With the emergence of the Novel Coronavirus (2019-nCoV), researchers worldwide have started detecting the probable pathogenesis of the disease. The renin-angiotensin system (RAS) and angiotensin-converting enzymes have received a good deal of attention as possible pathways involved in 2019-nCoV pathogenesis. As the experiments seeking to find potential medications acting on these pathways are being conducted in the early phases, having an ecological worldview on the relationship between the prevalence of COVID-19 disease and the genetic differences in the genes involved in the RAS system could be valuable for the field. In this regard, we conducted a meta-analysis study of the prevalence of ACE (I/D) genotype in countries most affected by the COVID-19. In the meta-analysis, 48,758 healthy subjects from 30 different countries were evaluated in 116 studies, using the Comprehensive Meta-analysis software. The I/D allele frequency ratio was pooled by a random-effect model. The COVID-19 prevalence data of death and recovery rates were evaluated as the latitudes for the meta-regression analysis. Our results demonstrated that with the increase of the I/D allele frequency ratio, the recovery rate significantly increased (point estimate: 0.48, CI 95%: 0.05-0.91, p = 0.027). However, there was no significant difference in the case of death rate (point estimate: 1.74, CI 95%: 4.5-1.04, p = 0.22). This ecological perspective coupled with many limitations does not provide a direct clinical relevance between the COVID-19 and RAS system, but it shows potential pathophysiological associations. Our results raise concerns about ethnic and genetic differences that could affect the effectiveness of the currently investigated RAS-associated medications in different regions.

Background Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems. Objective To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. Methods Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. Result There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. Conclusions COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.

Background: Preliminary studies of COVID-19 have provided some evidence that electrolyte disturbances may also be present in patients. In this study we aimed to evaluate the role of the arrival electrolytes and symptoms in prediction of Lung damage in CT scan based on the CO-RADS system. Methods: This was a retrospective cross-sectional analytical study. We included patients with laboratory confirmed COVID-19 infection, June 15 to July 7. Patients were included in study if there were no previous history of kidney disease. Demographic, clinical characteristics, laboratory findings, and CO-RADS High-resolution computed tomography (HRCT) of lung report were collected. Univariate logistic regression was employed first to identify the effective, correlated items. All statistics were performed with SPSS version 18.0. Results: In the current study, 36 (20 male- 16 female) patients with mean age of the 54.7 (STD:17.5) years old were studied. Most common symptom at the arrival was the Fever (52.8%), followed by Fatigue (18%), and dyspnea (44.4%). Computed tomography assessment revealed CO-RADS 2 in 4 (11.1%) patients, CO-RADS 3 in 1 (2.8%), CO-RADS 4 in 20 (55.6%), and CO-RADS 5 in 11 (30.6%) patients. In the comparison with the study groups based on the HRCT status (CO-RADS II,III vs. CO-RADS IV,V), patients with severe HRCT damage had significantly lower level of Phosphorus (P<0.05). Univariate logistic regression analysis showed that only one factors was associated with HRCT damage status (Phosphorus, P=0.040). Phosphorus upper than 4.5 was associated with better HRCT results with OR ratio of 3.71 (X2(1)=5.69; p=0.017). Conclusion: Our study illustrates that higher phosphate levels may be associated with better CT scan of lung outcomes in COVID-19; while hypophosphatemia is associated with severe lung injuries. This could help clinicians to manage hospitalized patients and may link the COVID-19 and parathyroid gland.