This special issue focuses on Diabetes, Covid-19 and managing patient’s diabetes when they are sick.

Recorded April 1, 2020.

This podcast will cover:

1. How do we help our patients with diabetes stay safe
2. Helping patient negotiate safety issues in the workplace
3. Safety Issues when people do not come in for care
4. Managing SGLT-2 inhibitors during the pandemic
5. Home detection and care of DKA
6. Renewing Medications
7. Telemedicine Visits

Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting.

Presented by:

Louis Philipson, MD, PhD, ADA Past President, Medicine & Science, University of Chicago

Anne Peters, MD, Diabetologist, University of Southern California

At least eight people died and hundreds were hospitalized after toxic gas leaked from a chemical factory in southern India early Thursday, officials said.

A California teacher battling breast cancer made headlines recently when she was told state law required her to pay for the cost of a sub during her treatment. Where else are these kinds of sick leave policies in place? And why aren’t the unions doing more to fight them?

Commissioner Wayne Lewis requested a list of the teachers who had taken sick days in the 10 districts where teacher absences caused work stoppages.

Casey Smitherman, the superintendent of the Elwood school district, cited the "negative attention" from the incident, according to the Indianapolis Star.

London : Scientific Press, 1895.

Manchester : J. Heywood, 1888.

Brian Whiston since 2015 has led the state's education department while it put together its plan under the Every Student Succeeds Act and took control of the state's school takeover district.

The virus tweaks bee behavior to infect new hives and may also spread other hive-killing pathogens and pests

THE people of Scotland have been offered a “light at the end of the tunnel” in the form of various potential relaxations to lockdown - but warned they will only get there if they double down on their compliance.

Stand-up Romesh Ranganathan is back with a second series of topical comedy show The Ranganation. He talks to Sherna Noah about filming the show in lockdown, the place of comedy in a crisis, and spending so much time with his family.

Children with sickle cell disease are at high risk of complications from influenza infection and have been recommended to receive annual influenza vaccine since the 1970s. Few safety studies, however, have examined the safety of influenza vaccine in this population.

This large cohort study did not find an association between influenza vaccination and hospitalization for sickle cell crises in children with sickle cell anemia. (Read the full article)

Children with sickle cell anemia are at risk of central nervous system damage, including stroke. Even children without evidence of abnormality on neuroimaging are at risk of significant declines in neurocognitive function, starting at early ages.

This study adds the observation that poorer neurocognitive and behavioral function is associated with older age in infants and toddlers with sickle cell anemia, much earlier than previously expected. (Read the full article)

Children with sickle cell disease (SCD) have a higher basal metabolic rate, and have historically been underweight. In the general pediatric population, the average BMI percentile has been rising over the past 2 decades.

BMI percentiles for children with SCD in New England are higher than historically reported, mimicking the weight status in the general pediatric population. In children with SCD, higher hemoglobin levels increased the odds of being overweight and obese. (Read the full article)

Before the introduction of conjugate pneumococcal vaccines and routine penicillin prophylaxis, febrile patients with sickle cell disease were known to have a 3% to 5% risk of bacteremia. Consequently, hospitalization rates for febrile episodes are >70%.

We observed no mortality or morbidity among those managed completely as outpatients, and bacteremia occurred in <1%. Physicians should strongly consider outpatient management of febrile children with sickle cell disease if there are no other indications for admission. (Read the full article)

Parent or provider reluctance to immunize infants during sick visits is a common reason why infants fall behind on the recommended schedule. One previous study suggested that immunizations at sick visits discouraged parents from making up missed well-baby visits.

Delaying immunizations at sick visits can lower immunization rates without improving rates of well-baby visits. Many infants will not return to makeup well-baby visits missed because of a sick visit, regardless of whether immunizations were delayed or given. (Read the full article)

Persons with sickle cell anemia are known to have increased medical expenses, but little is known about the effects of hydroxyurea treatment on costs. In adults with severe sickle cell anemia, hydroxyurea has been reported to reduce expenses from hospitalization.

In this randomized placebo-controlled prospective multicenter trial of hydroxyurea in very young children with sickle cell anemia, not selected for severity, hydroxyurea was associated with significant medical cost savings due to a reduction in hospitalization expenses. (Read the full article)

As more children with sickle cell disease survive into adulthood, they are increasingly hospitalized in both children’s and general hospitals and managed by different provider specialists. But it is unknown if hospital type and provider specialty affect patient outcomes.

Using a large national administrative dataset, this study revealed that general hospitals were associated with higher rates of intubation and longer lengths of stay compared with children’s hospitals for adolescents and young adults with SCD admitted with acute chest syndrome. (Read the full article)

Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease, resulting in morbidity. Magnesium is a vasodilator and has been shown to improve red blood cell hydration. Previous small studies have suggested that treatment with magnesium may decrease VOEs.

Intravenous magnesium sulfate is well tolerated in relatively high doses but had no effect on the length of stay in hospital, pain scores, or cumulative analgesia used in children admitted with painful VOEs in sickle cell disease. (Read the full article)

Obstructive sleep apnea syndrome (OSAS) prevalence in children with sickle cell anemia is not well described. Although these children often experience nocturnal oxygen desaturation, it is unclear whether they are more likely to have OSAS.

Children with sickle cell anemia have a high prevalence of OSAS with typical symptoms, beyond just nocturnal oxyhemoglobin desaturation. This study supports the need for increased efforts to screen for, diagnose, and treat OSAS in this vulnerable population. (Read the full article)

Growth impairment in sickle disease has been a consistent finding in published reports. Hydroxyurea (HU) decreases vasoocclusive events and increases hemoglobin levels, which may improve growth. However, HU may adversely affect growth in young children by its effect on DNA synthesis.

Height, weight, and head circumference were normal in HU-treated children in the study as compared with the World Health Organization standards. Height, weight, and BMI z scores were similar in placebo and treatment groups. There were no harmful effects of HU on growth. (Read the full article)

Hydroxyurea is a treatment option for young patients with sickle cell disease (SCD). Establishing the safety of hydroxyurea is of paramount importance. The effect of hydroxyurea on immune function and immunizations in SCD has not been studied previously.

Children with SCD receiving hydroxyurea have lower lymphocyte, CD4, and memory T-cell counts compared with those receiving placebo, but still in the range for healthy children. Despite slower response to measles vaccine, measles, mumps, and rubella and pneumococcal vaccines are effective. (Read the full article)

Patients with sickle cell disease frequently express dissatisfaction with emergency department treatment of painful crises. Time to opioid administration has been suggested as a quality of care measure for painful crises.

Although not associated with hospital admission, time to opioid administration in sickle cell disease painful crises was associated with secondary outcomes including improvement between the first 2 pain scores, decreased pain score area under the curve at 4 hours, decreased emergency department length of stay, and increased total opioids. (Read the full article)

A volunteer from Switzerland serving with OM Chile shares about a special experience she had when doing ministry in the streets of Santiago, Chile.

A day after the Justice Department dropped charges against Gen. Michael Flynn, President Trump is accusing Joe Biden and a host of Obama administration officials of trying to sabotage his presidency, saying “it’s all coming out.”
Read Full Article at RT.com

Enables early detection, mapping and management of coronavirus using USSD and official government WhatsApp service, Covid Connect

Blood thinners could improve the survival rate among the most severely ill Covid-19 patients, according to a hospital study in New York City.The finding comes as doctors have been observing blood clot disorders among coronavirus patients that can damage vital organs.The researchers found that intubated patients treated with anticoagulants – medicines that help prevent blood clots – had a mortality rate of 29 per cent.Of those who were not treated with blood thinners, 63 per cent died.And among…

Studies show black people are less likely to get adequate pain drugs compared to whites

After a week or so sick in bed in their New York City apartment in March, members of the Johnson-Baruch family were convinced they had been stricken by the novel coronavirus. Subsequent test results left them with more questions than answers. Lisa Bernhard has more.

After a week or so sick in bed in their New York City apartment in March, members of the Johnson-Baruch family were convinced they had been stricken by the novel coronavirus. Subsequent test results left them with more questions than answers. Lisa Bernhard has more.

Title: Severe Morning Sickness Passed From Moms to Daughters
Category: Health News
Created: 4/29/2010 8:10:00 PM
Last Editorial Review: 4/30/2010 12:00:00 AM

Title: Mere Sight of Sick Person May Boost Immune System
Category: Health News
Created: 4/29/2010 4:10:00 PM
Last Editorial Review: 4/30/2010 12:00:00 AM

Title: Few Sickle Cell Patients Receiving Beneficial Drug, Study Finds
Category: Health News
Created: 4/28/2015 12:00:00 AM
Last Editorial Review: 4/29/2015 12:00:00 AM

Title: Health Tip: Create a Sick-Day Plan for Diabetes
Category: Health News
Created: 5/5/2017 12:00:00 AM
Last Editorial Review: 5/5/2017 12:00:00 AM

Title: Nearly 100 Sickened by E.Coli-Tainted Romaine Lettuce
Category: Health News
Created: 4/27/2018 12:00:00 AM
Last Editorial Review: 4/30/2018 12:00:00 AM

Title: Workers With Cluster Headaches Take Twice as Many Sick Days
Category: Health News
Created: 2/6/2020 12:00:00 AM
Last Editorial Review: 2/6/2020 12:00:00 AM

Title: Flu Season That's Sickened 26 Million May Be at Its Peak
Category: Health News
Created: 2/21/2020 12:00:00 AM
Last Editorial Review: 2/21/2020 12:00:00 AM

It has been identified that arginine vasopressin (AVP), vasopressin receptor 2(V2R), and the aquaporin 2 (AQP2) signaling pathway in the inner ear play important roles in hearing and balance functions through regulating the endolymph equilibrium; however, the contributions of this signaling pathway to the development of motion sickness are unclear. The present study was designed to investigate whether the activation of the AVP-V2R-AQP2 signaling pathway in the inner ear is involved in the induction of motion sickness and whether mozavaptan, a V2R antagonist, could reduce motion sickness. We found that both rotatory stimulus and intraperitoneal AVP injection induced conditioned taste aversion (a confirmed behavioral index for motion sickness) in rats and activated the AVP-V2R-AQP2 signaling pathway with a responsive V2R downregulation in the inner ears, and AVP perfusion in cultured epithelial cells from rat endolymphatic sacs induced similar changes in this pathway signaling. Vestibular training, V2R antagonist mozavaptan, or PKA inhibitor H89 blunted these changes in the V2R-AQP2 pathway signaling while reducing rotatory stimulus– or DDAVP (a V2R agonist)-induced motion sickness in rats and dogs. Therefore, our results suggest that activation of the inner ear AVP-V2R-AQP2 signaling pathway is potentially involved in the development of motion sickness; thus, mozavaptan targeting AVP V2Rs in the inner ear may provide us with a new application option to reduce motion sickness.

Sickle cell disease (SCD) is associated with overactive bladder (OAB). Detrusor overactivity, a component of OAB, is present in an SCD mouse, but the molecular mechanisms for this condition are not well-defined. We hypothesize that nitric oxide (NO)/ ras homolog gene family (Rho) A/Rho-associated kinase (ROCK) dysregulation is a mechanism for detrusor overactivity and that NO-releasing nanoparticles (NO-nps), a novel NO delivery system, may serve to treat this condition. Male adult SCD transgenic, combined endothelial NO synthases (eNOSs) and neuronal NOS (nNOS) gene-deficient (dNOS^–/–), and wild-type (WT) mice were used. Empty nanoparticle or NO-np was injected into the bladder, followed by cystometric studies. The expression levels of phosphorylated eNOS (Ser-1177), protein kinase B (Akt) (Ser-473), nNOS (Ser-1412), and myosin phosphatase target subunit 1 (MYPT1) (Thr-696) were assessed in the bladder. SCD and dNOS^–/– mice had a greater (P < 0.05) number of voiding and nonvoiding contractions compared with WT mice, and they were normalized by NO-np treatment. eNOS (Ser-1177) and AKT (Ser-473) phosphorylation were decreased (P < 0.05) in the bladder of SCD compared with WT mice and reversed by NO-np. Phosphorylated MYPT1, a marker of the RhoA/ROCK pathway, was increased (P < 0.05) in the bladder of SCD mice compared with WT and reversed by NO-np. nNOS phosphorylation on positive (Ser-1412) regulatory site was decreased (P < 0.05) in the bladder of SCD mice compared with WT and was not affected by NO-np. NO-nps did not affect any of the measured parameters in WT mice. In conclusion, dysregulation of NO and RhoA/ROCK pathways is associated with detrusor overactivity in SCD mice; NO-np reverses these molecular derangements in the bladder and decreases detrusor overactivity.

Although studies of mixed chimerism following hematopoietic stem cell transplantation in patients with sickle cell disease (SCD) may provide insights into the engraftment needed to correct the disease and into immunological reconstitution, an extensive multilineage analysis is lacking. We analyzed chimerism simultaneously in peripheral erythroid and granulomonocytic precursors/progenitors, highly purified B and T lymphocytes, monocytes, granulocytes and red blood cells (RBC). Thirty-four patients with mixed chimerism and ≥12 months of follow-up were included. A selective advantage of donor RBC and their progenitors/precursors led to full chimerism in mature RBC (despite partial engraftment of other lineages), and resulted in the clinical control of the disease. Six patients with donor chimerism <50% had hemolysis (reticulocytosis) and higher HbS than their donor. Four of them had donor chimerism <30%, including a patient with AA donor (hemoglobin >10 g/dL) and three with AS donors (hemoglobin <10 g/dL). However, only one vaso-occlusive crisis occurred with 68.7% HbS. Except in the patients with the lowest chimerism, the donor engraftment was lower for T cells than for the other lineages. In a context of mixed chimerism after hematopoietic stem cell transplantation for SCD, myeloid (rather than T cell) engraftment was the key efficacy criterion. Results show that myeloid chimerism as low as 30% was sufficient to prevent a vaso-occlusive crisis in transplants from an AA donor but not constantly from an AS donor. However, the correction of hemolysis requires higher donor chimerism levels (i.e. ≥50%) in both AA and AS recipients. In the future, this group of patients may need a different therapeutic approach.

The majority of these children have tested positive for the virus or seem to carry antibodies from an earlier infection.

A woman from Burlington, Ont., says she's had COVID-19 symptoms for nearly two months and hasn't felt entirely supported by health-care workers.

With the COVID-19 coronavirus causing a global pandemic, a look back at the scientists who figured out viruses and their relationship to disease

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A woman allegedly spat at and threw the contents of a sick bowl over a nurse while being treated for Covid-19 symptoms.