Letter regarding "The clinical efficacy of low-dose whole-lung irradiation in moderate-to-severe COVID-19 pneumonia: RTMX-20 trial".
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ABSTRACT:
SUBMITTER: Li Z
PROVIDER: S-EPMC9682865 | biostudies-literature | 2022 Nov
REPOSITORIES: biostudies-literature
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Letter regarding "The clinical efficacy of low-dose whole-lung irradiation in moderate-to-severe COVID-19 pneumonia: RTMX-20 trial".
Li Zheng Z Hu Yue Y Li Qiang Q
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 20221123
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Project description:This is a paired prospective comparative cohort study with 58 patients, in order to analyze the clinical LD-WLI in patients with moderate or severe COVID19 pneumonia. The results of this study show that the Radiotherapy could be an option to improve the clinical response for patients with COVID-19.
| S-EPMC8613980 | biostudies-literature
Project description:PurposeThe COVID-19 outbreak is affecting people worldwide. Many infected patients have respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiation therapy in patients with COVID-19 pneumonia.Methods and materialsIn this clinical trial, conducted in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus the national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (interleukin-6 and C-reactive peptide) were recorded before and after irradiation.ResultsBetween May 21, 2020 and June 24, 2020, 5 patients received whole-lung irradiation. They were followed for 5 to 7 days to evaluate the response to treatment and toxicities. The clinical and paraclinical findings of 4 of the 5 patients (patient 4 worsened and died on day 3) improved on the first day of irradiation. Patient 3 opted out of the trial on the third day after irradiation. The mean time to discharge was 6 days for the other 3 patients. No acute radiation-induced toxicity was recorded.ConclusionsWith a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.
| S-EPMC7373065 | biostudies-literature
Project description:IntroductionRadiation therapy (RT), commonly used in cancer management, has been considered as one of the potential treatments for COVID-19 pneumonia. Here, we present the results of the pilot trial evaluating low-dose whole-lung irradiation (LD-WLI) in patients with COVID-19 pneumonia.MethodsTen patients with moderate COVID-19 pneumonia were treated with LD-WLI in a single fraction of 0.5 or 1.0 Gy along with the national protocol. The primary endpoint was an improvement in Spo2. The secondary endpoints were the number of days of hospital/intensive care unit stay, the number of intubations after RT, 28-day mortality, and changes in biomarkers. The response rate (RR) was defined as an increase in Spo2 upon RT with a rising or constant trend in the next 2 days, clinical recovery (CR) including patients who were discharged or acquired Spo2 ≥93% on room air, and 28-day mortality rate defined based on days of RT.ResultsThe median age was 75 years (80% male). Five, 1, and 4 patients received single-dose 0.5 Gy, two-dose 0.5 Gy, and single-dose 1.0 Gy LD-WLI, respectively. The mean improvement in Spo2 at days 1 and 2 after RT was 2.4% (±4.8%) and 3.6% (±6.1%), respectively, with improvement in 9 patients after 1 day. Five, 1, and 4 patients were discharged, opted out of the trial, and died in the hospital, respectively. Two of 5 discharged patients died within 3 days at home. Among discharged patients, the Spo2 at discharge was 81% to 88% in 3 patients and 93% in the other 2 patients. Overall, the RR and CR were 63.6% and 55.5%, respectively. The RR, CR, and 28-day mortality of the single 0.5 Gy and 1.0 Gy WLI groups were 71.4% versus 50% (P = .57), 60% versus 50% (P = .64), and 50% versus 75% (P = .57), respectively.ConclusionLD-WLI with a single fraction of 0.5 Gy or 1 Gy is feasible. A randomized trial with patients who do not receive radiation is required to assess the efficacy of LD-WLI for COVID-19.
| S-EPMC7709599 | biostudies-literature
Project description: Not available
| S-EPMC10965863 | biostudies-literature
Project description:PurposeStudies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies.Methods and materialsWe performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced.ResultsTen studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, -0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results.ConclusionsDespite a mild improvement in intubation-free days, WLI had no significant effect on patients' overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.
| S-EPMC9077801 | biostudies-literature
Project description:Aim. To study the efficacy and safety of subantimicrobial dose (SD) doxycycline(50 mg/d) in patients with active and moderate-to-severe Graves' orbitopathy (GO). Methods. Thirteen patients with active and moderate-to-severe GO received once daily oral doxycycline (50 mg/d) for 12 wk. Treatment response at 24 wk was used as the primary outcome, measured by a composite of improvement in Clinical Activity Score (CAS), diplopia, motility, soft tissue swelling, proptosis, and eyelid aperture. Secondary outcome was the change of quality of life score (QoL, including visual functioning subscale and appearance subscale). Adverse events were also recorded. Results. Overall improvement was noted in eight out of 13 patients (61.5%, 95% CI 31.6%-86.1%). Both CAS and soft tissue swelling significantly ameliorated in eight patients at 24 wk. Five patients (38.5%) had improvement in ocular motility of ≥8 degrees. Eyelid aperture (46.2%) also decreased remarkably. For QoL, a significant improvement in appearance subscale (P = 0.008) was noted during the study, whereas no difference was observed in visual functioning subscale (P = 0.21). Two patients reported mild stomachache at 12 wk. Conclusions. SD doxycycline appears to be effective and safe for the treatment of active and moderate-to-severe GO. It might serve as a new promising therapeutic strategy for GO. This trial is registered with NCT01727973.
| S-EPMC4499606 | biostudies-literature
Project description:The time to first antibiotic dose (TFAD) has been mentioned as an important performance indicator in community-acquired pneumonia (CAP). However, the advice to minimise TFAD to 4 hours (4 h) is only based on database studies. We prospectively studied the effect of minimising the TFAD on the early clinical outcome of moderate-severe CAP. On admission, patients' medical data and TFAD were recorded. Early clinical failure was expressed as the proportion of patients with clinical instability, admission to the intensive care unit (ICU) or mortality on day three. Of 166 patients included in the study, 27 patients (29.7%) with TFAD <4 h had early clinical failure compared to 23 patients (37.7%) with TFAD >4 h (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.35-1.35). In multivariate analysis, the pneumonia severity index (OR 1.03; 95%CI 1.01-1.04), confusion (OR 2.63; 95%CI 1.14-6.06), Staphylococcus aureus infection (OR 7.26; 95%CI 1.33-39.69) and multilobar pneumonia (OR 2.40; 95%CI 1.11-5.22) but not TFAD were independently associated with early clinical failure. Clinical parameters on admission other than the TFAD predict early clinical outcome in moderate-severe CAP. In contrast to severe CAP necessitating treatment in the ICU directly, in the case of suspected moderate-severe CAP, there is time to establish a reliable diagnosis of CAP before antibiotics are administered. Therefore, the implementation of the TFAD as a performance indicator is not desirable.
| S-EPMC2723669 | biostudies-other
Project description: Not available
| S-EPMC10496060 | biostudies-literature
Project description:Objectives We have reported previously that Belimumab, a human monoclonal antibody that inhibits B-cell activating factor(BAFF) could be an effective and safe option to treat Neuropsychiatric manifestations of SLE (NPSLE). To avoid inadequate efficacy of Belimumab and significant adverse events of often-used dose of cyclophosphamide (CYC) for SLE, we evaluated the efficacy, safety, and possible immune mechanisms of Belimumab treatment in combination with intermittent low-dose intravenous CYC for moderate-to-severe SLE. Methods In this non blinded and parallel-group trial, we collected 82 cases of moderate-to-severe SLE patients, 40 received Belimumab treatment and 42 received conventional treatments as historical controls for 24 weeks. The demographic features, clinical manifestations, and laboratory indicators including peripheral blood lymphocyte subgroups or subsets were compared before and after the treatments. Results Compared with the baseline, 6 months post Belimumab group treatment, disease activity score SLEDAI (13.78 to 3.82, P<0.05) and BILAG scores (16.40 to 5.48, P<0.05) were reduced; C3 (0.19 to 1.14, P<0.05) and C4 (0.04 to 0.22, P<0.05) increased; the absolute numbers of B and T cells were the first decreased and then significantly increased, tended to balance. Moreover, Belimumab group treatment significantly reduced the serum levels of IL-6, the ratio of B and T cells, and the proportion of infections and menstrual disorders. Conclusion Compared with conventional treatment, Belimumab with low-dose intravenous CYC significantly reduced disease activity scores and maintained the B/T cell balance for SLE patients at 24 weeks. It was more efficacy and safe (adverse events such as infection were significantly lower). It should be the mechanism that Belimumab combined with low-dose intravenous CYC therapy restores the balance of T and B cells, which proposes a potential treatment strategyfor SLE.
| S-EPMC9376229 | biostudies-literature
Project description:Radiation exposure has multiple effects on the brain, behavior and cognitive functions. It has been reported that high-dose (>20 Gy) radiation-induced behavior and cognitive aberration partly associated with severe tissue destruction. Low-dose (<3 Gy) exposure can occur in radiological disasters and cerebral endovascular treatment. However, only a few reports analyzed behavior and cognitive functions after low-dose irradiation. This study was undertaken to assess the relationship between brain neurochemistry and behavioral disruption in irradiated mice. The irradiated mice (0.5 Gy, 1 Gy and 3 Gy) were tested for alteration in their normal behavior over 10 days. A serotonin (5-HT), Dopamine, gamma-Aminobutyric acid (GABA) and cortisol analysis was carried out in blood, hippocampus, amygdala and whole brain tissue. There was a significant decline in the exploratory activity of mice exposed to 3 Gy and 1 Gy radiation in an open field test. We observed a significant short-term memory loss in 3 Gy and 1 Gy irradiated mice in Y-Maze. Mice exposed to 1 Gy and 3 Gy radiation exhibited increased anxiety in an elevated plus maze (EPM). The increased anxiety and memory loss patterns were also seen in 0.5 Gy irradiated mice, but the results were not statistically significant. In this study we observed that neurotransmitters are significantly altered after irradiation, but the neuronal cells in the hippocampus were not significantly affected. This study suggests that the low-dose radiation-induced cognitive impairment may be associated with the neurochemical in low-dose irradiation and unlike the high-dose scenario might not be directly related to the morphological changes in the brain.
| S-EPMC8438260 | biostudies-literature