[Covid-19 and the diabetes mellitus]
SIMONYI Gábor1
NOVEMBER 04, 2020
Hypertension and nephrology - 2020;24(05)
DOI: https://doi.org/10.33668/hn.24.020
Review
SIMONYI Gábor1
NOVEMBER 04, 2020
Hypertension and nephrology - 2020;24(05)
DOI: https://doi.org/10.33668/hn.24.020
Review
[In late 2019 the epidemic of new coronavirus disease (Covid-19) from Wuhan, China, posed major challenges to the health systems of even the most developed countries. High mortality of the disease has been observed mainly in the elderly and in those with various cardiovascular and metabolic comorbidities. In this summary, the relationship between diabetes mellitus]
Hypertension and nephrology
[The authors review those components and mechanisms in the two major regulatory systems of circulation and inflammation-coagulation whose internal balance and interactions are pathologically altered during SARS-CoV-2 infection, thereby enhancing lung and systemic inflammation threatening to enter into severe clinical condition. They examine the question of how – in addition to potentially promoting the coronavirus cellular entry and penetration – the RAS inhibitor therapy affects these changes and whether can be supposed difference between the anti-/pro-inflammatory influence of ACEi and ARB treatment of old hypertensive patients representing a remarkably high proportion of victims in COVID-19 epidemic. The paper is focussing to the pathomechanical background of inflammation beyond the direct immunological response to the infection: to the significance of immunological alterations characterizing old hypertensive patients also in basic condition, and to the key components as angiotensin II, ACE2, angiotensin1-7, bradykinin, ARB and ACEi. In conclusion a consideration on optimal point of action is offered in RASi treated and SARS-CoV-2 infected (old) hypertensive patients.]
Hypertension and nephrology
[The aim of this paper is to give an overview of the relationship between stress and hypertension and cardiovascular diseases, furthermore to introduce an evidence based stress management intervention available in Hungary. The correlation between cardiovascular disease and psychosocial factors (including concomitant mental disorders as well as personality traits or the effect of social environment) has been established in numerous studies aimed at investigating pathogenesis or various clinical endpoints. The 2016 Guidelines of the European Society of Cardiology include the assessment and the management of psychosocial problems with behavioral medicine interventions as a I.A level recommendation. The implementation of these guidelines in everyday clinical practice is crucial to decrease cardiovascular risk. This involves the training of health care professionals, the facilitation of multidisciplinary collaboration and the integration of behavioral intervention into everyday care. The Williams Life Skills (WLS) program is an evidence based behavioral medicine intervention aiming to improve stress management and communication skills which implemented internationally and also available all over Hungary. It involves the learning of simple coping strategies that facilitate the successful management of every day psychosocial stress situations and the self-conscious reduction of bodily and psychological tensions. In cardiovascular disease, this improves quality of life and survival. The WLS program is especially recommended for healthcare workers to decrease the negative health consequences of their high stress load and to prevent burnout. Stress may affect both doctors and patients during their interactions. Bálint groups have a positive impact on the physician-patient collaboration and help to reduce burnout by improving the understanding of the diseases from a more complex approach.]
Hypertension and nephrology
Hypertension and nephrology
[The ACE2-Ang(1-7)-Mas axis counterbalances the ACE/Ang II-AT1R axis in our body in order to maintain normal homeostasis. During the Covid-19 pandemic, this protective system came to the fore again and its beneficial effects on the cardiovascular-metabolic system, including the significant antihypertensive effect, are being clarified. In our brief summary, we analyze the essential aspects of this research.]
Clinical Neuroscience
[Shortly after that COVID-19 appeared it became clear, that although the disease mainly characterized by respiratory symptoms, other signs frequently appeared, which showed involvation of other organs. There are several new publications which report about neurological complications. According to data developing of encephalitis could be relatively frequent among these. Its symptoms can mostly be observed concommittantly with respiratory symptoms or during critical state of the disease, and several forms were detected. In our patient symptoms of central nervous system involvement appeared a few weeks after healing of COVID-19 pneumonia. Clinical signs, imaging, electroencephalograpy and cerebrospinal fluid analysis confirmed the diagnosis of encephalitis. Considering the previous SARS-CoV-2 infection and the results of the examinations, we think this case was a postinfectious central nervous system disease. There are only a few data available regarding encephalitis after Covid-19 disease in the literature, yet. ]
Hypertension and nephrology
[Results of cardiovascular safety studies with SGLT-2 inhibitors have shown that in addition to their hypoglycaemic and beneficial cardiovascular effects, they are renoprotective. A number of mechanisms underlying the renoprotective effects of SGLT-2 inhibitors have been shown to reduce albuminuria and deterioration of renal function. Their nephroprotective effects extend over a very wide range of eGFR and albuminuria categories. In the DAPA-CKD study, dapagliflozin was shown to exert its nephroprotective effect regardless of the presence of diabetes and a baseline eGFR, while also having a beneficial effect on cardiovascular endpoints and mortality. Following the confirmation of favourable renal results for SGLT-2 inhibitors, it is no coincidence that they have been included in national and international recommendations for the treatment of chronic kidney disease.]
Lege Artis Medicinae
[It is no exaggeration to say that there is a paradigm shift in the diabetes care. Since 2015, the driving force behind are primarily the widely spreading sensor technologies instead of the new insulin products and treatment regimens. The rapidly spreading sensor technologies are applied in more and more countries financially supported in type 1 diabetes since 2015. The use of Continuous Glucose Monitoring (CGM, tissue glucose sensor, simplified as sensor), which includes both real-time CGM (RT-CGM) and intermittently scanned CGM (isCGM), has grown rapidly over the past few years by improving sensor accuracy, greater convenience and ease of use, and expanding support of reimbursement. Numerous studies have demonstrated the significant clinical benefits of using CGM in diabetic patients, regardless of the type of insulin treatment. In this summary, we review the practical aspects of glucose monitoring, the optimal frequency of monitoring, the effectiveness, reliability, and role of continuous glucose monitoring systems.]
Lege Artis Medicinae
[Therapeutic patient education is a lifelong educational activity. As an approach focused on the needs, values and therapeutic strategies of patients, it promotes an increase in patients’ knowledge and skills according to the disease, results in a better quality of life, increased therapeutic compliance and a decrease of complications. Patients become partners and health care providers become coaches. Many type-2 diabetes patients refuse insulin therapy, even when this modality of treatment is indicated. This paper aims to explore diabetic patients’ reasons of accepting insulin therapy and the initial barriers to its use, as well as related education requirements.]
[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]
1.
2.
3.
4.
Journal of Nursing Theory and Practice
[Correlations Between Burnout and Socio-demographic and Workplace Related Factors Among Health-care Workers During The Covid-19 Pandemics]5.
Journal of Nursing Theory and Practice
[Operational Efficiency Investigation from APN Perioperative Perspective]1.
2.
3.
Lege Artis Medicinae
[The importance of continuous glucose monitoring in modern diabetes care]4.
Lege Artis Medicinae
[Options for assessing the quality of postoperative pain relief: multidimensional measurement tools]5.
COMMENTS
0 comments