From Ace 2 to Brain: Patterns, Correlations, Severity and Diversity of COVID-19 Symptoms among a Cohort of Patients

Author(s): Muamar M. A. Shaheen* and Manar A. J. Al-Junaidi


Background: Angiotensin II enzyme (ACE 2) was extensively investigated in SARS-CoV-2 as the viral entrance. The abundance, distribution and diversity of this enzyme dictate the wide range of symptoms patients suffer from during the acute phase of COVID-19 infection and determine late phase symptoms.

Objective: To determine factors associated with diversity of COVID-19 symptoms and relationship of these symptoms to each other. Design and methods: This is a retrospective cohort study that involved 191 Polymerase Chain Reaction (PCR) positive COVID-19 patients who were symptomatic while home quarantined between March 2020 and January 2021 in Hebron district, southern West Bank. A well prepared questionnaire was used to gather clinical data and information about symptoms patients suffered from during the acute phase of infection.

Results: 191 symptomatic PCR positive COVID-19 subjects were included in this study. They were 31.4 ± 16.4 years old and 59.2% females. Using Fisher`s exact test, there was a strong relationship between anorexia and loss of either taste, smell, or both or not losing any of them, p=0.002. Suffering from Gastrointestinal (GIT) symptoms; such as diarrhea, nausea, vomiting, or combination of them was associated with anorexia, p=0.002. We found a significant relationship between specific GIT symptoms and dizziness, or headache; p=0.00, for each one. There was a strong relationship between having any of the GIT symptoms and agues, or headache, p=0.045 and 0.000, respectively, on Pearson Chisquare test. There was also a relationship between gender and headache, p=0.002.

Conclusion: Local or systemic GI symptoms, neurological symptoms (headache, dizziness) along with smell and taste are connected to each other via gut brain axis or micro biota gut brain axis

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