scholarly journals Low-Dose Radiation Therapy for COVID-19: A Systematic Review

Radiation ◽  
2021 ◽  
Vol 1 (3) ◽  
pp. 234-249
Author(s):  
Seyed Mohammad Javad Mortazavi ◽  
Seyedeh Fatemeh Shams ◽  
Sahar Mohammadi ◽  
Seyed ALi Reza Mortazavi ◽  
Lembit Sihver
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Large Scale ◽  
Low Dose ◽  
Treatment Options ◽  
Clinical Status ◽  
Low Dose Radiotherapy ◽  
Risk Of Mortality ◽  
Potential Efficacy ◽  
Detailed Search

The ongoing COVID-19 pandemic is of great concern for the whole world, and finding an effective treatment for the disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is, therefore, a global race. In particular, treatment options for elderly patients and patients with genetic risk factors with COVID-19-associated pneumonia are limited, and many patients die. Low-dose radiotherapy (LDRT) of lungs was used to treat pneumonia many decades ago. Since the first report on the potential efficacy of LDRT for COVID-19-associated pneumonia was published on 1 April, 2020, tens of papers have addressed the importance of this treatment. Moreover, the findings of less than 10 clinical trials conducted to date are now available. We performed a detailed search of PubMed/MEDLINE, Web of Science, Google Scholar, and Scopus and selected the nine most relevant articles. A review of these articles was conducted. The available data indicate that in oxygen-dependent elderly patients with COVID-19-associated pneumonia, whole-lung radiation at doses of 0.5–1.5 Gy can lead to accelerated recovery and progress in clinical status, encephalopathy, and radiographic consolidation without any detectable acute toxicity. Although data collected so far show that LDRT could be introduced as a treatment with promising efficacy, due to limitations such as lack of randomization in most studies, we need further large-scale randomized studies, especially for elderly patients who are at greater risk of mortality due to COVID-19. However, more preclinical work and clinical trials are needed before any clear conclusion can be made.

Ongoing randomized clinical trials for the treatment of thrombosis in the antiphospholipid syndrome

2001 ◽  
Vol 21 (02) ◽  
pp. 77-81 ◽  
Author(s):  
G. Finazzi
Keyword(s):  
Clinical Trials ◽  
Large Scale ◽  
Low Dose ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Collaborative Study ◽  
Clinical Problem ◽  
Vascular Events ◽  
Dose Oral ◽  
Adverse Pregnancy

SummaryThrombotic events are a major clinical problem for patients with antiphospholipid antibodies (APA). However, current recommendations for their prevention and treatment are still based on retrospective studies. Data from large scale, prospective clinical trials are required to ultimately identify the optimal management of these patients. To date, at least four randomized studies are underway. The WAPS and PAPRE clinical trials are aimed to establish the correct duration and intensity of oral anticoagulation in APA patients with major arterial or venous thrombosis. The WARSS-APASS is a collaborative study to evaluate the efficacy and safety of aspirin or low-dose oral anticoagulants in preventing the recurrence of ischemic stroke. The recently announced UK Trial compares low-dose aspirin with or without low-intensity anticoagulation for the primary prevention of vascular events in APA-positive patients with SLE or adverse pregnancy history, but still thrombosis-free. It is hoped that the results of these trials will be available soon since clinicians urgently need more powerful data to treat their patients with the APA syndrome.

scholarly journals Unethical not to Investigate Radiotherapy for COVID-19

Dose-Response ◽  
2020 ◽  
Vol 18 (3) ◽  
pp. 155932582095010
Author(s):  
Jerry M. Cuttler ◽  
Joseph J. Bevelacqua ◽  
S. M. J. Mortazavi
Keyword(s):  
Clinical Trial ◽  
Low Dose ◽  
Clinical Status ◽  
Pilot Trial ◽  
University Hospital ◽  
Careful Examination ◽  
Rapid Improvement ◽  
Low Dose Radiotherapy ◽  
Emory University ◽  
Prospective Trials

The primum non nocere letter by Boon et al. urged caution and careful examination of the evidence and logistics of low-dose radiotherapy in COVID-19 patients. This is exactly what was requested in March and what has occurred since late April 2020 when the first phase I/II clinical trial was approved at the Winship Cancer Institute, Emory University Hospital. The preprint of day-7 interim results by the investigators concluded, “In a small pilot trial of 5 oxygen-dependent patients with COVID-19 pneumonia, low-dose whole-lung radiation led to rapid improvement in clinical status, encephalopathy, and radiographic infiltrates without acute toxicity or worsening the cytokine storm. Low-dose whole-lung radiation appears to be safe, shows early promise of efficacy, and warrants larger prospective trials.” Preliminary results from another clinical trial gave similar results. In conclusion, the authors believe it would be unethical not to investigate radiotherapy as a potential remedy against COVID-19 induced pneumonia

scholarly journals Ozone in Medicine. The Low-Dose Ozone Concept and Its Basic Biochemical Mechanisms of Action in Chronic Inflammatory Diseases

2021 ◽  
Vol 22 (15) ◽  
pp. 7890
Author(s):  
Renate Viebahn-Haensler ◽  
Olga Sonia León Fernández
Keyword(s):  
Oxidative Stress ◽  
Clinical Trials ◽  
Low Dose ◽  
Inflammatory Diseases ◽  
Clinical Status ◽  
Limiting Factor ◽  
Chronic Inflammatory Diseases ◽  
Systemic Treatments ◽  
Medical Ozone ◽  
Set Up

Low-dose ozone acts as a bioregulator in chronic inflammatory diseases, biochemically characterized by high oxidative stress and a blocked regulation. During systemic applications, “Ozone peroxides” are able to replace H2O2 in its specific function of regulation, restore redox signaling, and improve the antioxidant capacity. Two different mechanisms have to be understood. Firstly, there is the direct mechanism, used in topical treatments, mostly via radical reactions. In systemic treatments, the indirect, ionic mechanism is to be discussed: “ozone peroxide” will be directly reduced by the glutathione system, informing the nuclear factors to start the regulation. The GSH/GSSG balance outlines the ozone dose and concentration limiting factor. Antioxidants are regulated, and in the case of inflammatory diseases up-regulated; cytokines are modulated, here downregulated. Rheumatoid arthritis RA as a model for chronic inflammation: RA, in preclinical and clinical trials, reflects the pharmacology of ozone in a typical manner: SOD (superoxide dismutase), CAT (catalase) and finally GSH (reduced glutathione) increase, followed by a significant reduction of oxidative stress. Inflammatory cytokines are downregulated. Accordingly, the clinical status improves. The pharmacological background investigated in a remarkable number of cell experiments, preclinical and clinical trials is well documented and published in internationally peer reviewed journals. This should encourage clinicians to set up clinical trials with chronic inflammatory diseases integrating medical ozone as a complement.

scholarly journals Non-Peutz–Jeghers syndrome-associated ovarian sex cord tumor with annular tubules treated by radiotherapy: a case report and literature review

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199656
Author(s):  
Cheng Li ◽  
Reyida Aishajiang ◽  
Yongliang Teng ◽  
Tiankai Xu ◽  
Lijuan Ding ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Case Report ◽  
Literature Review ◽  
Large Scale ◽  
Standard Treatment ◽  
Treatment Options ◽  
High Serum ◽  
Serum Estradiol ◽  
Sharp Reduction ◽  
Peutz Jeghers Syndrome

There are no standard treatment options for metastatic and recurrent non-Peutz–Jeghers syndrome (PJS)-associated sex cord tumor with annular tubules (SCTAT). The effects of chemotherapy and/or radiotherapy are still not well-defined. Herein, we present a case of a metastatic and recurrent non-PJS-associated SCTAT showing high serum estradiol and progesterone concentrations after surgery and chemotherapy. Radiotherapy (50 Gy/25 fractions) triggered a sharp reduction in the sizes of the metastatic and recurrent masses, and estradiol and progesterone concentrations. Accordingly, we consider that radiotherapy might be effective and safe for metastatic and recurrent SCTAT. The roles of radiotherapy in non-PJS SCTAT should be further validated in large-scale prospective clinical trials.

Large granular lymphocyte leukemia. A rare disease with personalized treatment options

2014 ◽  
Vol 155 (11) ◽  
pp. 414-419
Author(s):  
Nóra Adamkovich ◽  
Mihály Kispál ◽  
László Krenács ◽  
Enikő Bagdi ◽  
Zita Borbényi
Keyword(s):  
Low Dose ◽  
Treatment Options ◽  
Significant Risk ◽  
Large Granular Lymphocyte ◽  
Common Complication ◽  
Large Granular Lymphocyte Leukemia ◽  
Dose Methotrexate ◽  
Risk Of Mortality ◽  
Immune Mediated ◽  
Large Granular Lymphocyte Leukaemia

Introduction: Large granular lymphocyte leukemia is rare, mainly chronic disease. The most common complication is neutropenia, but other immune-mediated cytopenia may also occur. There are no unified treatment recommendations and initiation of treatment mainly depends on the severity of the symptoms. Aim: The aim of the authors was to analyze the main steps of the diagnosis and the necessity and outcome of treatment in their patients diagnosed with large granular lymphocyte leukaemia. Method: The authors retrospectively analyzed the data of 17 large granular lymphocyte leukemia patients. Results: Of the 17 patients, 7 patients required treatment because of transfusion dependent anemia (4 patients) or neutropenia (3 patients). In 4 patients corticosteroid was given (supplemented with cyclosporine in one patients), while the other patients received anti-CD52 (one patient), low dose methotrexate (one patient) and combined chemotherapy (one patient). Five patients achieved partial response, and two patients died in sepsis. Conclusions: In this cohort only a smaller proportion of patients required therapy. Immunosuppression can be successful, but the effect in most cases was temporary. The most serious complication was sepsis, which is associated with a significant risk of mortality in cases with neutropenia. Orv. Hetil., 2014, 155(11), 414–419.

scholarly journals Role of low dose cytarabine in elderly patients with acute myeloid leukemia: An experience

2015 ◽  
Vol 04 (01) ◽  
pp. 004-006 ◽  
Author(s):  
Yasir Bashir ◽  
Sajjad Geelani ◽  
Nusrat Bashir ◽  
Shabeer A. Mir ◽  
Mosin Mushtaq ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Standard Treatment ◽  
Treatment Options ◽  
Effective Treatment Option ◽  
Patient Consent ◽  
Low Dose Cytarabine ◽  
Acute Myeloid

Abstract Purpose: To highlight the acceptable results seen after use of low dose cytarabine in elderly patients of acute myeloid leukemia (AML) with comorbidities. Materials and Methods: This was a prospective study carried on 30 newly diagnosed patients of AML over 60 years of age who were unfit for standard treatment regimens. We did not use azacytidine and decitabine in our patients because these therapeutic modalities being extremely costly and our patient affordability being poor. After taking patient consent and institutional ethical clearance these patients were treated with 20 mg/m2 cytarabine subcutaneously in two divided doses 12 h apart for 4 days every week for 4 weeks which constituted a cycle before disease, re-assessment was done. A repeat cycle was administered where ever needed and after attainment of remission, we continued low dose cytarabine for 2 days/week as maintenance after complete or partial response was documented. Results: In our study, we found that around 20% of patients achieved complete remission and 30% partial remission. The remission rates were definitely influenced by counts at presentation, performance at presentation, comorbidities, underlying myelodysplastic syndrome and baseline cytogenetics. Conclusion: Low dose cytarabine is effective treatment option for elderly patients with AML when standard treatment options are not warranted.

scholarly journals Is LDL apheresis a thing of the past?

2020 ◽  
pp. 140-144
Author(s):  
M Vally ◽  
R Khan ◽  
A Orchard
Keyword(s):  
Clinical Trials ◽  
High Intensity ◽  
Large Scale ◽  
Treatment Options ◽  
Safety Data ◽  
Density Lipoprotein ◽  
Systemic Circulation ◽  
Lipid Lowering ◽  
Ldl Apheresis ◽  
New Therapies

Patients with severe hypercholesterolaemia have a high lifetime risk for developing cardiovascular disease. These patients are traditionally treated with high-intensity statins and ezetimibe. Some patients are refractory to treatment and cannot achieve a desirable reduction in low-density lipoprotein cholesterol (LDL-C). LDL apheresis or lipoprotein apheresis (LA) is a radical treatment which involves the intermittent extracorporeal removal of atherogenic apolipoprotein B-100-containing lipoproteins from the systemic circulation. The procedure requires the use of highly specialised equipment and is carried out under medical supervision for patients with severe hypercholesterolaemia, refractory to treatment with high-intensity statins and ezetimibe. The advent of targeted therapies, including monoclonal antibodies and gene silencing therapies, offer treatment options that could replace LA for these patients. Large scale clinical trials for the PCSK inhibitors evolocumab and alirocumab show favourable outcomes in terms of lipid lowering, with a 50% to 60% improvement in baseline LDL-C levels. This suggests that these therapies could reduce the need for LA in patients with hypercholesterolaemia. This review describes the main clinical trials for the PCSK inhibitors and discusses the place of these therapies in the management of severe hypercholesterolaemia. While these new therapies show promise as an effective option for lowering LDL-C levels in patients refractory to conventional treatment and have added benefits of ease of administration and compliance to treatment, long-term safety data is still needed. Favourable safety data could relegate the use of LA for a select few patients who may not tolerate the new therapies.

scholarly journals Effect of Treatment with Colchicine After Acute Coronary Syndrome on Major Cardiovascular Events: A Meta-Analysis of Clinical Trials

2021 ◽  
Author(s):  
Erfan Razavi ◽  
Akam Ramezani ◽  
Asma Kazemi ◽  
Armin Attar
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Large Scale ◽  
Low Dose ◽  
Meta Analysis ◽  
Coronary Syndrome ◽  
Hs Crp ◽  
The Impact

Abstract Purpose Colchicine as an anti-inflammatory drug might be effective in the treatment of atherosclerosis, an inflammatory-based condition. The aim of this systematic review and meta-analysis was to evaluate the impact of colchicine on acute coronary syndrome (ACS). Methods We searched SCOPUS, PubMed, and Web of Science up to September 27, 2020. All clinical trials which evaluated the effect of colchicine on ACS patients and reported high-sensitivity C-reactive protein (hs-CRP) serum level or gastrointestinal (GI) adverse events with at least 5-day follow up or death, Myocardial infarction (MI), and stroke with at least 30-day follow up as outcomes were included. Results Finally, seven publications were analyzed. The results of our study revealed that colchicine has a marginally significant effect on hs-CRP attenuation. Furthermore, colchicine manifested promising results by declining the risk of stroke by 70%. However, MI and primary composite endpoint did not differ between the colchicine and non-colchicine group. Although colchicine did not significantly increase GI adverse events in the pooled analysis, the dose-dependent effect was detected. Low dose consumption can avoid GI side effects of colchicine. Conclusion Colchicine has shown some molecular and clinical promising results in ACS patients. The lack of effect of colchicine on MI and all-cause mortality can be partly attributed to the limitations of previous studies. Since colchicine is an inexpensive and easy-to-access drug that has shown to be safe in low-dose regimens in the clinical setting, it worth that future large-scale well-designed studies address this issue by resolving the limitations of previous research.

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