Effects of Covid-19 Infection on Some Pancreatic Functions in Diabetic Patients at Thi-Qar Province/Iraq

: People with diabetes mellitus (DM) represent a population group that is at high risk of developing a poor prognosis for COVID-19.Having diabetes can lead to serious illness, ICU stay, and death from COVID-19.The current study included 150 participants with diabetes, 100 of whom had COVID-19 (46 males, 54 females), and 50 had diabetes only (28 males and 22 females), aged between 37 and 69 years. The current situation is in the isolation center for people infected with the Corona virus at Al-Hussein Teaching Hospital and Shatrah General Hospital in Thi-Qar Governorate.The study included the impact of COVID-19 infection and its effect on pancreatic function.The results of the current study recorded a significant increase in fasting blood glucose concentration and cumulative glucose concentration in diabetic patients infected with Covid-19 virus compared to diabetic patients only by gender,


I. INTRODUCTION
Coronaviruses are a broad group of viruses that infect a wide range of animals, as well as people, and can cause moderate to severe respiratory illnesses. Two highly pathogenic zoonotic coronaviruses, severe acute respiratory syndrome coronavirus (SARS-COV) and Middle East respiratory syndrome coronavirus (MERS-COV), caused fatal respiratory illness in humans in 2002 and 2012, respectively, making emerging coronaviruses a new public health concern in the twenty-first century (Hu et al., 2021).COVID-I9 symptoms vary, ranging between mild and severe diseases. Headache, loss of taste and smell, nasal congestion and rhinorrhea, cough, pain in the muscle, sore throat, fever, and breathing problems are common symptoms (Habeeb and Hussain, 2021) Non gastrointestinal symptoms of COVID-19 include fever, cough, shortness of breath, chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. Gastrointestinal (GI) symptoms, including anorexia, nausea, vomiting, abdominal pain, and/ or diarrhea have been reported in patients with COVID-19. Additionally, abnormal liver enzymes are also observed (Sultan et al., 2020). It is known that diabetic patients, especially those with uncontrolled glycemia, are at higher risk to contract infections, a trend that correlates tightly with glycated hemoglobin levels. In clinical practice, higher incidence of foot infections, yeast infections, urinary tract infections, and surgical site infections is commonly seen in diabetic patients (Mazucanti and Egan, 2020). It has been stated that COVID-19 is associated with hyperglycemia, actually considered a direct predictor of the poor prognosis of the disease and an increased risk of death, briefly, the binding site and entry point of SARS-CoV-2 is the ACE2 receptor, which is highly expressed in the lung, liver, brain, placenta, and pancreas.SARS-CoV-2 infects the pancreas through ACE2, being highly expressed there when Although initial studies focused on lung injury and cardiovascular manifestations, other organ dysfunctions have been observed, notably in the kidney, pancreas, intestine, and olfactory epithelia (Gheblawi et al., 2020).
The GI manifestations of the COVID-19 infection include anorexia, nausea, vomiting, abdominal pain, and diarrhea. However, pancreatic involvement in patients with COVID-19 is rarely reported. Pancreatic symptomology usually corresponds to asymptomatic abnormal pancreatic enzyme elevation and acute pancreatitis. Here, present a rare case of acute pancreatitis in a patient with COVID-19 (Kataria et al., 2020).Despite learning more about this virus every day, the impact of COVID-19 on the pancreas remains less explored.report a patient with COVID-19 who presented with pancreatitis in the absence of respiratory symptoms (Lakshmanan and Malik, 2020)

A . Design of Study
The current study was conducted in Thi-Qar province,

B. Methods
A total of 150 sample, 100 sample of patients aged between 37-69 years, including 46 males and 54 females, are in the isolation center for people infected with Corona virus at Al Hussein Teaching Hospital in Thi-Qar and Shatrah General Hospital. The study also included 50 sample control 28 males and 22 females . after signing consent from the study take . 5 ml of venous blood was collected from patients and control which was added to gel tubes and EDTA tubes ,take 2 ml of blood with EDTA was used to make HBA1c, and another 3 ml of blood was put into a gel tube and then the tube centrifuged at 4000 rpm for 10 min to extract serum for glucose estimation test, and complications were carried out in an apendrof tube for the purpose of error avoidance and compensation if an error occurred and stored at -20°C until used for quantification of immunological parameters (glucagon, PRSS1 protease, serine, 1), all patient and observational data including age, gender, clinical presentation features, patient history, height, and weight were recorded.

C. Statistical Aanalysis
The data of the current study were analysis by using SPSS version 26, based in using independent sample t test, one way ANOVA at P <0.05.

Estimation Diabetic Parameters
The current study recorded a significant increase in the percentage of RBS and Hba1c in the sick group, which is diabetic patients with Covid-19, compared to the control group, which is diabetic patients only. It also showed a significant difference in the percentage of random blood sugar and Hba1c at p < 0.05, (as in table 1).

Pancreatic Hormone
The current result recorded a significant increase in the level of trypsin and glucagon hormone in Covid-19 infected DM, and also showed a significant difference in the percent of Trypsin and Glucagon hormone at p <0.05, (as in table 2).

Table (3) RBS and HbA1c Concentration of Covid-19
and DM patients only according to sex   The result also noted a significant difference in all age groups and BMI categories in patients compared with the match in control groups at p <0.05 as in table (6).

Trypsin Concentration According to BMI groups
According to BMI, the results showed a nonsignificant in BMI group of patient, and a non-significant recorded in control group. The result also noted a significant difference in BMI groups categories in patients compared with match in control groups at p <0.05 as in table (7).

Glucagon Concentration According to BMI groups
According to BMI, the results noted a nonsignificant difference in both patients and control. The result also noted a significant difference in BMI groups categories in patients compared with match in control groups at p <0.05 as in table (8).

v. Conclusion
The current study concluded that patients with Covid-19 diabetes have a high level of trypsin and glucagon, and patients with Covid-19 diabetes have a high concentration of glucose and HbA1c, and it was found that body mass and age did not affect the concentration factors.

VI. ACKNOWLEDGMENT
We are grateful to everyone who helped us collect samples at Al Hussein Teaching Hospital in Thi-Qar and Shatrah General Hospital. We also extend our thanks and gratitude to the Department of Life Sciences, Faculty of Science -Thi-Qar University.

VII. ETHICAL CONSIDERATION
The ethical permission was obtained from the Al Hussein

Teaching Hospital in Thi-Qar and Shatrah General
Hospital and from all participants in this work (patients and healthy) to conduct the research.

VIII. CONFLICT OF INTEREST
The authors declare no conflicts of interest