Low-Dose Whole Lung Irradiation for Treatment of COVID-19 Pneumonia: A Systematic Review and Meta-Analysis.

PURPOSE: Studies 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 MATERIALS: We 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. RESULTS: Ten 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. CONCLUSIONS: Despite 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.

Low-dose whole-lung irradiation in severe COVID-19 pneumonia: a controlled clinical trial.

INTRODUCTION: The COVID-19 pandemic has caused significant morbidity and mortality thus far. Considering the historical uses of high-voltage X-ray beams for unresolvable pneumonia, we aimed to assess whether low-dose whole-lung irradiation (WLI) could provide any benefits for patients with refractory COVID-19 pneumonia. METHODS: Eleven patients with refractory COVID-19 pneumonia were treated with WLI to a total dose of 1 Gy and compared to 11 patients in a matched control group from June to November 2020. The study's primary endpoint was improvement of chest X-ray severity score (CXRS), followed by changes in mean oxygen (O2) saturation and 28-day mortality as secondary endpoints. RESULTS: The final CXRS was significantly lower in the WLI group (8.7 ± 2.5) compared to the control group (12.3 ± 3.3) (P: 0.016). Change of CXRS from the first to the last chest X-ray was -2.2 ± 3.1 for the WLI group and 0.7 ± 3.9 for the control group, which showed a trend for lower CXRS in the WLI group (U = 30, p: 0.085). Mean O2 saturation showed insignificant improvement in the first 24 hours after radiotherapy (mean difference: 2.5 ± 4.1, Z=-1.6, P value: 0.11). Overall survival after 28 days was 32% in the WLI group and 11% in the control group (P: 0.48). The reason for death in many patients was not merely respiratory failure, but also other adverse situations like pneumothorax, cardiogenic shock and pulmonary thromboembolism. CONCLUSIONS: Low-dose WLI could improve the CXR severity score and O2 saturation in severely ill COVID-19 patients, but larger studies are required to determine its impact on mortality.

Implications of Sex Difference in CT Scan Findings and Outcome of Patients with COVID-19 Pneumonia.

PURPOSE: The novel coronavirus pandemic has caused significant morbidity and mortality since December 2019. Although the role of chest CT for diagnosing coronavirus disease 2019 (COVID-19) pneumonia is still debatable, the modality has been used in scenarios of constrained reverse-transcription polymerase chain reaction (RT-PCR) testing. The epidemiologic reports indicate an unexplored difference between men and women in disease severity. We aimed to study the role of sex on disease severity and its correlation with CT findings. MATERIALS AND METHODS: Authors retrospectively studied all confirmed cases of COVID-19 with thoracic CT scans obtained at three hospitals from February 25, 2020, to March 15, 2020, in Tehran, Iran. CT involvement patterns of COVID-19 were analyzed based on sex and age of patients. RESULTS: One hundred fifteen patients (64.3% [74/115] men) were enrolled, with a median age of 57 years (age range, 21-89). Thirty patients were admitted to the intensive care unit, and 30 patients died during the hospital stay. Seventy-seven percent (37/48) of patients with unfavorable prognosis were male. Peripheral distribution of opacities was more common in men than women. When grouped by an age cut-off of 60 years, the women in the elder group had a peribronchovascular distribution pattern, and younger men showed an anterior distribution of opacities. Women younger than 60 years had significantly lower severity scores (CT-scores) (7.5 ± 6.8). Receiver operating characteristic (ROC) curve analysis demonstrated a CT-score cut-off of 14.5 to have 100% sensitivity and 91.9% specificity for predicting poor prognosis in women younger than 60 years. CONCLUSION: Opacity patterns on chest CT scans in COVID-19 are different based on sex and age, and men are at higher risk of disease severity and death.© RSNA, 2020.

Antiretrovirals for Prophylaxis Against COVID-19: A Comprehensive Literature Review.

Although people living with human immunodeficiency virus and other comorbidities are expected to experience more grievous consequences with corona virus disease 2019 (COVID-19), recent cohort studies did not indicate this. Antiretrovirals (ARVs) might have a prophylactic role in these patients. The purpose of this study was to review the most recently published articles on the possible role of ARVs for pre- or postexposure prophylaxis against COVID-19. From June to October 2020, we searched scientific databases using specific key words to identify ongoing trials or articles published before October 2020 investigating any subgroups of ARVs for prophylaxis against COVID-19. Apart from molecular docking studies, in vitro, animal, and human studies are very limited for evaluating the prophylactic role of ARVs against severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) infection. According to our findings, there is no definite evidence to support use of protease inhibitors for this purpose, despite the promising results of molecular studies and limited clinical evidence for ritonavir-boosted lopinavir, darunavir, and nelfinavir when used early in the course of the disease. Nucleotide/nucleoside reverse-transcriptase inhibitors (NRTI) also have shown binding affinity to main enzymes of SARS-CoV-2 in molecular, in vitro, and animal studies. NRTIs like tenofovir and emtricitabine might exhibit a prophylactic role against SARS-CoV-2 infection. In conclusion, currently there is no evidence to justify the use of ARVs for prophylaxis against COVID-19.

Does recombinant human erythropoietin administration in critically ill COVID-19 patients have miraculous therapeutic effects?

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID-19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus.