness, he was transported to a health center where he was diagnosed with type II diabetes. In the process, he lost his cell phone and the little money he had. “I fainted up to three times and no one cared about my state of health or provided me with any necessary medication,” he laments.

After repeatedly asking for better treatment, Abdoul, against all odds, tested positive for Covid-19, without any apparent symptoms, then was placed in quarantine for an unusually long period of time.

Last month, a ruptured pipe flooded the new camp he was transferred to with sewage, forcing staff to group them into a single tent, in violation of sanitary protocol. Pushed to leave, he left the center with other residents, before asking to come back. But the authorities at the center refused him, which forced him to return to live on the streets. And it was there that he had a new crisis of diabetes and was taken care of by the center.

Today, Abdoul controls his sugar consumption, takes his tablets regularly. If he was still on the streets, his health problems could very well have cost him his life.

Types, differences and everything you need to know about it

Diabetes mellitus is a class of metabolic diseases all of which have in common high levels of sugar in the blood (glucose) that result from problems with insulin secretion, its action, or both. Usually, blood sugar is controlled by a hormone secreted by the pancreas called insulin. When there is an increase in blood sugar, the pancreas releases insulin to normalize blood sugar. There are mainly two types of diabetes: type 1 and type 2.

Both types are chronic diseases that affect the way blood sugar levels or the regulation of glucose in the body. Glucose is like the fuel that nourishes the cells of the body, but to get into the cells it needs a key which is insulin.

Type 1: People with diabetes of this type do not produce insulin.

Type 2: People with diabetes of this type do not respond to insulin and, later in the disease, often fail to produce enough insulin.

What is insulin?

Insulin is a hormone produced by specialized cells in the pancreas. Insulin is also important to strictly control the level of glucose in the blood.

Insulin treatment:

People with type 2 diabetes may need insulin when their meal plan, weight loss, physical activity, and medications do not reach target blood sugar (sugar) levels. In a progressive disease such as diabetes, insulin injections may be needed to compensate for the decrease in production by the pancreas. Therefore, insulin treatment should never be seen as a failure.

Possible healing:

Type 1: No cure at this time, but lifelong treatment can treat symptoms. Gene therapy, regenerative medicine using stem cells, or pancreatic islet transplantation over time may become an option.

Type 2: Currently no cure, but taking measures can slow progression and manage symptoms. Symptoms can be reduced with gastric bypass in people with severe obesity.

Prevention:

Type 1: It is not yet possible to prevent.

Type 2: A healthy diet with regular exercise should be followed. If prediabetes is diagnosed, follow a doctor’s instructions.

Outlook

Diabetes is a serious illness. For type 1, insulin and other medications can help people manage symptoms and lead normal lives. Although there may be a hereditary link for both types of diabetes, the risks of type 2 diabetes can be reduced and managed by adopting a healthy lifestyle and exercising regularly. Anyone diagnosed with prediabetes should make healthy lifestyle choices to eliminate the risk of developing type 2 diabetes.

Symptoms and treatment of diabetes in cats

How can you tell that your cat may be diabetic? Certain signs can alert …

If your pet drinks and eats a lot more than usual and urinates a lot, he may have diabetes, especially if he is overweight. These symptoms can be accompanied by fairly rapid weight loss. A visit to your veterinarian is essential, because it is better not to let such a situation worsen.

What are the risks ?

If you don’t quickly identify the symptoms, or if you don’t show your cat quickly to your vet, your pet may become dehydrated, vomit, or even go into a coma. He can also develop urinary or kidney disease.

What are the exams to do?

Only a veterinarian can make a diagnosis, based on a blood test and urinalysis. The aim is to detect whether or not there is hyperglycemia, i.e. too high a concentration of sugar in the blood. The urinalysis will determine if your cat has sulfur in the urine. An abdominal ultrasound can determine if the pancreas is also affected.

What are the treatments ?

In some cases, if the diabetes is mild, a change in diet may be enough to regulate your pet’s blood sugar levels. Croquettes are specifically designed for this; they are only available from a veterinarian. They are not found in supermarkets.

An overweight cat will have to lose weight gradually and a skinny cat will have to gain weight, under veterinary control and at its own pace.

Insulin administration in the morning and evening in the form of an injection pen will often be necessary. It is certainly binding, but essential. Hospitalization of the cat in a veterinary clinic will allow the best dosage of insulin therapy at the start of treatment. Thereafter, your cat will have to be brought in every six months for a consultation so that the veterinarian can check if his insulin treatment is still effective or if it needs to be adapted.

Early detection and treatment of diabetes in cats can sometimes prevent insulin intake.

Physical activity and diabetes control

It had been the first of two demonstrations for people who wish to find out more about this chronic illness.

With this workshop, the nurse provided her advice for secure physical activity as a diabetic. To begin with she counsels talking to her doctor to ensure to return to a fantastic start. Individuals with eye problems particularly ought to be taught, as exercise may damage sensitive blood vessels in the eye.

Then you need to begin softly and listen to your own body. Ms. Côté adds that working in pairs or in a group, along with being a security against the sudden, can be helpful for the social aspect. During instruction, it’s very important to carry identity documents with you and also to remain hydrated.

Since muscles feed sugar, physical activity increases the body’s utilization of glucose and increases insulin sensitivity. The blend of its components can occasionally reduce glucose too much.

The Canadian Society for Exercise Physiology advocates 150 minutes of exercise each week for many adults. The nurse also reiterates the value of exercise since it gives an assortment of advantages to the human body also helps prevent complications in diabetes.

Participants asked questions regarding particular foods and heard, among other items, that bananas, in 30g, are extremely sweet and rely on 2 portions. In terms of peanut butter, 1 tablespoon is your 15 gram serving. The nurse confirms it is imperative to be approximately 60 gram of carbohydrate daily and also to remain between 4.5 and 6.5 mmol / L as blood glucose level for optimum wellness.

The following webinar will be provided via Zoom Tuesday January 26th. Ms. Côté will examine carbohydrates and describe how to read labels which are sometimes misleading.

Type 2 diabetes: the younger he declares himself, the more disastrous the consequences

The sooner a individual develops type 2 diabetes in life, the more severe the health issues. The harm done, particularly into the blood vessels, also introduces a risk of complications like heart disease and stroke.

Our bodies are designed to move, from a young age. A sedentary lifestyle, correlated with a bad diet rich in polyunsaturated fatty acids, which leads to excessive weight that’s just the cornerstone of this type two diabetes. This disorder, the spread of that is widespread in Western societies due to our styles. Based on statistics in the Federation of Diabetics, the disorder affected 3.7 million individuals in France at 2015, and over 90 percent of these have type 2 diabetes. Researchers in the University of Melbourne (Australia) have demonstrated that type 2 diabetes which affects children, teens and young adults has a more damaging effect on their health, particularly in their own blood vessels.

Diabetes as a manifestation of this Method of life

As a result of this failure of insulin, that the body can no more control blood glucose , the concentration of sugar in blood flow, which contributes to chronic hyperglycemia. Diabetes Isn’t a single disorder and can be divided into three Distinct branches:
– Gestational diabetes just affects pregnant girls, even when they have a history of diabetes. It may cause complications during pregnancy however vanish after the birth is finished. It’s triggered by recurrent hyperglycemia, excessive urination and acute thirst. Type 1 diabetes could be controlled by insulin given many times every day, routine physical activity and a balanced diet plan. In addition, we speak about natural diabetes since it can be present at birth but won’t appear till later. It’s preferred with a sedentary lifestyle, obese, obese and a bad diet that’s quite full of saturated fatty acids. Over the years, insulin resistance and chronic hyperglycemia may cause many different complications, such as damage to blood vessels.

Normally, type 2 diabetes doesn’t have any taste and strikes at all ages. However, according to investigators, for every additional year of age at the time of analysis, the odds of dying during the analysis decline by 4 percent. In their own, the results aren’t surprising, since the more a individual resides with diabetes, the further complications collect. But they still work against the results because generally,”older individuals face more complications from the illness than younger people that are relatively fitter, but at the sort of diabetes, it’s’different,'” he explained. From Jeffrey Mechanick, manager of the Mount Sinai Heart Cardiovascular Center at New York (USA).

Increased dangers when diabetes is premature

To discover, the researchers mixed the results of 26 studies involving a total of over 1.3 million individuals in 30 nations. For a few of the researchers, participants, that had been originally aged 22 to 67, were followed for many decades.

The probability of diseases related to damage to blood vessels is reduced by 3 to 5 percent for every year of increasing age at identification.

Previously, type 2 diabetes has been primarily a disorder of the elderly. But, with all the prevalence incidence of obese, the disorder is being diagnosed with adult children, in addition to in teens and children. When diagnosed with mature children, the disorder is frequently associated with excessive weight in the kid, in addition to eating habits and lack of exercise obtained early in life.

“It is important for young individuals with type two diabetes to determine their physicians regularly to maximize their risk factors for your center,” said Joanna Mitri, an endocrinologist at the Joslin Diabetes Center in Boston and a professor in the School of Harvard Medicine. It’s essential that young people don’t underestimate the chance of complications in diabetes, by controlling their blood glucose, but by their own blood pressure and cholesterol.

Diabetes mellitus: causes and symptoms

There are around seven million people in Germany who have been diagnosed with diabetes mellitus – but estimates assume that there are many more people who still go unrecognized. The more people know about the danger of diabetes, its causes and symptoms, the sooner it can be recognized and countermeasures can be taken. In the following, we will introduce you to the causes and signs of metabolic disease, and explain which tests are necessary for diagnosis and how treatment is performed.

Definition: what is diabetes?

When people talk about diabetes, they are usually referring to diabetes mellitus. Diabetes mellitus is a chronic disorder of sugar metabolism. This is where the colloquial term “diabetes” comes from.

There are different forms of diabetes mellitus that have different causes and symptoms and require different treatments. The most common forms are type 1 and type 2 diabetes, with type 2 diabetes accounting for about 90-95% of cases. The hormone insulin plays an important role in both diseases.

This is how insulin affects blood sugar levels

Sugar belongs to the group of carbohydrates and is an important supplier of energy. We do not only consume sugar in the form of sweets, but mainly in the form of starch, for example in cereals or potatoes. During digestion our body breaks down carbohydrates and grape sugar (glucose) is produced. This increases the level of sugar in the blood, that is, the amount of sugar in the blood.

In order for this sugar to pass from the blood to the cells of the body, where energy is needed, the body’s own hormone insulin is needed. When the concentration of sugar in the blood rises, insulin is released into the blood from certain cells in the pancreas (called Langerhans cells), which then helps transport the sugar to the cells and thus lower blood levels. blood sugar.

However, if the pancreas no longer produces enough insulin or if the cells no longer respond properly to insulin, glucose cannot travel from the blood to the cells. While the organs “starve” because no sugar is entering them, the concentration of sugar in the blood is very high.

Some of the excess sugar is excreted in the urine. This makes the urine taste sweet – which was actually used in the past to diagnose diabetes. Hence the name of the disease comes from: Diabetes mellitus means something like “sweet flow of honey”.

Types and causes of diabetes

Diabetes mellitus can have many different causes. The following forms of diabetes are distinguished, depending on the cause:

In type 1 diabetes, the insulin-producing cells of the pancreas (beta cells) are usually destroyed by an immune process (i.e. an autoimmune disease) in childhood or adolescence – this early onset is also called juvenile diabetes. In this form of diabetes, there is a so-called absolute insulin deficiency.
Type 2 diabetes is usually the result of being overweight, sedentary and unhealthy eating. This form gradually develops from a resulting insulin resistance and is also called adult diabetes in a trivial way. However, that shouldn’t hide the fact that younger adults can develop this form of diabetes too.
The unofficial name of type 3 diabetes covers a very different group of different and very rare forms of diabetes. The causes are:
genetic defects in the beta cells that hinder the release of insulin (MODY forms)
genetic defects in the action of insulin
Pancreatic disorders (for example, chronic pancreatitis or cystic fibrosis)
hormonal disorders (such as Cushing’s syndrome or acromegaly)
Medicines or chemicals (for example, corticosteroids or ingested thyroid hormones)
Infections (such as cytomegaly)
unusual forms of immune-mediated diabetes (such as insulin autoimmune syndrome)
other genetic causes (for example Wolfram syndrome or Down syndrome)
Gestational diabetes is a type of diabetes that – as its name suggests – is diagnosed for the first time during pregnancy, regardless of whether the disease was previously undetected. This is mostly type 1 or type 2 diabetes.
LADA (latent autoimmune diabetes in adults) is a special form of type 1 diabetes that occurs after a delay and only occurs in adults. It is often mistaken for type 2 diabetes in the early stages and only gradually develops the typical characteristics of type 1 diabetes

What causes type 2 diabetes?

Type 2 diabetes is the most common type of diabetes mellitus. In many cases, its development is influenced by one’s own lifestyle: the trigger is often a combination of an unhealthy diet, too little exercise and being overweight.

Being overweight means that the organs need more and more insulin before they let blood sugar into the cells. One speaks of insulin resistance, an important harbinger of diabetes mellitus. At the same time, the years of overproduction of insulin, which the increased demand brings with it, leads to a kind of “exhaustion” of the insulin-producing cells. This means that insulin is still being produced, but not enough. Experts therefore speak of a relative insulin deficiency.

In addition to the factors mentioned, the risk factors also include smoking, increased blood pressure and increased blood lipid levels. However, genetic predisposition, older age or certain medications (e.g. cortisone) can also play a role in the development of the disease.

Symptoms and signs of diabetes

The early detection of diabetes is important in order to start appropriate treatment and avoid secondary diseases. But how do you recognize diabetes?

Possible signs or symptoms of diabetes include:

  • excessive thirst
  • Increased need to urinate and passing large amounts of urine – especially at night
  • a tendency to infections, for example urinary tract infections
  • Cravings
  • Fatigue, exhaustion and a drop in performance
  • poorly healing wounds
  • dry and itchy skin
  • heavy legs
  • excessive or decreased sweating
  • Type 2 diabetes usually develops slowly

Years, with type 1 diabetes the onset of the disease is more likely within weeks. This form of the disease can also lead to unexplained weight loss and gastrointestinal problems.

What happens if diabetes is not recognized?

If diabetes is not noticed or is not properly treated, permanent high blood sugar can lead to serious complications. For example, a lack of insulin can lead to a diabetic coma with nausea, vomiting and loss of consciousness.

Due to the high sugar content in the blood, damage to the vessels develops over time, which can sometimes irreversibly damage the eyes, feet, heart, kidneys or other organs. Diabetics are therefore at an increased risk of developing diseases such as nerve damage, stroke, heart attack, kidney failure, high blood pressure, or erectile dysfunction.

Gestational diabetes mainly puts the child at risk, and it can also lead to so-called poisoning during pregnancy (gestosis).

The problem with diabetes is the generally slow development of insulin resistance. Many internal organs are affected while the disease is not yet known or the symptoms and signs are not yet evident.

 

Take the following diabetes symptoms seriously – and take targeted action in the event of a diabetic coma

Diabetes is among the most usual prevalent ailments. If left untreated, organs have been ruined; at the worst case situation, the end result is a diabetes slump with deadly consequences.

  • The initial form is triggered with a false response of their own immune system and generally starts at a young age.
  • The immune system of these influenced attacks the cells in the pancreas which make the hormone insulin.
  • Over 5 million people in Germany are affected with diabetes – also called diabetes mellitus or diabetes . Type 2 diabetes is also called diabetes.
  • Learn here that symptoms talk for diabetes and what to do immediately in case of a diabetic neuropathy.

Regardless of if diabetes type 1 or two: The two metabolic disorders have the exact same consequence. The glucose metabolism doesn’t operate generally, which drives the blood glucose level up indefinitely. The cause of this: Your body can’t create the hormone insulin in adequate amounts (type 1 diabetes) or it can’t use it nicely (type 2 diabetes). Diabetes has to be treated in almost any instance, as a permanently large blood glucose level damages the blood vessels, which may result in sensory disturbances like tingling in the toes. Organs such as the kidney can also be damaged. At the worst instance, those influenced fall into a diabetic coma – with life threatening consequences.
Recognizing diabetesYou should take the symptoms seriously

Since the portal diabetes-deutschland advises, physicians suspect a large number of unrecognized diabetes sufferers. The cause of this is that diabetes disorders frequently can’t be clearly assigned, but could also talk for different ailments. These symptoms may signal type 2 diabetes since the most Frequent form of the disorder:

That’s the reason why the diagnosis is frequently sudden.

Act promptly in Case of a diabetic coma

There are various kinds of diabetic coma, on the 1 hand hyperosmolar coma and on the flip side ketoacidotic coma. The former generally only impacts type 2 diabetes. Blood glucose levels over 600 mg / dl happen, which contributes to a huge loss of fluid within the body. The enhanced urinary excretion contributes to the reduction of electrolytes: influenced individuals dry out (desiccosis). Metabolic imbalances happen since there’s a deficiency of insulin from the body – such as when folks neglect to inject insulin.

Hyperosmolar coma is considerably rarer than ketoacidosis and generally develops gradually over weeks and days, according to diabetes-ratgeber. net. Fatigue, eyesight difficulties, calf cramps or fat reduction are precursors that precede a hyperosmolar coma, according to Heilpraxisnet. Medical caution is essential in order that diabetes could be suitably controlled and consequently prevent diabetic coma. To prevent an overacid coma, patients with higher blood glucose (more than 250 mg / dl) plus a ketone body evaluation that reveals overacidity ought to take the countermeasures discussed by their physician. (jg) * Merkur is a part of this Ippen-Digital editorial community throughout Germany.