Reviewer’s report
Title: 
Does Endometriosis Increase Susceptibility to COVID–19 Infections? A
case-control study in Women of Reproductive Age
Version: 
2 
Date: 
18 Jan 2021
Reviewer's report:
Some issues still need to be corrected and revised. 
In the introduction it is necessary to contextualize the endometriosis disease. 
And search in the literature articles that suggest the relationship between ACE2
and the pathophysiology of endometriosis, in all the study this relationship is
only described in relation to endometrial tissue. Such information will be useful
in the discussion. I suggest reading the articles below:
Nakao T, Chishima F, Sugitani M, Tsujimura R, Hayashi C, Yamamoto T.
Expression of Angiotensin II Types 1 and 2 Receptors in Endometriotic Lesions
.Gynecol Obstet Invest. 2017;82(3):294-302.
Nenicu A, Körbel C, Gu Y, Menger MD, Laschke MW.
Combined blockade of angiotensin II type 1 receptor and activation of
peroxisome proliferator-activated receptor-
γ
 by telmisartan effectively inhibits
vascularization and growth of murine endometriosis-like lesions.Hum Reprod.
2014 May;29(5):1011-24. 
Cakmak B, Cavusoglu T, Ates U, Meral A, Nacar MC, Erbaş O.
Regression of experimental endometriotic implants in a rat model with the
angiotensin II receptor blocker losartan.J Obstet Gynaecol Res. 2015
Apr;41(4):601-7. 
Zhang Z, Yuan Y, He L, Yao X, Chen J.
Involvement of angiotensin II receptor type 1/NF-
κ
B signaling in the
development of endometriosis.Exp Ther Med. 2020 Oct;20(4):3269-3277.
In the introduction, to lines 96 and 97, the reference cited does not support
"From the clinical perspective, induce and/or worsen pulmonary symptoms of
COVID-19 infection".This phrase is inadequate and generalized. 
The reference affirms "A rare subgroup of those with endometriosis have
thoracic endometriosis (lesions within the pleural cavity or on the diaphragm).
The exact prevalence is unknown but some case series suggest that up to 12% of
those with endometriosis have extra-pelvic endometriosis, with the thorax being
the most common site (8). In general, there is a paucity of literature labeling this
form of endometriosis as a risk factor for respiratory or systemic illness beyond
catamenial pneumothorax (9). As such, it is challenging to know whether this
group is at increased risk of becoming infected with SARS-CoV-2 or developing
COVID-19." 
And affirms "adequate preoperative screening and diagnosis of SARS-CoV-2
will be an important consideration for the resumption of endometriosis surgery
(26). Though most patients undergoing surgery for endometriosis are relatively
young and healthy, we must be cognizant of the increased risk in those with
perioperative SARS-CoV-2 infection. It has recently been noted that post-
operative pulmonary complications occur in half of the patients with
perioperative SARS-CoV-2 infection and are associated with high mortality
(27)." 
In relation to sample size, o the study by Signorelli 
was reported that the
prevalence of COVID-19 varied from 0.35- 13%, the prevalence of Italy in
general was 4%, 
and not 3.2% described in line 144. 
And it is necessary to better explain why the 13% figure is the one that most
closely approximates the prevalence of Iran based on the reference 26.
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