Impact of lockdown measures on health outcomes of adults with Type 2 diabetes mellitus in Bangladesh

COVID-19 lockdown measures appreciably affected patients’ lifestyles, negatively impacting on their health. This includes patients with Type 2 Diabetes Mellitus (T2DM). Care of these patients was also negatively impacted due to a priority to treat patients with COVID-19, certainly initially, within hospitals and clinics in Bangladesh, combined with a lack of access to clinics and physicians due to lockdown and other measures. This is a concern in Bangladesh with growing rates of T2DM and subsequent complications. Consequently, we sought to critically analyze the situation among patients with T2DM in Bangladesh during the initial stages of the pandemic to address this information gap and provide future direction. Overall, 731 patients were recruited by a simple random sampling method among patients attending hospitals in Bangladesh, with data collected over 3 timescales: before lockdown, during the pandemic, and after lockdown. Data extracted from patients’ notes included current prescribed medicines and key parameters, including blood sugar levels, blood pressure, and comorbidities. In addition, the extent of record keeping. The glycemic status of patients deteriorated during lockdown, and comorbidities as well as complications related to T2DM increased during this period. Overall, a significant proportion of key datasets were not recorded in patients’ notes by their physician before and during lockdown. This started to change after lockdown measures eased. In conclusion, lockdown measures critically affected the management of patients with T2DM in Bangladesh, building on previous concerns. Extending internet coverage for telemedicine, introduction of structured guidelines, and appreciably increasing data recording during consultations is of the utmost priority to improve the care of T2DM patients in Bangladesh

The global impact of the COVID-19 pandemic on the education of healthcare professionals, especially in low- and middle-income countries

The COVID-19 disaster has appreciably increased morbidity and mortality, as well as the delivery of healthcare, across countries exacerbated by the contagious nature of the virus.[1-4] Numerous public health measures were instigated across countries at the start of the pandemic to try and limit its spread without effective medicines and vaccines.[5,6] Introduced measures included lockdown activities, social distancing instructions, quarantining measures, wearing of personal protective equipment (PPEs), handwashing and sanitizers as well as the closure of borders.[5-8] Instigated measures also included the closure of universities appreciably affecting the education of healthcare professionals (HCPs), including physicians and pharmacists, across countries.[9-11] The extent of lockdown and other activities instigated during the early stages of the virus varied appreciably across countries leading to differences in observed morbidity and mortality rates.[12-15] For instance, comprehensive measures introduced early among several Asian countries including Korea, Malaysia, Taiwan, and Vietnam as well as among several African countries including Ghana, Malawi and Namibia, limited the number of deaths certainly when compared with Western European countries including Italy, Spain and the U

A pilot study regarding the consequence of the COVID-19 pandemic on healthcare education in India and the implications

Introduction: The early approaches to prevent the spread of COVID-19 included lockdown and social distancing measures leading to university closures. These measures forced unparalleled changes to the delivery of healthcare education. Concerns included the preparedness of faculty and students to e-learning as well as the routine availability and funding of equipment and internet bundles. This needed addressing with fully trained healthcare professionals required given rising inappropriate use of antibiotics in India, growing prevalence of non-communicable diseases as well as patients with joint co-morbidities. Consequently, a need to ascertain the current impact of the pandemic on healthcare student education across India. Materials and Methods: Pilot study among ten purposely selected healthcare educators in both private and public universities. The questionnaire built on published studies. Results: Identified challenges included a lack of familiarity with online education, no bedside teaching, lack of equipment and affordability of internet bundles, poor internet connectivity and postponed examinations. Ways forward included faculty training on e-learning, providing students with loans and other financial support to purchase equipment and internet bundles, establishing COVID-19 prevention protocols and protective equipment, recording lectures and tutorials to make up for lost time, and simulated methods to teach clinical aspects. Conclusion: Despite the challenges, there was a rapid move to online learning among surveyed universities. Alongside this, courses to address lack of familiarity with e-Learning approaches with hybrid teaching approaches here to stay. The next step will be to undertake a wider study and use the combined findings to provide future guidance

Pilot study on the current management of children with COVID-19 in hospitals in Bangladesh; findings and implications

Objective: The focus on COVID-19 in children in low- and middle-income countries including Bangladesh has been on addressing key issues including poor vaccination rates as well as mental health issues, domestic violence and child labour. However, the focus on optimally managing children in hospitals is changing with new variants and concerns with the development of hyperinflammatory syndromes. There are also concerns with the overuse of antimicrobials to treat patients with COVID-19 in hospitals enhancing resistance rates. The Bangladesh Paediatric Association have developed guidelines to improve patient care building on national guidance. Consequently, there is a need to document the current management of children with COVID-19 in Bangladesh and use the findings for future guidance. Methods: Rapid analysis of the management of children with COVID-19 among eight private and public hospitals in Bangladesh with varying numbers of in-patient beds using purposely developed case report forms (CRFs). The CRFs were piloted before full roll-out. Results: Overall low numbers of children in hospital with COVID-19 (4.3% of in-patient beds). The majority were male (59.6%) and aged 5 years or under (63.5%). Reasons for admission included respiratory distress/ breathing difficulties with 94.2% of COVID-19 cases confirmed. All children were prescribed antibiotics empirically, typically those on the Watch list of antibiotics and administered parenterally, with only a small minority switched to oral therapy before discharge. There was appreciable prescribing of Vitamins (C and D) and zinc and encouragingly limited prescribing of other antimicrobials (antivirals, antimalarials and antiparasitic medicines). Length of stay was typically 5 to 10 days. Conclusion: Encouraging to see low hospitalisation rates and limited use of antimicrobials apart from antibiotics. Concerns with high empiric use of antibiotics and limited switching to oral formulations can be addressed by instigating antimicrobial stewardship programmes. We will be monitoring this

Targeting specific checkpoints in the management of SARS-CoV-2 induced cytokine storm

COVID-19-infected patients require an intact immune system to suppress viral replication and prevent complications. However, the complications of SARS-CoV-2 infection that led to death were linked to the overproduction of proinflammatory cytokines known as cytokine storm syndrome. This article reported the various checkpoints targeted to manage the SARS-CoV-2-induced cytokine storm. The literature search was carried out using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Journal articles that discussed SARS-CoV-2 infection and cytokine storm were retrieved and appraised. Specific checkpoints identified in managing SARS-CoV-2 induced cytokine storm include a decrease in the level of Nod-Like Receptor 3 (NLRP3) inflammasome where drugs such as quercetin and anakinra were effective. Janus kinase-2 and signal transducer and activator of transcription-1 (JAK2/STAT1) signaling pathways were blocked by medicines such as tocilizumab, baricitinib, and quercetin. In addition, inhibition of interleukin (IL)-6 with dexamethasone, tocilizumab, and sarilumab effectively treats cytokine storm and significantly reduces mortality caused by COVID-19. Blockade of IL-1 with drugs such as canakinumab and anakinra, and inhibition of Bruton tyrosine kinase (BTK) with zanubrutinib and ibrutinib was also beneficial. These agents' overall mechanisms of action involve a decrease in circulating proinflammatory chemokines and cytokines and or blockade of their receptors. Consequently, the actions of these drugs significantly improve respiration and raise lymphocyte count and PaO2/FiO2 ratio. Targeting cytokine storms' pathogenesis genetic and molecular apparatus will substantially enhance lung function and reduce mortality due to the COVID-19 pandemic.https://www.mdpi.com/journal/lifeam2023Pharmacolog

The impact of the COVID-19 pandemic on the education of medical, dental and non-medical healthcare professionals in Bangladesh : findings and connotation

Lockdown measures in response to the COVID-19 pandemic had an appreciable impact on the education of all medical, dental, and non-medical healthcare professional (HCP) students. These included the closure of universities necessitating a rapid move to e-learning and new approaches to practical’s. However initially, there was a lack of knowledge and expertise regarding e-learning approaches and the affordability of internet bundles and equipment. We initially con-ducted two pilot studies to assess such current challenges, replaced by a two-stage approach including a full investigation involving 32 private and public universities during the early stages of the pandemic followed by a later study assessing the current environment brought about by the forced changes. Top challenges at the start of the pandemic included a lack of familiarity with e-learning approaches, cost of the internet, lack of IT equipment and the quality of the classes. Universities offered support to staff and students to a varying degree to address identified challenges. Since then, e-learning approaches have widened the possibilities for teaching and learning at convenient times. However, challenges remain. In conclusion, there were considerable challenges at the start of them pandemic. Several key issues have been addressed with hybrid learning here to stay. Remaining challenges include a lack of ICT equipment. However, new innovations will continue

The response to COVID 19 across countries and the implications for future pandemics

We have previously reported that COVID-19 was first identified in Wuhan, China, in December 20191-4. By mid-August 2021, there were over 208 million confirmed cases worldwide with more than 4.3 million deaths giving a case fatality ratio of 2.1%5. Since COVID-19 is principally spread through airborne aerosols and physical contact6-8, and an appreciable number of patients are asymptomatic, early strategies to prevent the spread of the virus in the absence of proven effective medicines included lockdown and other preventative measures4,9

COVID-19 and the impact on the education of healthcare professionals across countries with a particular focus on developing countries

COVID-19 has had an appreciable impact on morbidity, mortality and costs across countries, which is continuing. Before the advent of vaccines, the only effective measures to limit the spread of the virus and its impact were initiatives to limit contact between people through lockdown and other measures. Public health measures included the closure of borders and hospital clinics, introduction of social distancing and improved prevention including the wearing of personal protective equipment (PPE) such as masks and regular hand washing, routine testing and subsequent tracing and quarantining of infected personnel as well as the closure of schools and universities. However, there was considerable variation in the rate of their implementation across countries, which appreciably impacted on prevalence and mortality rates

Diabetes Mellitus: A Path to Amnesia, Personality, and Behavior Change

Type 2 diabetes mellitus is increasingly being associated with cognition dysfunction. Dementia, including vascular dementia and Alzheimer’s Disease, is being recognized as comorbidities of this metabolic disorder. The progressive hallmarks of this cognitive dysfunction include mild impairment of cognition and cognitive decline. Dementia and mild impairment of cognition appear primarily in older patients. Studies on risk factors, neuropathology, and brain imaging have provided important suggestions for mechanisms that lie behind the development of dementia. It is a significant challenge to understand the disease processes related to diabetes that affect the brain and lead to dementia development. The connection between diabetes mellitus and dysfunction of cognition has been observed in many human and animal studies that have noted that mechanisms related to diabetes mellitus are possibly responsible for aggravating cognitive dysfunction. This article attempts to narrate the possible association between Type 2 diabetes and dementia, reviewing studies that have noted this association in vascular dementia and Alzheimer’s Disease and helping to explain the potential mechanisms behind the disease process. A Google search for “Diabetes Mellitus and Dementia” was carried out. Search was also done for “Diabetes Mellitus”, “Vascular Dementia”, and “Alzheimer’s Disease”. The literature search was done using Google Scholar, Pubmed, Embase, ScienceDirect, and MEDLINE. Keeping in mind the increasing rate of Diabetes Mellitus, it is important to establish the Type 2 diabetes’ effect on the brain and diseases of neurodegeneration. This narrative review aims to build awareness regarding the different types of dementia and their relationship with diabetes

Assessing the management of patients with Type 2 diabetes in Bangladesh during pre- and post-COVID-19 era and the implications : a pilot study

There is growing concern with the management of patients with Type 2 diabetes (T2DM) across countries with sub-optimal management increasing morbidity, mortality and costs. In Bangladesh, the number of patients with diabetes will increase to an estimated 13.7 million by 2045, mainly T2DM, unless addressed. Alongside this, continued concerns with high rates of uncontrolled blood glucose levels as well as complication rates, including both microvascular and macrovascular complications in patients with T2DM in Bangladesh. This adds to the cost of care, which can be a concern among patients in Bangladesh with high co-payment rates. Alongside this, concerns with the impact of COVID-19 and associated lockdown measures on the care of these patients. Greater proactivity in managing these patients can help. Consequently, a need to ascertain what data is routinely collected in public hospitals in Bangladesh, including during the pandemic, to guide care. A pilot study was undertaken among 8 patients in Chittagong Medical College using purposely designed case report forms to ascertain the extent of clinical information collected against agreed target levels. There was typically poor control of blood glucose levels, which has resulted in increased prescribing of insulin. However, better control of blood pressure, lipids and albumin levels. There were appreciable missing knowledge gaps especially during the pandemic. This needs addressing