By Dana Malcolm
#USA, April 11, 2023 – Rare but highly fatal is how the US Centers for Disease Control (CDC) describes Marburg Virus Disease (MVD), the latest illness it has warned US doctors to be on the lookout for. An April 6th, the Health Advisory published over the Health Alert Network called for more vigilance following outbreaks in two African Nations, Tanzania, and Equatorial Guinea.
Closely related to Ebola, the hemorrhagic fever causes symptoms of fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding in those infected. It is caused by both the Marburg virus (first discovered in Germany) and the Ravn virus, carried by fruit bats.
The World Health Organization (WHO) announced the Tanzanian outbreak on March 24th. At that time, there were eight cases and five deaths, a fatality rate of over 60 percent. In Equatorial Guinea there were nine confirmed cases as of March 22nd and seven deaths. The outbreaks are concerning in that they are first time outbreaks for both countries. At that time, the risk of the virus spreading globally was deemed to be very low.
There is no approved vaccine or treatment for the disease yet, though a human trial of an experimental vaccine, described as promising, was completed this January with further testing to be done across Africa and the US. Mortality rates from MVD can be as high as 90 percent if infected persons do not get supportive care the CDC says.
Signs & Symptoms
After an incubation period of 2-21 days, symptom onset is sudden and marked by fever, chills, headache, and myalgia. Around the fifth day after the onset of symptoms, a maculopapular rash, most prominent on the trunk (chest, back, stomach), may occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may appear. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.
Clinical diagnosis of Marburg virus disease (MVD) can be difficult. Many of the signs and symptoms of MVD are similar to other infectious diseases (such as malaria or typhoid fever) or viral hemorrhagic fevers that may be endemic in the area (such as Lassa fever or Ebola). This is especially true if only a single case is involved.
The case-fatality rate for MVD is between 23-90%.
How to Manage Your Diabetes in Extreme Summer Heat
How weather can affect your blood sugar
We often look forward to a change of seasons and warmer temperatures. But if you have diabetes, you may be especially sensitive to the hot weather of summer.
Extreme heat can affect your blood sugar control. If you use insulin or your blood sugars aren’t effectively controlled, you could be at higher risk during the summer months. Worsening blood sugar control is often the main concern, and depending on your level of activity, developing low blood sugars may also be a concern.
If you’ve had complications from diabetes that have damaged the nerves to sweat glands, you may be unable to sweat properly. This can become serious as outdoor temperatures rise, leading to heat exhaustion and heat stroke.
Extreme temperatures can also damage your medications and testing equipment, says Dr. Marwan Hamaty, endocrinologist at Cleveland Clinic, Ohio. “I always remind my patients to take precautions to protect themselves and their supplies during both winter and summer.”
He says it’s important to get a handle on your blood sugar control before you engage in summer fun. “If your blood sugars are mostly higher than 250 mg/dl, I recommend improving your blood sugar control before engaging in heavy physical activity — regardless of the climate and the temperature, as recommended by the American Diabetes Association.”
Dr. Hamaty also advises that the extreme heat of summer affects blood sugar levels. How the heat affects your levels depends on what you’ve eaten, whether you’re well-hydrated and your activity level.
If the heat and your activity make you sweat a lot, you may become dehydrated, leading to a rise in glucose levels. “If you become dehydrated, your blood glucose levels will rise. This can lead to frequent urination, which then leads to further dehydration and even higher blood sugar levels — a kind of vicious cycle,” he says.
Things can become even worse if the treatment includes insulin: “Dehydration reduces blood supply to your skin and, therefore, the ability of your body to absorb the insulin you’ve injected is reduced,” he says.
Most types of insulin can tolerate temperatures up to 93-95 degrees Fahrenheit. Exposing your supply to anything higher than this will make the medication quickly break down. Be careful and pay attention to any insulin you’re carrying with you in the heat.
While it’s fine to store insulin and glucagon in the refrigerator, hot temperatures (as well as freezing temperatures) will cause the medications to degrade, making them ineffective and unusable. High temperatures can have a negative effect on other medications and diabetes management supplies too. Don’t forget about the weather’s effect on things like test strips and monitoring devices. When the mercury begins to rise, these items can change in their effectiveness.
Physical activity usually causes blood sugar levels to decrease, reducing your need for insulin. The sudden addition of exercise may put you at an increased risk for low blood sugars.
Therefore, if you’re active in extreme heat, know that you’re at high risk for both low and high blood sugars. This means you should take extra precautions and monitor your sugar levels before exercising.
“I advise my patients to maintain warm skin and adjust insulin dosage prior to engaging in physical activity because insulin adjustment could vary significantly,” says Dr. Hamaty. “But don’t allow the heat to keep you indoors. It’s OK to participate in outdoor activities and enjoy all types of weather as long as you take a few precautions.”
Dr. Hamaty also suggests seeking input from your doctor regardless of the temperature before adding physical activity to your routine.
Follow these tips to help manage your diabetes while enjoying the outdoors:
- Drink plenty of water.Staying hydrated is important for everyone during physical activity, and it’s especially critical if you have diabetes.
- Avoid becoming dehydrated.Carry small bottles of water or low-calorie electrolyte-replenishing sports drinks in a backpack or on a belt while you’re hiking or playing sports.
- Adjust your insulin as needed.Ask your provider or diabetes educator how you should adjust your insulin (and sometimes eating extra carbohydrates) before exercising. Typically, your first few doctor’s visits focus on urgent issues, such as getting diabetes under control. Ask about how to adjust your insulin so you can prepare to be physically active.
- Test your blood sugar levels frequently.Since hot temperatures can cause blood sugar levels to fluctuate, it’s a good idea to test more often. That way, you can take appropriate and immediate action to keep your levels stable. You should continue frequent monitoring for several hours after you’re done with your workout or other activity. That’s because the effects of activities on blood sugars usually last for a longer period of time.
- Keep items to treat low blood sugar with you. This includes glucose tabs or glucose gel. If you’re at high risk for very low blood sugar (if you have frequent low blood sugar or had very low blood sugar previously), you should also have a glucagon kit available.
- Take some snacks with you.Some snacks can serve as a meal replacement while others help prevent low blood sugar. Discuss possible options with your dietitian.
- Protect your medication and supplies. Take proactive steps to protect your insulin, glucagon kit and other supplies before you head outdoors, regardless of the temperature. Consider a car cooler that plugs into a 12-volt car adapter to keep your supplies at the proper temperature. This will keep the temperature stable for some time. If you’re going away from your car for an extended period, you’ll need to take your supplies along with you. If you are on insulin pump, be sure to protect your insulin pump from high temperatures. Depending on the situation and how long your activity will be, you might simply need to monitor your glucose more often. In certain circumstances (if it’s extremely hot or you’re out for an extended amount of time) consider using a long-acting insulin temporarily along with meal insulin injection instead of an insulin pump.
- Avoid sunburn. You can get sunburned while skiing on the slopes or while hiking in the summer. Sunburn stresses your body and can raise blood sugar levels. Use a broad-spectrum sunscreen and wear protective eye gear.
- Finally, limit how much time you spend outside in extreme temperatures. “While I advise staying active during the peak winter or summer months, I also tell my patients to try to take advantage of outdoors activities when temperatures aren’t too extreme,” says Dr. Hamaty. By taking a few precautions, you can enjoy an active, healthy lifestyle in most any weather.
New COVID boosters get EMERGENCY USE thumbs up
September 19, 2023 – The old bivalent vaccines are out and a new 2023-24 formula for residents 6 months and over, has been approved for use by the US Centres for Disease Control (CDC). The emergency use authorization comes as the CDC tries to protect the population against the latest variants and flu season approaches.
These vaccines contain the XBB.1.5 component, one of the offshoots of the Omicron variant and should be ready in time for fall. But concern is being expressed not just in the United States but in the UK and other countries over the emergence of the variants Eris (EG.5) and Pirola (BA.2.86).
Though XBB.1.5 is no longer the most circulating variant, they are related and the FDA says the vaccine neutralizes them (including EG.5 and BA.2.86) efficiently.
Pirola, as the variant is referred to online, is being watched closely because it is extremely mutated.
“The public can be assured that these updated vaccines have met the agency’s rigorous scientific standards for safety, effectiveness, and manufacturing quality. We very much encourage those who are eligible to consider getting vaccinated,” they FDA said.
It means the older Moderna and Pfizer bivalents are no longer authorized for use in the country. The two manufacturers are also the only ones approved to distribute the newer doses.
Approval has also been granted in the UK for a new shot that targets XBB 1.5. but only Pfizer has secured that nod.
Eleuthera Medical Center Marks 5 Years, Private community clinic ‘grows with the demand’, adds Dental and Dermatology to slate of services
#Eleuthera, The Bahamas, September 19, 2023 – A Family Island clinic that started with a vision to serve the community with the best in private medical care and wellness regardless of a patient’s financial standing celebrated its fifth anniversary this month, announcing new services it said were those most strongly requested by patients.
Eleuthera Medical Center (EMC), the flagship of Bahamas Wellness Health Systems, marked its anniversary adding dental and dermatology to its growing list of medical specialties that includes primary wellness, vision, gynecology and pediatrics. Some services are offered on an ongoing daily basis provided by physicians at one of Bahamas Wellness Health Systems (BWHS) four clinics, others are offered on a rotating basis by visiting medical specialists and associates on a regularly scheduled rotating basis.
“When we opened our doors to this clinic in 2018, we knew there was a need for full-time medical care and especially attention to wellness in Eleuthera,” said EMC and Bahamas Wellness Health Systems founder Dr. Arlington Lightbourne. “But we underestimated how appreciative the community would be that there were always physicians on call, that in the case of an emergency we could respond, that we provided an ambulance and emergency care saving patients from having to be airlifted to Nassau or beyond.”
Lightbourne said the years have not been without challenges.
“For nearly 18 months, we endured COVID, conducting testing outdoors, trying to keep our spirits strong and staff well so they could care for others and yet in a small community like Eleuthera where you know someone in everyone’s family it’s hard not to feel the pain and suffering others feel,” said Dr. Lightbourne. “But we doubled down and said we are here for the long haul and whatever the path is to provide the best in care, to make that care affordable and to improve the wellness of the community overall, that is the journey we are on, and it has been an incredibly rewarding one.”
To support that emphasis on wellness, the clinic located in the settlement of Palmetto Point adjacent to Governors Harbour in the heart of central Eleuthera, offers regularly scheduled lectures and town meetings with a nutritionist and wellness expert who is part of the team. Lightbourne’s interest in well-being stems from his work in Emergency Care at both PMH and Doctors Hospital where the vast number of cases he treated were the result of non-communicable diseases and conditions including heart attacks, high blood pressure and cancer related to lifestyle – poor diet high in fats and low in nutrition and lack of proper physical exercise.
Today, he said he is seeing more interest in preventative care, a sign that Bahamians learned from Covid and its aftermath that wellness matters.
“We have a brighter future ahead of us and I am proud of what we are doing in Eleuthera and our other clinics to make a difference in The Bahamas with careful diagnoses and individual attention to how people conduct their daily lives when it comes to their overall wellness,” said Lightbourne, now the deputy director of the Bahamas Medical Association and an authorized NHI provider.
BHWS also operates clinics in Nassau, Spanish Wells and Lower Bogue.
Photo Caption: The Hon. Clay Sweeting, MP, Central and South Eleuthera, welcomes the Bahamas Wellness Medical Center’s ambulance. He is pictured with Dr. Jessica Moss, Emergency Medicine Specialist and Vice President & Medical Director at Eleuthera Medical Center, and Dr. Arlington Lightbourne, founder of the expanding clinic, which is celebrating its fifth anniversary serving the community by adding dental and dermatology to its growing list of specializations.
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