“The virus disappears – but the inflammation continues”

Why some Covid 19 patients become seriously ill and end up in intensive care is still unclear. In an interview, an expert explains what an essential role the immune system could play.

The immunologist Professor Dr. Andreas Radbruch already has the t-online podcast “Soundtrack Knowledge” talked about the effects of the coronavirus on the body. In an interview, he explains why the immune system can make Covid 19 disease worse and what he thinks of the current research on the bradykinin hypothesis.

t-online: Professor Radbruch, new research shows that hormones could be responsible for many serious Covid-19 cases. The so-called bradykinin hypothesis states that the coronavirus disrupts the body’s own functions such as regulating blood pressure and leads to an overreaction of the immune system. As an immunologist, how do you rate this theory?

Prof. Radbruch: I am somewhat surprised at the response to this study in the public media. In itself, this is relatively trivial. Because the immune reaction in Covid-19 patients can lead to inflammation and this is accompanied by vasodilating hormones. In this case a so-called peptide hormone with the beautiful name “Bradykinin”. This is not very different from histamine. A Dutch research group put forward this hypothesis in April and brought bradykinin into play. The new US study simply evaluated the research of others and wrote it down on paper.

(Source: Gero Breloer)
Prof. Dr. Andreas Radbruch is Scientific Director of the German Rheumatism Research Center and President of the European Federation of Immunological Societies.

According to the study authors, the body keeps making bradykinin, which cannot be broken down. A “bradykinin storm” is said to be responsible for many deaths in Covid 19 patients. Do you find that plausible?

I don’t think you can call that a storm. I see this more as a reflection of the ongoing illness that can drag on for weeks and months. Unfortunately, some of the patients are in the intensive care unit for a very long time. For me this shows that there is a serious inflammation going on there. Whether the coronavirus constantly causes cells to produce bradykinin is complete speculation.

It is also very difficult to detect the bradykinin. That did not happen in the study. If they had at least measured that the bradykinin itself is extremely highly concentrated on site, then you would have proof.

A “cytokine storm” was also mentioned in previous studies …

This refers to inflammatory cytokines that are suddenly released in large quantities. There was literature that claimed that Covid-19 patients suffered sepsis as a result, i.e. blood poisoning. The effect is comparable to an anaphylactic shock: If you are allergic, it can happen that a bee sting is enough to kill you.

But I think that it is not appropriate to call it a storm here either. Because the patients are not in a stormy, but a chronic inflammatory situation. A storm would pass again. Then one comes Sepsis it is also very dangerous. At the beginning it is extremely intense and then you recover from it – or not. Controlling sepsis is still a huge medical problem today.

Is it true that there are gender differences and that men are more prone to overreacting the immune system?

Yes, it seems that the reactions in women are milder. Men react more violently. The reasons for this are still unclear.

This is also the case with autoimmune diseases, some of which are mainly men, others more women. With women, the whole thing is more balanced. To this day it is not known exactly why, for example, predominantly women Lupus and not at least as many men.

You yourself examined the immune response of Covid 19 patients in a research team in the intensive care unit at the Charité in Berlin. What are your findings?

In our manuscript we describe that that Coronavirus triggers a chronic immune response. In the seriously ill patients we look at in the intensive care unit at the Charité, the virus disappears after a certain time – but the immune reaction and thus the inflammation continue. The body tries to slow down the immune response, but it fails. Why this is the case with some Covid 19 patients and not with others is still a great mystery. It can be assumed that it has to do with how the infected person’s immune system deals with the virus. Whether it will find a way to clear up the coronavirus efficiently and quickly or not.

Charité - Universitätsmedizin Berlin: Seriously ill Covid 19 patients are treated here.  (Source: Getty Images / Panama7)Charité – Universitätsmedizin Berlin: Seriously ill Covid 19 patients are treated here. (Source: Panama7 / Getty Images)

We also suspect that an autoimmune reaction is triggered. There are many diseases, such as chronic intestinal inflammation, where the immune system reacts against its own components, but it shouldn’t react against them. The cytokine we looked at is called TGF-β. Patients develop more and more of it over time; the cells in the lungs, for example, are full of it. The cytokine was supposed to suppress the immune response, but it doesn’t. Patients are then treated with medication to manage symptoms. But the cytokine also has the unfriendly side that it can lead to scarring in the lung tissue. This is a side effect that has been used in severe cases of Covid-19 has been described.

This can lead to long-term damage …

Exactly, the mucous membranes can scar. The tissue is then sometimes no longer functional.

Does it play a role in the severity of the disease, how strong the immune system is before the infection?

Patients who suffer from a suppressed immune system, for example rheumatism, are not recommended to reverse immunosuppression. You should keep taking your medication. So it seems to be different whether you inhibit chronic inflammation or have an acute immune reaction against a pathogen. So far there is no evidence that these patients with suppressed immune systems react worse to the virus.

Rather, it seems to be the case that most people infected with corona already have some kind of pre-conditioning because the body has already gone through something similar with related pathogens. The immune system then has memory cells. So if someone has been infected with other cold viruses, it can get on very quickly and efficiently SARS-CoV-2 responds. On the other hand, the patients who don’t do this are in a bad way. That seems to be much more important as to whether someone has to go to intensive care or not. The dose of the pathogen, its vitality and its ability to penetrate into the depths of the lungs also determine the course.

Thank you for the interview, Prof. Radbruch!

Important NOTE: Under no circumstances does the information replace professional advice or treatment by trained and recognized doctors. The content of t-online.de cannot and must not be used to make independent diagnoses or to start treatments.

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Ahead of Menopause, These Are The Physical Changes That Women Experience From Their 30s

TEMPO.CO, Jakarta – Before your 30s are over, you may start to notice that many things with your body are no longer the same as they used to be. This is because the hormones that have been stable since puberty begin to fall, ovulation begins to end and some of the side effects are quite large. Welcome to the beginning menopause.

“Perimenopause, or the years before menstruation completely stops, can start as early as age 35, but most women will experience it in their mid-40s,” says Toni Mueller, MD, gynecologist at Complete Women Care in Southern California. page Good Housekeeping. This transition to menopause usually lasts about seven years, and for some women it can last as long as 14 years.

During this time, rates hormone estrogen, progesterone, and testosterone start to fall, which triggers a variety of symptoms. “The big problem is your periods will be irregular, maybe less frequent, but heavier,” says Dr. Mueller. “You can also start experiencing hot flashes and night sweats.”

Other potential side effects include reduced muscle mass, more belly fat, lower energy levels and libido, more intense mood swings before menstruation, and difficulty concentrating. “Estrogen is also what keeps your vaginal flora in sync, so now is when you can start experiencing less lubrication and more painful intercourse,” says Dr. Mueller. Other vaginal changes include a higher risk for yeast infection and thinning of your external genital tissue, which can cause irritation and pain during sex.

In your 50s for most women, this is the decade you say goodbye to your period forever, which can bring about a lot of emotional and physical changes. Some can be positive, especially if you’ve had painful periods in the past – the PMS symptoms and cramps go away forever too. But other changes can be difficult to deal with. “The biggest concern here is a drop in estrogen, which is felt throughout the body,” says Dr. Mueller. “For example, hot flashes can be intense and more prominent.” Most women have hot flashes for about seven years, although they can continue for more than a decade (the earlier the hot flashes, the longer they tend to last).

Shifting your hormone levels also affects your bone strength and heart health. “Estrogens protect bones, so now you have to start worrying about osteoporosis,” says Dr. Mueller. “And estrogen helps keep LDL cholesterol down and HDL cholesterol high, so without it you have a higher risk for heart disease, stroke, and heart attack.” Half of postmenopausal women will also experience vulvovaginal problems, such as dryness, burning, and irritation, and most of these women will have a negative impact on their sex life because of these symptoms.

When you are in your 60s and after you may no longer experience the more irritating symptoms of menopause, such as hot flashes, but you are not out of trouble. “Woman in this decade we still experience significant vaginal dryness, which means it can be very painful to have intercourse, ”says Dr. Mueller. “And they are also at higher risk of developing many cancers and heart disease.”

Because you’ve been through so many physical changes since your 40s, you may also have a hard time accepting your new self. Research shows that it’s natural to feel sad about losing your younger body or that you suddenly become trapped in a body you don’t recognize.

But you don’t have to sit around and accept all of these changes. You have options that can improve your physical and emotional well-being, from prescription drugs to home remedies. “How women feel during these decades depends on what they do during the transition to menopause,” says Dr. Mueller.

Ask your doctor about hormone replacement therapy (HRT). While not for everyone, HRT can be an effective way to relieve some of the major symptoms associated with menopause, such as hot flashes and vaginal dryness. “With hormone therapy, you can make a big difference in the quality of your life,” says Dr. Mueller. There are several different options (a specific prescription for estrogen or progestin, or a combination), and your doctor can determine if you are a good candidate and the right one for you. If you decide to try HRT, that doesn’t mean you’ll be using hormones for the rest of your life – your doctor will likely start you on a low dose and you continue it for as short as needed.

In addition to your normal self-care routine to cut back stress, prioritizing sleeping and eating well – all steps that can help reduce menopausal symptoms – there are also helpful home treatments for vaginal problems such as painful sex, dryness, burning and itching. Try using lubricants during sex and using vaginal moisturizers or topical estrogen creams or gels to relieve discomfort.

Lastly, prioritize your physical health. Strength training several times a week and increasing your heart rate regularly can help you avoid the muscle loss and weight gain associated with aging. Exercise can also reduce the risk of heart disease and some cancers. The more you pay attention to yourself, the happier you will be with your body and the easier it will be to adjust to all of these changes.

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Estrogens: Does the Pill Protect Against Covid-19 – or Does It Harm?

06.08.2020 – 18:47

Study explains context
Estrogens: does the pill protect against the coronavirus?

Foto: iStock.com/Rattankun Thongbun

The estrogen in the pill appears to protect against the coronavirus. But at the same time, there are other risks associated with Covid-19.

According to various studies, women develop Covid-19 less frequently than men. The thought has often arisen that it could be due to the estrogen level. Now researchers are explaining: The pill may (also) protect. But at the same time, it could also be a risk.

Some love it, others hate it: the contraceptive pill, or in short, the pill, is repeatedly criticized. While health problems such as thrombosis or psychological changes are associated with it, some women swear by the positive side effects of the contraceptive. Now there are new findings – and they have to do with the Sars-CoV-2 coronavirus. Does the pill protect against Covid-19? Or does it increase the risk of severe courses? In theory, both are possible.


The pill: study suspects protective effect against Covid-19


Statistics show: Worldwide more men than women contract Covid-19. This has long been associated with the hormone balance. Roughly speaking, more testosterone seems to provoke more difficult courses. Coronavirus, on the other hand, does not seem to like estrogen so much. According to scientists, the “female hormone” estrogen should be able to influence how many immune cells a person produces and how well they react to infections.




A large-scale study by King’s College in London has now examined this more closely and found that women who take a combination contraceptive were on average 13 percent less likely to develop severe symptoms of Covid-19. To this end, the scientists evaluated the data from around half a million women between May and June.

Estrogen appears to have protective effects


The researchers examined pre-menopausal women who used contraceptive pills and women during and after menopause who were on hormone replacement therapy to prevent menopause symptoms and the associated risks. Because with menopause, the estrogen level in women drops. The fact that estrogen has an impact on risk also shows that the difference between older women and men is no longer as great as other observational studies have already shown.


“In addition, we have a younger group of women who take the pill [als Kombinationspräparat] compared to a similar group that does not take the pill, and found less severe symptoms of Covid 19. This indicates that the hormones in the pill have a certain protective effect against Covid-19, “explains study co-author Dr. Karla Lee. However, the study has not yet been reviewed by independent experts and is currently still in the preprint Status: To what extent estrogen can now help protect against Covid-19 needs further research.


Wormwood drops: risk of blood clots increases


However, other studies also show less positive effects of the pill in connection with the coronavirus. It is now known that the pill – depending on the type and composition – can increase the risk of thrombosis. But Sars-CoV-2 can also cause blood clots, the Pulmonary embolism, Strokes or just Thrombosis can cause. Both together could further increase the risk. The preprint study, which has not yet been reviewed, has already been recorded by the journal “Endocrinology”.


But it’s not just the pill. Overall, high estrogen levels can increase your risk of blood clots. Therefore, the doctors in the study especially warn pregnant women, women who take certain pill preparations or those who use estrogen-based hormone replacement therapy. However, further research is also needed here.


“During this pandemic, we need further research to determine whether women who become infected during pregnancy should take anticoagulants, or whether women should stop taking the pill or hormone replacement therapy for the duration of the infection,” said study co – author Dr . Daniel Spratt from the Maine Medical Center in Portland, USA.


Covid-19 can mess things up in the body. More about that Coronavirus read on our topic page.


Studies:





The latest videos from BILD der FRAU

The latest videos from BILD der FRAU

show description


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very cheap and long-known drugs help save the lungs with coronavirus

Cloving hospital on the basis of the Medical Scientific and Educational Center (ISSC) Moscow State University named after M.V.Lomonosov took the first patients on April 21 and completed his work on June 13. It turned out that it was possible to achieve the best treatment results for COVID-19 in Moscow. Over the entire period, 4 patients died, and among severe patients who got mechanical ventilation, the mortality rate was less than 14% (for comparison, the average for the city and the world was up to 70 – 80%). Eighteen doctors out of 220 employees of the hospital were infected with coronavirus, there were no deaths among the medical staff.

What approaches were used at the University Hospital of Moscow State University to achieve such results? We continue the conversation with the head. Department of Therapy, Faculty of Fundamental Medicine, Moscow State University, Head of the Department of Age-Associated Diseases, Medical Scientific and Educational Center, Doctor of Medical Sciences, Cardiologist Yana Orlova.

MEDICINE FOR COUGH FOR 80 RUBLES

– Most of those who are ill or are afraid to get sick are worried about fibrotic changes in their lungs. They say that you have developed special therapy that can reduce the risk of developing fibrosis. Is it possible?!

– Yes, we launched an appropriate clinical study. There are no final results yet, but we have developed clinical practice.

“What did you do to save the lungs?”

– We used a combination of bromhexine and spironolactone (both are long-known very cheap drugs. – Ed.). Bromhexine is an expectorant that has been prescribed to patients with pneumonia and cough for many years. At the same time, experimental data showed that this drug can block a specific enzyme and impede the penetration of coronavirus into cells. True, it was on this effect that we counted to a lesser extent in inpatients, since such an effect is important mainly in the early stages of the disease. But the expectorant effect of bromhexine really helps patients with COVID. I heard that our colleagues in Peter launched a study of bromhexine for prophylactic purposes. We will wait for the results.

Coronavirus infected 18 doctors from 220 employees of the hospital, there were no deaths among the medical staffPhoto: Ivan MAKEEV

FIBROSIS OBSTACLE

– The second drug – spironolactone – is traditionally widely used in cardiology for the treatment of heart failure, severe hypertension. It has a small diuretic, magnesium and potassium-preserving effect, continues Yana. Orlova. – It has several mechanisms through which it can be useful in coronavirus infection.

Firstly, a mechanism that prevents the development of fibrosis in general in the body. There are works that, in particular, show that spironolactone reduces fibrosis in the heart. At the same time, it is known that the tendency to fibrosis is not local, but systemic – where there is more inflammation, there will certainly be fibrosis. And we see, of course, fibrotic changes in the “covide” in our patients. Therefore, we prescribed spironolactone as a drug for the prevention of this process.

Secondly, this drug blocks sex hormone receptors, in particular testosterone. Some published studies suggest that “high-testosterone” men suffer from “covid” more often and develop more severe fibrotic changes. Therefore, blocking these receptors for several weeks during COVID treatment may be useful in reducing the severity of complications. We are not talking about a longer intake, since male patients are unlikely to agree with a decrease in testosterone levels in the long term.

And perhaps the most important point. In almost all of our patients, we observed hypokalemia (a decrease in potassium levels. – Ed.). With coronavirus infection, potassium is intensely excreted from the body, and scientific articles even suggest that hypokalemia serves as the trigger for a cytokine storm. So spironolactone has a real chance to reduce the risk of this dangerous complication. But the main thing, in my opinion, is that lowering the level of potassium in the body is extremely harmful to the heart and triggers life-threatening rhythm disturbances, increasing the risk of sudden death. We, like all others, replenished potassium with droppers, but it was more effective to retain it in the body with the help of spironolactone.


Men certainly get worse than women;  the elderly are heavier than the young;  overweight people are heavier than patients without excess weight Photo: Ivan MAKEEV

Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patientsPhoto: Ivan MAKEEV

WHEN PRESCRIBED PATIENTS

– Yana Arturovna, how many patients did you have on average?

– About 10 – 14 days. But someone and 50 days.

– Have you noticed signs by which it can be assumed that the disease in the person brought is likely to go the hard way?

– Such studies were carried out in the world, our clinical practice confirmed them. Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patients. Men with a classic male type of baldness, a lot of facial hair, we can say brutal men get sick harder.

– Under what conditions did you discharge patients?

– We acted as close as possible to the recommendations Ministry of Health: so that the temperature for three days was not higher than 37.5 degrees; so that C-reactive protein (an indicator of inflammation) is lower than 10 mg / l, and saturation, that is, the level of oxygen in the blood, is higher than 96%.

“HEAD OF EPIDEMIOLOGY DEPARTMENT OF ITSELF WORKED AT SANPROPUSNIK”

– How often do you get sick doctors and nurses?

– In the first month no one got sick at all. We have a very powerful epidemiological service. The head of the sanitary-epidemiological department, a senior researcher, correctly organized the whole process, and for the first two weeks she personally worked in the sanitary inspection room at the exit from the “red zone” and helped doctors and nurses who were exhausted after the shift safely remove protective clothing.

Then both people’s fatigue and viral load accumulated. By the middle of the second month, sick people began to appear. There were no seriously ill patients. We treated part of the staff in our observation, part of it was treated at home. In total, 18 people were infected from the medical staff (less than 10%).

– Doctors take something for prevention? Vitamins C, D, Zinc?

– I saw the recommendations of American nutritionists, they speak out positively about taking zinc, melatonin and vitamin C. There were somewhat conflicting data on vitamin D. But we did not give any such recommendations to our employees. We have all the prevention was associated with minimizing contacts and other measures of epidemiological safety.

Physicians are the heroes of our time.“If you think that you are special and that a pandemic will not affect you, you are deeply mistaken,” listen to what the doctors who are fighting with coronavirus say

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Cortisol high, what is the stress hormone and how to lower it

This is a hormone that is produced on the pulse of the brain, synthesized by the adrenal gland, which is metabolized by the liver and excreted with the urine. Its name comes from the fact that the organism, when it is subjected to forms of overexertion psycho-physical, increases the production

Cortisol, as explained in the portal Humanitas, a renowned hospital of the Milanese, is a hormone known particularly as the “stress hormone”, is synthesized by the adrenal gland, which is metabolized by the liver and excreted with the urine. It is so called because it helps the body respond to a stress condition, but also because when it is subjected to a form of burnout and psycho-physical, its production increases.

What determines

deepening



The excessive stress at work can harm the heart: study

This hormone, produced under the impulse of the brain, in the moments of greatest tension, the body determines the rise in blood sugar and blood fat, providing the energy the body needs, as well as explains in an article by professor Francesco Cavagnini on the website of the Istituto Auxologico Italiano. Together with it are then released adrenaline and norepinephrine, two other hormones secreted by the medullary layer of the adrenal glands and by some nerve endings: the combination of these three elements, it helps to increase your blood pressure so as to improve, for example, the physical performance. Once the phase of acute stress, the body back in balance and decrease muscle tone, breathing, heart rate and blood pressure, allowing the body to relax.

The levels in the body

The level of cortisol produced by the body varies throughout the day, and the energy needed by the body changes, following this alternating pattern. The enhanced peak production, ” explains Cavagnini, “occurs in the moment before the awakening, to provide the body with the energy it needs to face the day”. Stress levels influence on this production, as I said, making sure that the level of cortisol remains high, and this allows, for example, to work through the night, but it also has negative effects, hindering sleep, and in the long run by changing the sleep-wake rhythm. Also, those who suffer from chronic stress and manifests high levels of cortisol in the evening, may run some risks, such as those to develop forms of atherosclerosis-related hypertension, which increase the cardiovascular risk. “In addition, an excess of chronic cortisol weakens the immune system and may promote diseases such as osteoporosis”, explains the expert.

How to control stress and lower cortisol

The main advice of the experts is to compensate for the stresses of working life with a healthy lifestyle and good habits, including healthy eating, not smoking, dedicate some time to relaxing activities and sleep the right number of hours every night. For example, an important role is played by power, often associated with just the cortisol. Professor Andrea Lania, always on the portal of Humanitas, has explained that the stress can induce a person to eat more and more upset. “To mediate the association between chronic stress and eating behaviour, there is the stress hormone. Cortisol, in fact, increases the appetite, and seems to orient towards a greater consumption of the so-called comfort food, the food that can give comfort in the event of a stress, tend to be more satisfying in terms of taste, full of sugars and fats,” he said. So resist temptation, it may be important to regulate cortisol, as well as to avoid excesses of sugar, fat, and exciting (including caffeine), and give priority to foods such as legumes, vegetables, white meat, fish, fruit, cereals, and extra virgin olive oil. Moderate use of alcohol, enjoy moments of relaxation and sports activities can contribute in the same way to adjust the levels of this hormone.

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experts explain why obesity “helps” coronavirus

– Has long been known that overweight people have lowered immunity, says head of the Department of endocrinology of the medical faculty Russian national research medical University. N. And. Pirogov Tatiana Demidova. Research and practice show that in these patients increases the risk of atherosclerosis sharply increases the risk of heart attacks, strokes and heart failure. Increased risk of endocrinological, oncological diseases, joint diseases, psychological disorders.

Epidemic COVID has added another item to the list of high threats to people who are overweight. It turned out that when infected with coronavirus patients with obesity more often require hospitalization, fall into the ICU, on the ventilator (artificial lung ventilation). Alas, is growing and the risk of death.

– If the original messages from China on the most severe cases COVID it was mainly about the older people with severe chronic diseases, according to the latest data from Europe and USA the risk group includes people with obesity – says Tatiana Demidova.

FACTS AND FIGURES

In what diseases most often develop complications due to coronavirus

90% of patients admitted with severe COVID-19 US hospitals, were the following comorbidities:

– hypertension — 49.7%,and

– obesity or 48.3%,

– chronic lung disease — 34,6%,

– diabetes type 2 diabetes was 28.3%,

– cardiovascular disease — 27,8%.

Thus, obesity is second among the States in which CouId be severe.

CORONAVIRUS, INFLUENZA, AND HIV, “LIKE” ADIPOSE TISSUE

Visceral adipose tissue, that is, one that is in the abdomen, is, in fact, highly individual body, experts explain. This body affects the immune, endocrine system and metabolism in the body as a whole.

– People who are overweight fat cells are much larger. So, is synthesized in much more of various hormones and inflammatory cells. Among them, including interleukin-6, interleukin-1, tumor necrosis factor, and others, – says Tatiana Demidova. Often in the body, there is a creeping inflammation.

At the same time observed that many viral infections and especially COVID-19 amplify the effects cytokines and lead to the extension of the generalization of inflammation. “It was proved that adipose tissue serves as a reservoir for some viruses, such as influenza, HIV and cytomegalovirus. Also, according to the latest data, it can be activated and coronavirus,” adds Demidov.

INSULATION NEEDS TO BE LONGER?

Studies have shown one more feature of coronavirus. As it turned out, he is able to spread rapidly in adipose tissue surrounding internal organs – lungs, liver, kidneys, heart, etc. because Of this, developing severe damage to these vital organs and people with excess weight, excess amount of adipose tissue increases the risk of death from multiple organ failure.

There is evidence that such patients are also unable to stay longer carriers of the virus, require longer hospital stay and isolation, said Tatyana Demidova.

AFTER INFECTION — DIABETES

There is evidence and that not less than one-third of patients hospitalized with COVID-19 in China, European countries and the United States, the infection resulted in damage of the pancreas. This was confirmed by elevated enzymes amylase and lipase, and glucose levels in the blood plasma.

– This is a very disturbing circumstance. Since we talking about high risk of developing diabetes type 2 diabetes in people with the original obesity after recovery from infection, says Dr. Demidov.

It is not excluded that after the break the pace of the epidemic COVID, we will see a worldwide surge in the incidence of diabetes, experts say.

So now, when the opportunity walks, sports, seasonal ripe fruits and vegetables rich in fiber, doctors suggest the obese individuals to exert their maximum effort for getting rid of really dangerous extra pounds.

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