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Early signs and symptom of Diabetes : Foo

Spotting Diabetes (Mellitus) Early: Signs and Symptoms

There are signs that let you know if you have diabetes mellitus and give you a chance to start treatment early before things get too detrimental. These signs depend on what kind of diabetes mellitus you might have. Diabetes means “excessive urination” and mellitus means “honey”, these two words together means “sweetness in urine” or in other words “sugar/glucose appearing in urine”. There are many forms of diabetes mellitus that are due to different causes.

Diabetes may be primarily—caused by another disease, or secondary—caused by damage of the pancreas by another disease. Approximately 98% of diabetes patients have primary diabetes mellitus, the idea behind this article is to help learn about the two kinds of primary diabetes: Type 1 and Type 2 diabetes.

Insight and self-consciousness, makes it mainstream to ponder the wholeness of our health. There is an abundance of social media influencers advertising “eating plan” and “exercise regimen”. Lifestyle apps that keep you healthy by reminding you to drink water, recommending what best to eat and at what time and ensuring you have enough breaks during the day.

Considering all these general mindfulness being the “in thing” in our society, it is alarming to see that so many people don’t understand the inner workings of their own bodies. So many people go through everyday life,  experiencing the symptoms of diabetes but take it as a normal occurrence because a large number of the symptoms do not present as dangerous on their own, and that in itself is its danger. Understanding and recognising some early symptoms of diabetes can help us understand when we need to seek some form of medical consultation.

Early Symptoms Of Diabetes

The most common signs of diabetes mellitus (both type 1 and type 2) are frequent thirst, excessive urination and increased hunger. The excess glucose (sugar) in your blood that isn’t absorbed into your body due to diabetes is diluted by water and gotten rid of by the kidneys. This is the reason for frequent urination.

Because a lot of water is accompanying the glucose on the way out, the body gets dehydrated. You become thirsty and drink a lot of water to replace what was lost. Basically, glucose and other nutrients and food groups necessary for daily life from your everyday meals. Because there is now less glucose in your body (it has been flushed out), you start to feel hungry and crave food to compensate for the lack.

This leads to a cycle of always eating and drinking without actually getting any of the benefits. Controlling your blood glucose levels and keeping them optimal makes it possible to live life normally, eating and drinking whenever you wish without a condition forcing you to.

It is sad to see that these symptoms are so often written off as ‘normal’, but it is understandable. A busy person will not think thirst or a little nausea is a big deal, and even the more severe symptoms closely resemble the symptoms of a common cold or flu that goes away on its own after some days of rest and many bowls of chicken soup.

Not enough people realise that all these signs are hinting at the body’s inability to absorb glucose, which is caused by a lack of or resistance to insulin—the hormone that transports glucose to where it’s needed. To be on the safe side, if after being sick your thirst still lingers, a visit to the doctor should be the next thing on the list. One single blood test can clear years’ worth of doubt.

The human body extracts glucose from food to use it as fuel. Every process in the body requires it, like how a car needs gas to run. The cells, tissues and organs get the glucose that’s digested in the stomach after it has been transported out by insulin. Therefore, without insulin, there would be no energy for you to do work. The body would stop functioning properly.

The unique combo of continuous thirst, frequent urination, and sudden weight loss are key signs of an increased amount of glucose in the blood. These three symptoms are common in both type 1 and type 2 diabetes. Type 1 and Type 2 diabetes are different branches of the same disease. They are both caused by problems regarding insulin.This difference between the two types is the reason why the rest of the symptoms begin to vary after the early stages.

In Type 1 diabetes, the pancreas does not produce enough insulin to transport all the glucose you eat to where it is needed, so the rest remains in the blood.

In Type 2 diabetes, the pancreas produces enough insulin but the body does not recognise it so it cannot use it, and that causes the glucose to remain in the blood.

Symptoms Of Type 1 Diabetes

Type 1 diabetes happens suddenly and at any age in life—but usually it occurs before the age of 40. It happens when the pancreas stops secreting insulin. It is caused by degeneration of the cells of the pancreas, damage to the pancreas due to autoimmune diseases, congenital disorder of pancreas cells or destruction of those cells by viral infection.

what is dka (diabetic ketoacidosis)?
Diabetic Ketoacidosis)?

When it occurs in infancy or childhood, it is called ‘juvenile diabetes’. It can take weeks or months for the pancreas to completely stop secreting insulin, but eventually a normal, healthy person will become insulin-deprived and their glucose levels will shoot up to dangerous levels. A patient with Type 1 diabetes will become dependent on insulin injections for treatment so Type 1 diabetes is also called Insulin-dependent diabetes mellitus (IDDM).

Since the body can’t access the glucose in blood, it begins to find alternate sources of energy and starts breaking down fat and muscle. The end products of this are ketones (ketoacids).

The abundance of these acids makes the blood more acidic and leads to acidosis. This will cause fatigue, lack of appetite and confusion.  

When the ketone level in your blood is very high, your heart will begin to beat faster and your breathing rate increases. Your breath will have a sweet, fruity smell because of the many ketones present in the bloodstream—and at this stage the amount would have reached a life-threatening level that can cause unconsciousness.

 

Symptoms Of Type 2 Diabetes

Type 2 diabetes is caused by a partial deficiency of insulin caused by the body’s cells not being able to receive the hormone even after it has been produced. It is the more common type of diabetes and usually occurs after the age of 40. Only a few forms of it actually required insulin as treatment. It can be controlled by taking oral hypoglycemics (drugs that make the body more receptive to insulin/increase insulin production). Because of this, this type of diabetes is also called noninsulin-dependent diabetes mellitus (NIDDM).

Insulin Resistance can be caused by genetic factors, stress or lifestyle changes. Examples of these lifestyle changes are bad eating habits and lack of physical activity that leads to obesity. Physical activity helps a person burn glucose and makes their body more sensitive to insulin while being overweight increases insulin resistance (scientists aren’t completely sure why).

A patient with Type 2 diabetes does not need insulin in the beginning because the pancreas overproduces to compensate for the unreceptive cells—this is the reason why Type 2 diabetes often goes unnoticed for years. But eventually, the pancreas isn’t able to keep up and the glucose builds up in the blood even with insulin being constantly produced. Eating healthy, cutting back on sweets and losing excess weight helps control the glucose levels in a person with type 2 diabetes. Early treatment positively impacts and maintains a good quality of life.

 

Complications Of Diabetes Mellitus

Diabetes Foot

Prolonged hyperglycemia (high blood glucose levels) damages the retinas of your eyes (which spoils your vision). When caught early, this condition is manageable, but if left untreated, Diabetic Retinopathy will cause permanent damage to the retina of the eyes. Not only this, high glucose levels can damage the kidneys (Diabetic Nephropathy) and nerves (Diabetic Neuropathy) of the body as well as hypertension and heart attack.

A person with diabetes is more prone to getting fungal infections, and when they are infected it is quite hard to treat. Yeast grows from sugar and is naturally occurring in the body but when too much yeast accumulates it causes pain and itching. It grows in moist and warm places like the mouth, the folds of the skin, the genitals, the eyes and the foot (especially the toenails).

Without treatment, such infections can lead to blindness or become life-threatening when the yeast manages to get into the bloodstream of a patient who has a depressed immune system and spreads to other parts of the body.

The high blood glucose also causes slow wound healing due to lack of energy and the neuropathy of the nerves will prevent you from feeling pain sensations, so a lot of tiny wounds become ulcers and if left untreated can cause problems later on.

For this reason, it is always good to pay close attention to the state of your body and catch these signs and symptoms before they progress too far and become deadly. Early intervention and correction of elevated blood glucose can promote proper circulation and healing while preventing the onset of all these complications.

 

Juvenile Diabetes:

Young children aren’t able to properly convey the changes that occur in their bodies due a lack of understanding or communication skills. Because of this, it’s hard for parents to tell whether their children are suffering from Type 1 diabetes, especially since the symptoms are so easy to miss—being very hungry and very thirst are easily noticeable signs but these are also just the normal behaviours of growing children and shouldn’t be a cause for alarm. 

The following are some behaviours observed in children with Type 1 diabetes:

  • Getting yeast infections (thrush).  
  • Acting out of character. Being moody or restless. Having mood swings. 
  • Losing weight despite having frequent meals.
  • Feeling tired, dull and lacking strength to play.
  • Peeing more, or even wetting themselves despite having been toilet trained.
  • Having a sweet smelling breath

If while watching their children grow, parents notice any of these symptoms of elevated blood glucose levels in their infants, toddlers or young children they should immediately seek their pediatrician’s guidance.

Type 1 diabetes can strike at any age. The sudden pause in Insulin production leads to a rapid rise in glucose levels which can quickly become Diabetic Ketoacidosis (DKA). Catching these signs early can ensure that insulin is given promptly and the quality of life is preserved. 

 

When to See a Doctor

The symptoms of diabetes in the early stages can easily be confused as a minor illness, so it can be hard to pinpoint exactly whether you, or someone you care about, has it. But that’s okay.

If you are want to confirm whether what you have been experiencing could have been diabetes, you can ask yourself these questions:

  • After getting a cold or the flu. Do you recover quickly? Do you still feel sick?
  • Have you noticed any cuts and grazes that seem to be taking longer than usual to heal?  
  • Do you experience numbness and tingling in your hands or feet? Is this a recent development or a long term condition?
  • Have you always wrestled with yeast infections, or are recurring infections a new struggle?
  • Have you noticed weight loss you can’t explain? Are you overweight?
  • Have you felt thirstier, or found yourself drinking more than usual in recent weeks or months?
  • Have you noticed any changes in your vision?

 

Catching It Early Makes All The Difference

If you are concerned about your health, visit your physician and tell them your concerns. A simple test strip or lab draw, can supply you both with a wealth of information about if necessary, treatment can be started. Early diagnosis and treatment by a professional makes all the difference between managing your condition and having to suffer unknowingly.

Since 2012, our goal at mySugr has always been to make diabetes suck less for people within the diabetes community.  We have long endeavored to educate, advocate, and elevate the global working knowledge of living life with both type 1 and type 2 diabetes to the fullest. Utilizing our combination approach of sound coaching and advancing tech, we’ve made huge strides at creating an environment that lets all people with diabetes maintain optimum health while living their best life!

 

Diabetetic And Unaware

According to the World Health Organization (WHO), the number of people with diabetes rose from 108 million in 1980 to 422 million in 2014—”About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.6 million deaths are directly attributed to diabetes each year.”

According to the American Diabetes Association, in 2018, 10.5% (34.2 million American adults) of the American population had diabetes. 24.8 million were diagnosed and 7.3 million were undiagnosed. And 1.5 million Americans are diagnosed with diabetes every year.

This means that right now millions of people walking around with a dangerously high amount of glucose in your blood, experiencing complications and receiving no treatment for them. We hope that everyone reading this gains an understanding of diabetes, whether they have it or not.

We know that it is improbable to reach everyone, but if you can help spread awareness and educate those around you on the symptoms of early stage diabetes, that means an increased awareness in your community, which can reduce the number of undiagnosed diabetic patients in your direct environment.

If you have a family member or relative who has been diagnosed as being diabetic, to be on the safer side, you should visit your doctor to discuss the possibility of being at risk. A bi-annual blood test can provide a constant baseline for your doctor to monitor for any unusual increase in blood sugar levels. 

 

Dr. Babajide Ogunlana

If you or your child struggle to maintain a healthy weight, ask your doctor and/or your child’s pediatrician for pre-screening and lab work to look out for early signs of diabetes. By working hand in hand to achieve optimum health, you and your medical team can be proactive partners in warding off any symptoms of diabetes before they begin to damage peripheral systems.

If you or your child have other genetic factors (such as other auto-immune conditions), you should ask your doctor for pre-screening lab work to rule out any signs of diabetes. Auto-immune conditions tend to breed additional auto-immune conditions. Still, by creating a team-work approach to full-body care, you can provide a protective screening system that stands sentry against the early warning signs of diabetes. In this way, you can begin any treatment at the earliest possible opportunity and set the stage for successful long-term health.

 

 

 

African Women’s Health Project International #AWHPI – Fight Cancer Global.

Join Dr. Babajide Ogunlana this month of October, on the African Women’s Health Project International #AWHPI in collaboration with Fight Cancer Global. AWHPI 2020 Learn Pink Breast Cancer Awareness campaign initiative for the entire month of October. Throughout the month of October on each Monday, we will be disseminating vital information via all our Social Media platforms, and will be making and sharing videos relating to the fight against Breast Cancer. Additionally, we are showcasing our AWHPI Learn Pink Breast Cancer Awareness campaign Champions.
We are delighted to have the partnership collaboration of Fight Cancer Global – the leading global corporation on the fight against Cancer with operations in over Sixty Countries worldwide!

We are delighted to showcase our AWHPI Learn Pink Breast Cancer Awareness Champions FOUNDERS here…

foot odour

Foot Odour and Smelly Feet

The feet actively supporting the rest of the body, tend to be covered up all day. Thereby restricting the follow of air that helps reduce sweat and decrease bacteria activity on the feet.  Which can cause the feet to smell worse than other parts of the body. Smelly feet and foot odour can become problematic and if not treated accordingly leads to not only embarrassing moment, but affect your self confidence and freedom to wiggle those feet of yours

At one point in time we all tend to sweat and perspire on the feet  due to several reasons like those listed below. When these sweat itself can not evaporate then it leads to smell or stinking feet. This is usually caused by skin bacteria breakdown and secretes. Fungal infection, such as Athletes’ feet and other factors listed below can cause foot odour. 

To help prevent this condition of smelly feet or foot odour at the office, during sport practice, at your loved ones home or just simply stretching your feet out at garden or when having a picnic at the park. Dr. Babajide Ogunlana has a few tips: 

  • Avoid  the use of shoes that are tight to the feet as this can help reduce heat that makes the feet sweat and feed the growth of bacteria. Doing this also helps to avoid you developing conditions such as  bunions, toes fungus and corns and callus.
  • Clean your feet regularly with soap and water at least once a day and more if you do rigorous activities such as exercising, running , sport and walking. Take your time to dry your feet thoroughly afterwards, especially between your toes.
  • Have an extra pair of shoes so that you can rotate your shoes daily. This will give them a chance to air and dry at least 24 hours before the next wear. You can use Clean Sweep an antimicrobial Shoe Protection Shield, clinically proven to inhibit the growth of odor-causing bacteria, fungus, and mold. In your shoes at the end of the day after wearing them. Antiperspirant spray  or deodorant can help your feet stay dry or the use of foot powder to absorb sweat from your feet.
  • Use wool or cotton socks  preferably  and not nylon,  as they help to  absorb moisture better. Change your sock at least once a day, use sports socks and medicated insoles that are made to keep feet dry, and special antibacterial socks, which have a deodorising effect for your feet and shoes.
  • Avoid going barefoot in public space and communal facilities like gyms, bathing places and swimming pools. It is very easy to pick up germs, such as bacteria, fungus, and warts
  • Wear flip flops and when practicing yoga, clean your feet with antiseptic wipes or hygienic baby wipes in case you don’t have access to a shower right after class.
  • Good foot hygiene is essential , keep toenails trim and clean and remove callused skin with a foot file. Get a foot soak like using a salt bath, tea soaks or apple cider vinegar will help with callused skin and bacteria.

 

  • Reduce and if possible avoid the consumption of refined carbohydrates. Instead, take a balanced diet, with enough fruits & veggies and plenty of water.  

Condition that can lead to such foot odour and smelly foot are; 

  • Fungal Infection
  • Standing All Day 
  • Overactive Sweat Glands
  • Genetics
  • Injury Due To Structural Tissue
  • Bacterial  Breakdown On Skin
  • Hormonal Changes
  • Daily Stress
  • Poor Personal Hygiene 
  • Wearing Same Shoe Everyday Without Airing Them
Chucky trainer trend

Chunky trainer trend bad for feet

Fashionable shoes are seldom sensible. However, some trends are better for feet than others. While some might assume the current look of wearing trainers with thick, chunky soles would be good for your feet – think of all that extra cushioning – leading podiatrists say otherwise.

Part of the popularity of these shoes might have come from the fact they are much more comfortable than other fashion shoes for women, particularly high heels. However, they come with their own risks. In particular, the weight of the trainers is an issue that could lead to health problems down the line.

Could COVID Toes Be An Emerging Acro-Ischemia Symptom Of The COVID-19 Virus?

By Nicholas A. Campitelli, DPM, FACFAS and Kelly Kubiak DPM

COVID-19, caused by the novel coronavirus named SARS-CoV-2, causes a variety of clinical symptoms with the most common symptoms being a dry cough, fever, myalgia and fatigue.1 Less common symptoms include dyspnea, sputum production and diarrhea. However, as the COVID-19 virus continues to spread across the world, new information about the disease is emerging all the time.

One now hears the term COVID toes being noted when patients who have the COVID-19 virus present with extremity symptoms. These patients may or may not carry an official diagnosis of COVID-19. These patients may present with a digital ischemic appearance of purplish or red lesions on their toe(s) that are often painful.2 However, one could easily confuse the presentation of such symptoms for frostbite, Raynaud’s disease or chilblains. Most reports of such a phenomenon are seen primarily in younger populations with or without other symptoms.3

The exact cause of these symptoms is still unknown. One prominent theory involves a likely underrecognized vascular component to the disease.4 The COVID-19 virus is known to attack cells in the lung via the angiotensin converting enzyme 2 (ACE2) receptor. The ACE2 receptor is not limited to just the lungs. It is also found in other organs including the heart, kidney and intestines. The ACE2 receptor is also found on endothelial cells that line vessels throughout the whole circulatory system, including the very small vessels in the toes.4 Researchers out of the Pathology and Cardiology Departments from University Hospital Zurich, in Zurich, Switzerland speculate that the virus attaching in these small vessels results in the vascular symptoms now known as COVID toes.4

What Recent Case Reports Reveal About COVID Toes

As information on the novel coronavirus continues to evolve, more research on COVID toes may emerge. In a recent report out of China, Zhang and colleagues discussed seven critical patients with the COVID-19 virus, who had an average age of 59 years and clinical symptoms including finger/toe cyanosis, skin bullae and dry gangrene to the digits. These patients also reportedly had prolonged prothrombin time (PT), an elevated D-dimer level and diagnosed disseminated intravascular coagulation (DIC). Five of the seven patients ended up dying from the COVID-19 virus.

However, most reports on COVID toes come from various news media and seem to be in younger age groups with many of these patients not having any respiratory symptoms.3 A press release from the French National Union of Dermatologists and Venereologists warns of skin manifestations of COVID-19 that the group classifies as acrosyndromes.2 This group defines symptoms as the appearance of pseudo-frostbite, a sudden appearance of persistent and sometimes painful redness, and transient hive lesions on the fingers and/or toes.2

In a recent case study out of Italy from the International Federation of Podiatrists, Mazzotta and Troccoli describe self-healing lesions in children and adolescents, and believe the etiology is vascular in nature.3 Kerri Purdy, MD, FRCPC, president of the Canadian Dermatology Association, also agrees with a vascular origin.6 In a recent interview, Dr. Purdy stated that the presentation is similar to chilblains but she believes the etiology is vascular, not thermal, in nature. She attributes it to small vessel blockages as emerging evidence points to the COVID-19 virus contributing to a hypercoagulable state.6

Physicians in France and Spain also report lower extremity symptoms in various younger populations.2,3 As the aforementioned report out of China shows, COVID toe is not limited to the young but may possibly be the only symptom present in a patient with the COVID-19 virus.5

Our Experience With A Possible Presentation Of COVID-Related Pedal Symptoms

Here one can see a photograph of the patient taken at initial presentation on April 6, 2020. Her chief concern was severely painful reddish and purple lesions to her toes bilaterally. On April 6, 2020, a 13-year-old female presented to the office complaining of severely painful reddish and purple lesions to her toes bilaterally (see top two photos to right). Her symptoms began several weeks Here one can see a photograph of the patient taken at initial presentation on April 6, 2020. Her chief concern was severely painful reddish and purple lesions to her toes bilaterally. earlier and an ER physician originally treated this as cellulitis with an antibiotic. The condition eventually spread to multiple toes with blisters developing on some of the lesions (see next two photos to right). The pain was so severe the patientHere one can see a photo taken prior to presentation to the author's office, on March 31, 2020. Her symptoms were present for a few weeks, with pain making shoe gear intolerable. could not tolerate shoes.

The initial presentation was consistent with Raynaud’s disease as it was almost certainly some Here one can see a photograph taken by the patient's mother one day prior to presentation at the author's office. Even with treatment by the ER for presumed cellulitis, the lesions progressed and some even blistered.type of vasculopathy. The patient denied trauma and did not exhibit any signs or symptoms of infection. The patient had palpable dorsalis pedis and posterior tibial pulses, a sluggish capillary refill time and toes cool to the touch consistent with Raynaud’s disease. The family shared this suspicion as they noted a family history of Raynaud’s disease. At this time, this seemed to be the most likely diagnosis. We dispensed a prescription for nitroglycerin paste for the patient’s pain and symptoms.

Over ten days after presentation to the author's office, the patient related improvement in symptoms, as seen in these photos.Ten days later, the patient reported an improvement in her symptoms and clinical presentation, which was confirmed with pictures sent by the patient’s mother (see next two photos to right).

Over ten days after presentation to the author's office, the patient related improvement in symptoms, as seen in these photos.At this point in time, similar symptoms began to appear in reports of children around the world connected to COVID-19. Further questioning of the patient and her mother confirmed that the patient had a serious flu-like condition the previous month. There were also siblings in the household who had exhibited a fever, sore throat and cough approximately two weeks in duration. These siblings also tested negative for influenza and strep. When the patient began experiencing exhaustion and shortness of breath, she never had testing for influenza due to her siblings’ negative status. She did, however, test negative for mononucleosis. Her pediatrician prescribed an antibiotic and an inhaler. She did not receive a COVID-19 test.

Anecdotally, we learned through social media of a 13-year-old male from the same school of the first patient who exhibited similar symptoms and painful complaints about his toes. His symptoms had a six-week duration and consisted of erythema Here one can see a photo of a 13-year-old male from same school of the first patient who exhibited similar symptoms and painful complaints about his toes. His symptoms had a six-week duration and consisted of erythema and pain to his toes. and pain to his toes (see bottom two images to right). The erythema eventually progressed to purpuric-appearing lesions on all of the toes very similar in nature to the previous patient. His Here one can see a photo of a 13-year-old male from same school of the first patient who exhibited similar symptoms and painful complaints about his toes. His symptoms had a six-week duration and consisted of erythema and pain to his toes. pediatrician prescribed oral steroids three weeks after the initial presentation of symptoms and this treatment eventually allowed the patient to tolerate shoe gear. This patient displayed no clinical symptoms of the COVID-19 virus and had no other pertinent findings such as fever or dermatological lesions elsewhere. Accordingly, the patient was not tested for COVID-19 at that time.

In Conclusion

The aforementioned cases provide anecdotal evidence of two patients in the same geographic area who presented with symptoms that are possibly consistent with COVID toes albeit without a confirmed diagnosis of the COVID-19 virus. Both patients were in their early teens and early reports have suggested that COVID toes appear to be most prevalent in this age group.3 Both patients described color changes and a painful presentation with four to six weeks of symptoms before noting improvement. Only one of the patients exhibited crusted lesions as noted in an aforementioned report out of France.2 One patient had other symptoms suggestive of the COVID-19 virus and the other patient did not. This is consistent with similar findings in another recent report out of Spain that noted COVID toe in both symptomatic and asymptomatic patients.7 While these authors recommended topical corticosteroid treatment for patients with these lesions, other cautions exist regarding the use of systemic steroids in patients with the COVID-10 virus so practitioners should exercise caution in this population.7,8 

For the presented patients above, improvement occurred with nitroglycerin paste and topical steroids respectively.  It may be prudent to also suggest that similar patients exercise caution and self-quarantine due to the possible association with the COVID-19 virus.

At the present time, there is limited, if any, true scientific literature to guide clinical decision making in the diagnosis of these questionable COVID toes. This presents difficulty in presenting a possible diagnosis yet to be proven scientifically or backed with peer-reviewed literature. With that said, there is evidence to suggest that the two aforementioned patients who presented with pain, red-to-blue colored lesions and vasculitis to their toes could possibly have had COVID toes. The symptom timeline along with the presence of the virus in the United States supports this. Certainly, more research is necessary to specifically correlate known COVID-19 status and COVID toe presentation before we can confirm the true etiology and association of COVID toes.

Dr. Campitelli is the Director of the Podiatric Residency Program at the Western Reserve Hospital in Cuyahoga Falls, Ohio. He is an Adjunct Clinical Professor at the Kent State University School of Podiatric Medicine

Dr. Kubiak is a third-year podiatric surgery resident at the Western Reserve Hospital in Cuyahoga Falls, Ohio. 

References

  1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  2. La Revue du Praticien. Covid revealing acrosyndromes. Available at: https://drogunlana.com/2020/04/30/the-benifits-of-middle-age-fitness/ .  Accessed April 27, 2020.
  3. Mazzotta F, Troccoli T. Acute acro-ischemia in the child at the time of COVID-19. International Federation of Podiatrists. Available at: https://www.fip-ifp.org/wp-content/uploads/2020/04/acroischemia-ENG.pdf. Accessed April 27, 2020.
  4. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020. Available at: https://doi.org/10.1016/S0140-6736(20)30937-5. Accessed April 27, 2020.
  5. Zhang Y, Cao W, Xiao M, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Chinese J Hematol. 2020;41(0):E006.
  6. Young L. ‘COVID toes’ could be another symptom of coronavirus infection: experts. Global News. Available at: https://globalnews.ca/news/6848644/covid-toes-skin-rash-coronavirus-symptom/ . Published April 21, 2020. Accessed April 27, 2020.
  7. Consejo General de Colegios Oficiales de Podólogos de España:  COVID-19 Compatible Case Register.  Available at: https://drogunlana.com/2020/04/30/the-benifits-of-middle-age-fitness/ . Accessed April 27, 2020.
  8. World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected. Available at: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected . Accessed April 29, 2020.
April 30, 2020
By Nicholas A Campitelli DPM FACFAS
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