Medical students at Weill Cornell Medicine-Qatar (WCM-Q) helped answer an important question about the potential dangers posed by blood pressure medication for people infected with COVID-19.
The trainee doctors participated in a systematic review, which is used for evidence-based medicine and so may help healthcare professionals make medical decisions. The study examined whether a certain family of blood pressure-lowering medications (RAAS inhibitors) may upregulate the expression of ACE2, which is the protein that SARS-CoV-2 uses to invade our cells, and so increase the risk of infection or severity of the disease.
To test the hypothesis, the review examined the medical data of COVID-19 patients who had taken or had not been taking the RAAS inhibitors. Dr Dalia Zakaria, a lecturer in biology under the Department of Pre-Medical Education at WCM-Q, led the research and mentored the students. She said the results had been surprising.
She said that they were expecting to find that those patients taking RAAS inhibitors were indeed more likely to be infected by the novel coronavirus or have more serious outcomes once infected. What they actually found, though, was that the drugs have benefits. She said that this is because the main problem with COVID-19 is the hyper-inflammatory state that the virus induces in the patient. The drugs actually reduce the inflammatory response and as such could be considered beneficial for those with the disease.
This is one of the positive aspects of systematic reviews, you must take all relevant papers into account, so the conclusions you reach are free from any bias.
The first student to participate in the study was Hiba Naveed, a co-first author of the paper. Now in her third year of the medical curriculum, Hiba joined so she could take part in an ABSR (Advanced Biomedical Science Research) project.
I wanted to be involved – for the experience and for the opportunity to learn. One of my fields of interest is cardiology and this research project tied in fairly well with it. In addition, it focused on COVID-19 which I believe is important to learn about considering our current situation.
Hiba’s role included screening 1,658 abstracts and 173 full articles, followed by data extraction from 14 studies, in addition to contributing to writing the manuscript. Regular meetings on Zoom were held with Dr Dalia to discuss the progress of the research. They also communicated via email whenever necessary.
The experience was wonderful and I felt very supported throughout. Dr Dalia is an astounding mentor to have.
The sheer number of research papers to review was one of the major challenges of the study. Because of the pandemic, the situation was very fast-moving and new data was coming to light all the time.
This led to Abdallah Elshafeey joining the research project. Elshafeey is also a co-first author and in the fourth and final year of the medical curriculum. Fellow students Emmad Janjua, Areej Nauman, Hussam Kawas, Ridhima Kaul, Dana Al-Ali and Arwa Saed Aldien also joined the project. Dr Mohamed Elshazly helped review the clinical data, while WCM-Q librarian Sa’ad Laws, helped unearth new and relevant research papers.
Abdallah said it had been a valuable learning experience.
I learned a lot about writing a systematic review and the hard work that goes into it and I learned a lot from my team members, who all had excellent and unique contributions to this work.
He said that Dr Dalia was an incredible mentor who provided the framework for the project and a vision of the final product. He said that she mentored him every step of the process and provided so much support for his role, which was to look at the data that the team gathered and make sense of it. He also helped write the manuscript.
He added that he was very happy when the work was accepted for publication. He said that it was a very rewarding moment to see their team’s hard work recognised.
The full title of the study is The Interplay Between the Immune System, the Renin-Angiotensin-Aldosterone System (RAAS), and RAAS Inhibitors May Modulate the Outcome of COVID-19: A Systematic Review. It can be read in full here.
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