gaining insight into diabetogenicity of SARSCoVII and other possibilities
gaining insight into diabetogenicity of SARSCoVII and other possibilities
Kimia Sagharichi ,1Saman Hakimian,2Shaghayegh Yazdani,3,*
1. Department of microbiology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran 2. M.sc student of Pathogenic Microbes Islamic Azad universtity, Central Tehran Branch, Tehran, Iran 3. Department of microbiology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
Introduction: Coronavirus disease 19 (covid19), caused by the seventh coronavirus, SARScoVII, was first reported in Wuhan, Hubei province, China, in December 2019 and spreading swiftly all around the globe, resulting in protected public health emergency in our time. One study showed that SARScoVII binds to ACEII, an essential receptor for viral entry and Renin-angiotensin-aldosterone system down regulator, with 10-20 times higher affinity compared to SARS-CoV. However, it has been seen that it is not only not inhibited by ACE-inhibitors or angiotensin blockers but also is up-regulated with their use. As both viruses have a homology of 70% in terms of genome, structure, and even pathogenicity, considering the effects of the first novel virus can help to distinguish the latter.
Methods: A recent study showed that CD4+ and CD8+ decreased in covid19 patients resulting in cytokine and chemokine storm. Additionally, new data indicates that 20-50% of patients with a positive PCR test for SARScoVII have chronic diabetes, the second most common disease associated with SARScoVII, affecting all age groups, mostly 47-59-year-old folks and even the comparison of pre-prandial and post-prandial glucose levels revealed 29.4% and 64.5% above target levels, respectively and at least one hypoglycemic event occurrence. In another study on a one-year-old Hispanic male with no comorbidities presenting anorexia, polydipsia, a 10-pound weight loss over three weeks with an initial blood glucose level of 470 mg/dL and HbA1c of about 14.8%, and positive results from nasal swab test using Thermo fisher essay on the admission day without showing any symptoms of fever, cough and respiratory. The second test was taken on the third day of hospitalization using the BDmax assay and turned positive. Markers of T1DM such as islet antigen2 antibodies and glutamic acid decarboxylase antibody titers were grossly abnormal. After the patient's discharge with oral potassium and 2000 IU vitamin D and lockdown and DKA protocol, he was seen one day, one week, three weeks afterward, and DM was well-controlled.
Results: Respiratory: the severity of covid19-related respiratory diseases varies significantly from mild requiring minimal oxygen support with a nasal cannula to acute hypoxemic respiratory failure requiring ventilation. In 80% of cases, the disease is only limited to the upper respiratory tract, but in the remaining 20%, pulmonary infiltrates indicating alveolar viral invasions have been witnessed.
Hematologic system: covid19 has affected the hematologic system in the forms of lymphopenia, especially in severe cases. Inflammatory indices such as lactate dehydrogenase, C-reactive proteins, and IL-6 or even hyperprocalcitonin and hyper-ferritin may emerge as poor prognosis identification.
Conclusion: Patients with covid19 are also at a higher risk of venous thromboembolic (VTE) diseases because elevated serum fibrinogen and D-dimer levels, producing while the body is forming or breaking clots, are common coagulopathy see in hospitalized covid19 patients. Increased serum D-dimer levels can demonstrate increased mortality rate amongst covid19 patients; in one cohort study examining the rate of thromboembolic events in 184 ICU patients, all standard receiving dosage of VTE prophylaxis showed the thromboembolic event incidence of 31%.
Cardiovascular system: between 5%-25% of hospitalized covid19 patients will have an incidence of myocardial involvement, as well as what has witnessed in the autopsy of covid19 patients, manifested by infractions, heart failure, and dysrhythmias due to increased metabolic demands and procoagulatory activity. Also, higher serum troponin levels, described as an indicator of cardiac injuries and hypoxia, can be seen in many covid19 hospitalized patients. Neurologic system: neurologic manifestations have been reported in more than one-third of covid19 patients. The potential neurologic damage includes direct viral neuron damages, excessive pro-inflammatory responses, and unintended host immune responses after the acute phase. The prevalence of hypogeusia and hyposmia suggest viral invasion of the olfactory nervous system via the olfactory bulb.