Avoiding COVID-19 complications with diabetic patients could be achieved by multi-dose Bacillus Calmette-Guérin vaccine: a case study of beta cells regeneration.

Diabetes mellitus (DM) is one of the major risk factors for COVID-19 complications as it is one of the chronic immune-compromising conditions especially if patients have uncontrolled diabetes, poor HbA1c and/or irregular blood glucose levels. Diabetic patients' mortality rates with COVID-19 are higher than those of cardiovascular or cancer patients. Recently, Bacillus Calmette-Guérin (BCG) vaccine has shown successful results in reversing diabetes in both rats and clinical trials based on different mechanisms from aerobic glycolysis to beta cells regeneration. BCG is a multi-face vaccine that has been used extensively in protection from tuberculosis (TB) and leprosy and has been repositioned for treatment of bladder cancer, diabetes and multiple sclerosis. Recently, COVID-19 epidemiological studies confirmed that universal BCG vaccination reduced morbidity and mortality in certain geographical areas. Countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies that have shown low numbers of reported COVID-19 cases. Some countries have started clinical trials that included a single dose BCG vaccine as prophylaxis from COVID-19 or an attempt to minimize its side effects. This proposed research aims to use BCG vaccine as a double-edged weapon countering both COVID-19 and diabetes, not only as protection but also as therapeutic vaccination. The work includes a case study of regenerated pancreatic beta cells based on improved C-peptide and PCPRI laboratory findings after BCG vaccination for a 9 year old patient. The patient was re-vaccinated based on a negative tuberculin test and no scar at the site of injection of the 1st BCG vaccination at birth. The authors suggest and invite the scientific community to take into consideration the concept of direct BCG re-vaccination (after 4 weeks) because of the reported gene expressions and exaggerated innate immunity consequently. As the diabetic MODY-5 patient (mutation of HNF1B, Val2Leu) was on low dose Riomet® while eliminating insulin gradually, a simple analytical method for metformin assay was recommended to ensure its concentration before use as it is not approved yet by the Egyptian QC labs.

Diabetic foot--what can we learn from leprosy? Legacy of Dr Paul W. Brand.

Leprosy and diabetes, though two very different conditions, may both result in severe loss of sensation in the feet, which are then a great risk of painless injury and ulceration. Seminal observations made by the late Dr Paul W. Brand, a surgeon working with leprosy patients in South India in the mid-20th century, resulted in the subsequent development of treatments to manage insensitive foot ulcers that are today entirely applicable to patients with diabetes. As a consequence of his research, the recognition of the relationship between insensitivity, repetitive pressures and skin breakdown has helped our understanding of the aetiopathogenesis of neuropathic foot lesions in diabetes: the development of the total contact cast and other casting devices to treat such lesions forms the basis of management of diabetic foot lesions with off-loading devices that are widely used in the 21st century in diabetic foot clinics around the world. Moreover, observations by Brand that the foot 'heats up before it breaks down' resulted in more recent research showing that self-skin temperature monitoring might help reduce the incidence of recurrent neuropathic foot ulcers in diabetes. In summary, Brand's understanding of 'the gift of pain' that, when lost, results in the late complications of diabetic neuropathy has guided the prevention, diagnosis and management of diabetic foot problems in the 21st century.

The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes.

PURPOSE: The purpose of this study was to develop and validate a method of measuring activity limitation in leprosy and diabetes. The resulting questionnaire should be quick and simple to use in basic clinical settings, not require any testing skills or equipment, be validated across a number of cultures in order to be widely applicable, be relevant for anyone with long-standing peripheral neuropathy and be sensitive to changes in clients' capabilities. Because of impaired sensibility in hands or feet, persons affected by leprosy or diabetes are expected to be aware that many activities carry a risk of injury, particularly repetitive stress, excess pressure, friction or burns. They are expected to avoid these risky activities, or modify how they are carried out, in order to prevent injury. An additional aim of the study was therefore to find ways of assessing how far clients were aware of safety issues and how much they limited their activities voluntarily because of safety concerns. METHOD: Lists of activities of daily living relevant for the target populations were generated through individual interviews and focus group discussions. A questionnaire of 374 items was compiled and administered to 436 persons affected by leprosy and 132 affected by diabetes in five countries in four continents. A total of 76% of respondents had impairments. Occupational therapists not otherwise involved in this study gave an independent assessment of the degree of activity limitation of 207 respondents. The process of item selection from this database is presented step by step. Items for the SALSA scale were practised by at least 70% of respondents in all participating populations, were easy to perform for some but difficult for others, correlated well with the assessment of independent practitioners and had good item-total correlation. The present set of 20 items is well represented by a single principal component and had a high scale reliability coefficient. RESULTS: On a 20-item scale, one would expect a score of 20 if the respondents practiced all the activities listed without difficulty. Higher scores reflect increasing activity limitation. The SALSA score varied from 10 to 75 with a mean of 32. The distribution of the scores was not different between men and women or between disease groups. There was a consistent increase of the SALSA score with age and with the level of impairment. Compared to India and Nigeria, the average SALSA scores, adjusted for age and impairment level, were higher in Israel and Brazil, but lower in China. The spearman correlation coefficient between the SALSA scores and the scores assigned by the independent experts was 0.67. Among 23 respondents without overt disease, the SALSA score had a median of 19 and half the respondents scored between 18 and 20. CONCLUSIONS: The present research has resulted in the SALSA scale, a short questionnaire which can be administered within 10 min and which provides a standardized measure of activity limitation in clients with a peripheral neuropathy. It can be used to make comparisons between (groups of) individuals in different countries and in the same person (or group) over time. General health workers can use SALSA to screen clients and refer those with high scores to specialised services. In addition, the scale will assist service providers in designing appropriate interventions.