Diabetic Foot in Algeria: Gangrene of the Extremities during Covid 19

The purpose of this presentation is to publish a catalog of the lesions encountered during the attack of the limbs by COVID 19. It does not claim the explanation. We preferred to stay open for our patients and therefore not to close our diabetic foot center since the start of the pandemic to date. These direct face-to-face visits were made possible thanks to all the health precautions taken to protect our patients, carers, and the entire active team at our center.

The Cardiovascular Events in Metabolic Surgery Compared to the New Classes of Glucose-Lowering Agents in Patients with T2DM

Type 2 Diabetes Mellitus is a prevalent chronic disease with several macrovascular and microvascular complications. Cardiovascular diseases including coronary artery disease and stroke are common macrovascular complication that reduces the quality of life and lead to early mortality. Additionally, they pose enormous socioeconomic burden on the societies and the governments. Therefore, any intervention that reduces the cardiovascular events in patients with diabetes will have positive impact of the patients and the society. Thus, this systematic review aimed to evaluate the cardiovascular events after metabolic surgery in comparison with the new classes of glucose lowering agents in patients with type 2 diabetes mellitus. The review included 11 randomized controlled trials to both GLP-1 RA and SGLT-2 i groups. It also included 7 metabolic surgery studies, 2 of these are randomized controlled trials and the other 5 are observational studies. These studies were the most relevant studies to the research question. The results revealed different baseline demographic and clinical characteristics between the medication trials and metabolic surgery studies. Moreover, it revealed significant reduction in cardiovascular events in metabolic surgery studies when compared to medication trials. It also showed significant HbA1c and weight reduction in the metabolic surgery group. The remission of diabetes was very high in the metabolic surgery group while none of medication trials accomplished diabetes recovery. However, both medication and surgery groups had adverse events. In conclusion, the review is consistent with previous literature. It suggests that metabolic surgery is more effective than medical therapy in reducing cardiovascular events. Although this conclusion should be interpreted with caution due to the differences in baseline characteristics between studies. In general, the review recommends younger adult diabetic patients with obesity and history of established cardiovascular diseases to undergo metabolic surgery. Whereas, older patients with history of cardiovascular disease should be advised to take one of the medications that has been proved to reduce cardiovascular events. Future studies that compare metabolic surgery and the new classes of the glucose lowering agents is recommended to confirm the findings in this review.

Female Social Empowerment and the Psychological Expression of Endocrinological Issues during Menopause

We conducted two clinical studies: Study 1 compared high functioning narcissistic men and women against low functioning narcissistic and non-narcissistic patients as well as non-narcissistic successful individuals with prestigious careers. Results established the interconnection between narcissism, masochism, and sadism. Narcissistic women exhibited more masochistic traits, while narcissistic men were distinguished by their sadistic features. Both narcissistic males and females manifested higher sadistic tendencies than all other groups; they also exhibited histrionic and depressive trends. Since the masochistic and sadistic extremities are the opposite ends of the same dimension, an individual can internally oscillate from one pole to the other, without ever escaping the confinement of this vicious circle. Study 2 analyzed the testing records and psychotherapy notes of 14 postmenopausal women, using the FSFI, DES, and MMPI-2. Results unveiled a high correlation between reported female satisfaction with vaginal rejuvenation procedures, and the MMPI-2 Lie, Depression, and Hysteria scales, revealing a tendency to withhold or mask the truth, sustained by an emotional organization that revolves around shame and sadness. Based on the statistically significant results of the two studies we discuss a number of issues related to overall social development and healthy interpersonal relationships: The current social arrangements of several societies where women must obey and serve men, contaminates social progress by nurturing underdeveloped, deprived females whose secret accumulated rage can be either expressed in silent dullness or indifference, passive defiance leading to inactivity or inertia, or overt rebellion leading to the breakdown of the family constellation, something seen by the increasing divorce rate in several countries.

Covid-19 Mutations and How the Vaccine Enhances Immune Intelligence

We traced the coronavirus classification and evolution, analyzed the Covid-19 composition and its distinguishing characteristics when compared to SARS-CoV and MERS-CoV. Despite their close kinship, SARS-CoV and Covid-19 display significant structural differences, including 380 amino acid substitutions, and variable homology between certain open reading frames that are bound to diversify the pathogenesis and virulence of the two viral compounds. A single amino acid substitution such as replacing Aspartate (D) with Glycine (G) composes the D614G mutation that is around 20% more infectious than its predecessor 614D. The B117 variant, that exhibits a 70% transmissibility rate, harbours 23 mutants, each reflecting one amino acid exchange. We examined several globally spreading mutations, 501.V2, B1351, P1, and others, with respect to the specific amino acid conversions involved. Unlike previous versions of coronavirus, where random mutations eventually precipitate extinction, the multiplicity of over 300,000 mutations appears to have rendered Covid-19 more contagious, facilitating its ability to evade detection, thus challenging the effectiveness of a large variety of emerging vaccines. Vaccination enhances immune memory and intelligence to combat or obstruct viral entry by generating antibodies that will prohibit the cellular binding and fusion with the Spike protein, ultimately debilitating the virus from releasing its contents into the cell. Developing antibodies during the innate response, appears to be the most compelling solution in light of the hypothesis that Covid-19 inhibits the production of Interferon type I, compromising adaptive efficiency to recognize the virus, possibly provoking a cytokine storm that injures vital organs. With respect to that perspective, the safety and effectiveness of different vaccines is evaluated and compared, including the Spike protein mRNA version, the Adenovirus DNA, Spike protein subunits, the deactivated virus genres, or, finally, the live attenuated coronavirus that appears to demonstrate the greatest effectiveness, yet, encompass a relatively higher risk.

The War Against SARS-CoV-2: The Immune Giant Collapsing Under Its Own Rampaging Cytokine Storm

We examined SARS-CoV-2 (Covid-19) available treatments and prophylactic methods that included interventions associated with inhibiting the ‘type II transmembrane serine protease’ (TMPRSS2) to limit the fusion between the Covid-19 Spike proteins and ACE2 receptors, or newly developed therapeutics like Remdesivir that interferes with the viral RNA replication. We explored the dilemma of ACE2 receptors that have a protective function against high blood pressure associated disorders, yet, they serve as the viral points of entry, elevating the probability of infection. Human tissues’ analysis reveals a higher ACE2 expression in adipose tissue, placing obesity-related conditions in the eye of the pandemic storm. It primarily exposes males due to the surge of ACE2 receptors in the testes along with other tissues. Males manifest a relatively higher positive ACE2 correlation with certain immune cells in the lungs, thyroid, adrenals, liver and colon, while females evidence higher ACE2 correlations with immune cells in the heart. The remaining tissues’ ACE2/immunity expressions are equivalent in both sexes, indicating that despite its preference for males, the threat of Covid-19 can easily target females. Recent reports indicate that Covid-19 is empowered by hindering the critical process of viral recognition during the adaptive immune response leading to the “cytokine storm,” the aggravated immune response that indiscriminately perseveres, rampaging the host’s vital organs. Sedentary lifestyle, age-related hormonal imbalance, and adiposity induced inflammation predispose the body to the immune collapse following Covid-19 invasion, spotlighting the detrimental aftermath of metabolic dysfunction, and excess food consumption, provoked by elevated cortisol and dysregulated appetite hormones. ACE2 expression is suppressed in the skeletal muscle, rendering fitness and weight management an effective Covid-19 preventive intervention, along with social distancing, hygiene, and facial coverings. Physical activity, or exercise alternative methods have recently demonstrated statistically significant reductions of the inflammatory marker C-Reactive Protein (CRP), triglycerides, visceral fat, cortisol and the orexigenic hormone ghrelin, juxtaposed by optimal increases of IGF-1, skeletal muscle mass, Free T3, HDL, and the anorexic hormone leptin.

Bio-statistical Analysis on the Enterprise Dynamic Management in the COVID-19 Pandemic

Background: With the worldwide spread of the novel coronavirus (COVID-19), the global economy has entered a cold winter, and the International Monetary Fund predicts that the global economy will shrink by about 3% in 2020. The outbreak of the epidemic has also caused heavy losses to the Chinese economy. In the first quarter of 2020, actual GDP fell sharply for the first time by 6.8% year-on-year for the first time. This is the first decline since record. Then, according to the data from the business survey in March, China's economy has improved compared with February, which shows that the economy has rebounded under the influence of policies. Judging from the current situation, although China has passed the peak period of the epidemic, affected by the high cases abroad, it can only be carried out slowly for the resumption of production. Enterprises, as micro-individuals under the macro economy, need to pass through analyzing the dynamic management of the enterprise to deepen the reform of the commercial system and stimulate the vitality of the enterprise. This will also provide data support for the government formulating relevant policies, which is conducive to the synergy of various policies and enhance the momentum of economic recovery. On the other hand, we choose tourism as our specific research object. Thus, we need to set different scenarios according to the development situation of the epidemic, evaluate the impact of the novel coronavirus epidemic on China's tourism industry, and discuss tourism development and opportunities in the post-epidemic era from the aspects of tourism's response to the epidemic and the development trend of the tourism after the epidemic [4].

Febrile Corona virus and Autism

Background: A number of reports have pointed to the apparent relationship between reduced IGF1 in pregnancies and the development of autism in the offspring. Fever due to inflammatory processes in the gravida emerges as a potential key factor in this phenomenon. Methods of Inquiry: Investigations have reported an increase in neonatal autism related to enhanced production of interleukins in some gravidas before delivery. The medical records of the mothers of autistic children were examined retrospectively for pertinent factors. Women who had endured infection-related fevers during their pregnancies were more likely to have delivered children with neurologic deficiencies such as autism and schizophrenia. Conclusions: Inflammatory occurrences such as with women infected by Covid-19 during pregnancy produce enhanced levels of cytokines, especially interleukin-6, which can disrupt IGF1-mediated neurogenesis and CNS circuitry formation in the neonate.

A Review of COVID19 associated factors: CRP, Creatinine, Bilirubin, VLDL, HDL, Triglycerides, Cortisol and Thyroid Function

The objective was to identify key factors associated with compromised immunity in search of preventative solutions that can safeguard health. Elevated C-reactive protein (CRP) synthesized by cytokines, creatinine, and bilirubin are consistently featured in the profiles of COVID-19 patients, indicating persistent inflammation, oxidative stress and excess toxicity. Accumulated adiposity, BMI>25, and abnormalities in VLDL, cortisol, triglycerides, and thyroid function have been mostly indirectly linked to COVID-19 by their conspicuous presence in obesity, diabetes, pulmonary defects, and cardiovascular diseases that exacerbate COVID-19 vulnerability and fatality rates. The COVID-19 documented affinity for ACE2 receptors which are primarily expressed in adipose tissue, heart, thyroid, and male tissues, unveils the virus’ principal targets, and emphasizes the importance of striving for cardiovascular health, weight control, and metabolic stability. Exercise is universally accepted as an optimal solution, however, the expense, length of commitment, and effort involved in sustained physical activity become progressively more challenging with hormonal disharmony, and an imbalanced lipid profile, consequently multiplying the incidences of obesity. We explored the effects of an exercise alternative that demonstrated reduced visceral adiposity, lower levels of CRP, creatinine, bilirubin, cortisol, VLDL, and triglycerides, juxtaposed by upraises in HDL and Free T3. Importantly, all variables optimally increased and decreased without ever drifting into abnormality.

The Affinity between Obesity and COVID-19

The objective was to identify some of the common denominators that undermine health and increase COVID-19 vulnerability. The virus has a binding affinity for ACE2 receptors which are abundant in adipose tissue, placing obesity at the spotlight of the COVID-19 susceptibility factors. Obese individuals manifest respiratory problems that elevate viral mortality rates. Visceral adiposity progressively increases with age, often accompanied by inflammation, high VLDL, triglycerides, Free T3 abnormalities, low testosterone, and exacerbated cortisol. Disturbances in the anorexic and orexigenic hormones leptin and ghrelin respectively, lead to weight gain, rendering physical activity challenging and cumbersome. The lack of exercise compromises health and immunity. Toxicity is enhanced by inactivity, while moderate exercise promotes cardiorespiratory fitness (CRF), safeguarding against most chronic diseases. However, excessive exercise results in an inverse cortisol/testosterone relationship leading to hormonal imbalance. In search of solutions to proactively protect public health, we conducted a randomized double-blind clinical trial on ten overweight menopausal women with medical issues including diabetes and hyperphagia, to investigate the possibility of weight reduction and increased appetite regulation. Results delineated a statistically significant decrease in BMI, visceral adipose tissue, VLDL, and triglycerides, an inverse relationship between both testosterone/cortisol and leptin/ghrelin, and reduced hyperphagia. Testosterone and leptin, along with Free T3 and IGF-1 climbed towards the peak of the normal range, juxtaposed by cortisol and ghrelin that decreased but without regressing outside normalcy.

Study of Thyroid Function Tests in Cirrhosis of Liver And Correlation of Thyroid Function Tests Levels With Severity of Liver Dysfunction

Background: One of the leading causes of morbidity and mortality in the world is chronic liver diseases. Thyroid hormones regulate the basal metabolic rate of all cells, including hepatocytes, and thereby modulate hepatic function. The liver in turn metabolizes the thyroid hormones and regulates their systemic endocrine effects. Thyroid dysfunction may perturb liver function, liver disease modulates thyroid hormone metabolism, and a variety of systemic diseases affect both organs. Keeping in mind the above view we have done this study by highlighting the association between thyroid function tests with severity of liver dysfunction in cirrhosis of liver by using child Pugh scoring Methods: All patients aged 30-80 years with cirrhosis of liver who are attending Rajarajeshwari Medical College and Hospital. Detailed history, physical examination and drug history was taken as per pre-designed performa. Relevant investigations were done for assessing thyroid function and liver cirrhosis. Severity of liver dysfunction was graded by using Child Pugh Scoring Results: The prevalence of hypothyroidism among patients with liver cirrhosis was 64%. Majority of the cases had a high TSH and TSH levels were directly correlated severity of liver disease. Total T3 levels were low in majority of the cases and it was inversely correlated with severity of liver disease. FT3 was low in most of the cases with child B and child C score; it was inversely correlated with severity of liver disease. FT3 was found to be a more sensitive marker than total T3 for assessing severity of liver disease. Conclusion: Thyroid dysfunction is common in cirrhosis of liver hence thyroid function tests should be carried out in all cirrhotic patients to assess the severity and prognostication of such patients.