Use of Renin-Angiotensin System Antagonists in patients with hypertension and COVID-19 infection: A rapid review and meta-analysis

Key Findings@#Among patients with confirmed COVID-19 infection and hypertension, there is insufficient evidence that RAS antagonists are associated with mortality or severe COVID-19 disease. • There is uncertainty with regards to the safe use of renin-angiotensin system (RAS) antagonists, such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), for COVID-19 patients with hypertension and other comorbidities (heart failure, chronic kidney disease) because of two possible contradictory mechanisms 1) upregulation of ACE2 receptors that may facilitate the virus entry into the lung. and 2) control of unabated angiotensin II levels reducing acute lung injury. • Based on very low-quality retrospective cohort studies, there is insufficient evidence that RAS antagonists are associated with increased mortality (6 studies) or severe disease (10 studies) among patients with confirmed COVID-19 infection and hypertension. • There are 36 ongoing studies (21 RCTs, 1 single-arm trial, 4 prospective cohorts, 4 retrospective cohorts, 4 casecontrol, and 2 cross-sectional) on this topic. • The European Society of Cardiology (ESC) Council on Hypertension, the International Society of Hypertension (ISH) and the joint statement by the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) all caution against discontinuing RAS-related treatments in patients with hypertension who become infected with COVID-19.

Speckled pigmentation and palmoplantar keratoses leading to the mass detection of chronic arsenic poisoning

@#<p style="text-align: justify;">Arsenic is a known human carcinogen and skin manifestations are the earliest and most specific markers of chronic arsenic poisoning. A 43-year-old man from Luzon presented at the Section of Dermatology with a one-year history of hyperkeratotic papules and plaques on the palms and soles. Numerous round hypopigmented macules were scattered on the upper back. Initial 24-hour urine arsenic level was elevated at 288mcg/liter. The patient underwent successful chelation with N-acetylpenicillamine and the palmoplantar keratoses were treated with cryotherapy and topical 20% salicylic acid in white petrolatum. In cooperation with the Department of Health, a comprehensive health and environmental assessment was conducted in the affected communities. This case highlights the role of dermatologists in the diagnosis and management of this public health problem.</p>