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Coronavirus disease 2019 (COVID-19) is associated with lung inflammation and cytokine storm. Photobiomodulation therapy (PBMT) is a safe, non-invasive therapy with significant anti-inflammatory effects. Adjunct PBMT has been employed in treating patients with lung conditions. Human studies and experimental models of respiratory disease suggest PBMT reduces inflammation and promotes lung healing. This is the first time supportive PBMT was used in a severe case of COVID-19 pneumonia. A 57-year-old African American man with severe COVID-19 received 4 once-daily PBMT sessions by a laser scanner with pulsed 808 nm and super-pulsed 905 nm modes for 28 min. The patient was evaluated before and after treatment via radiological assessment of lung edema (RALE) by CXR, pulmonary severity indices, blood tests, oxygen requirements, and patient questionnaires. Oxygen saturation (SpO2 ) increased from 93–94% to 97–100%, while the oxygen requirement decreased from 2–4 L/min to 1 L/min. The RALE score improved from 8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). Additional pulmonary indices (Brescia-COVID and SMART-COP) both decreased from 4 to 0. CRP normalized from 15.1 to 1.23. The patient reported substantial improvement in the Community-Acquired Pneumonia assessment tool. This report has presented supportive PBMT in a patient with severe COVID-19 pneumonia. Respiratory indices, radiological findings, oxygen requirements, and patient outcomes improved over several days and without need for a ventilator. Future controlled clinical trials are required to evaluate the effects of PBMT on clinical outcomes in patients with COVID-19 pneumoni
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Received: 2020.06.12
Accepted: 2020.07.31
Available online: 2020.08.07
Published: 2020.XX.XX
2353 2 3 35
A 57-Year-Old African American Man with
Severe COVID-19 Pneumonia Who Responded to
Supportive Photobiomodulation Therapy (PBMT):
First Use of PBMT in COVID-19
ABCDEF 1 Scott A. Sigman
ABCDEF 2 Soheila Mokmeli
A 3 Monica Monici
BCDEF 4 Mariana A. Vetrici
Corresponding Author: Scott A. Sigman, e-mail: sasigmanmd@icloud.com
Conflict of interest: None declared
Patient: Male, 57-year-old
Final Diagnosis: COVID -19
Symptoms: Shortnessofbreath•hypoxia
Medication:
Clinical Procedure: Photobiomodulation therapy (PBMT)
Specialty: InfectiousDiseases•Pulmonology
Objective: Unusual or unexpected effect of treatment
Background: Coronavirus disease 2019 (COVID-19) is associated with lung inflammation and cytokine storm. Photobiomodulation
therapy (PBMT) is a safe, non-invasive therapy with significant anti-inflammatory effects. Adjunct PBMT has
been employed in treating patients with lung conditions. Human studies and experimental models of respira-
tory disease suggest PBMT reduces inflammation and promotes lung healing. This is the first time supportive
PBMT was used in a severe case of COVID-19 pneumonia.
Case Report: A 57-year-old African American man with severe COVID-19 received 4 once-daily PBMT sessions by a laser scan-
ner with pulsed 808 nm and super-pulsed 905 nm modes for 28 min. The patient was evaluated before and
after treatment via radiological assessment of lung edema (RALE) by CXR, pulmonary severity indices, blood
tests, oxygen requirements, and patient questionnaires. Oxygen saturation (SpO2) increased from 93–94% to
97–100%, while the oxygen requirement decreased from 2–4 L/min to 1 L/min. The RALE score improved from
8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). Additional pulmonary indi-
ces (Brescia-COVID and SMART-COP) both decreased from 4 to 0. CRP normalized from 15.1 to 1.23. The pa-
tient reported substantial improvement in the Community-Acquired Pneumonia assessment tool.
Conclusions: This report has presented supportive PBMT in a patient with severe COVID-19 pneumonia. Respiratory indi-
ces, radiological findings, oxygen requirements, and patient outcomes improved over several days and with-
out need for a ventilator. Future controlled clinical trials are required to evaluate the effects of PBMT on clini-
cal outcomes in patients with COVID-19 pneumonia.
MeSH Keywords: Anti-InammatoryAgents•COVID-19•LaserTherapy•RespiratoryDistressSyndrome,Adult
Full-text PDF: https://www.amjcaserep.com/abstract/index/idArt/926779
Authors’ Contribution:
Study Design A
Data Collection B
Statistical Analysis C
Data Interpretation D
Manuscript Preparation E
Literature Search F
Funds Collection G
1 Team Physician, UMASS Lowell, Fellow of the World Society of Sports and
Exercise Medicine, Fellow of the Royal College of Surgeons in Ireland, Chelmsford,
MA, U.S.A.
2 Training Institute, Canadian Optic and Laser Center, Victoria, BC, Canada
3 Department of Experimental and Clinical Biomedical Sciences, University of
Florence, Florence, Italy
4 Department of Biological Sciences, University of Lethbridge, Lethbridge,
AB, Canada
e-ISSN 1941-5923
© Am J Case Rep, 2020; 21: e926779
DOI: 10.12659/AJCR.926779
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APPROVED GALLEY PROOF
Background
Coronavirus disease 2019 (COVID-19) is caused by Severe
Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).
The presentation of COVID-19 includes dyspnea, lung edema,
and pneumonia. Morbidity and mortality are associated with
Acute Respiratory Distress Syndrome (ARDS) and cytokine
storm. Hospitalized COVID-19 patients are classified as severe
if they require intensive care unit (ICU) admission [1,2]. Here,
we report the first case of the use of supportive or adjunctive
photobiomodulation therapy (PBMT) in a patient with severe
COVID-19 pneumonia.
PBMT is an emerging alternative modality with demonstrated
anti-inflammatory effects in pain management, lymphedema,
wound healing, and musculoskeletal injuries. Additional terms
for PBMT include low-level laser (or light) therapy (LLLT), cold
laser, and photobiostimulation [3]. The effects of PBMT differ
from the thermal effects produced by the high-power lasers
used in cosmetic and surgical procedures to destroy the tis-
sue [4,5]. PBMT utilizes non-ionizing, non-thermal light sources
in the visible and infrared spectra (400–1000 nm) [3]. In PBMT,
light is applied over damaged tissues and the light energy ab-
sorbed by intracellular chromophores or biomolecules starts a
cascade of molecular reactions that improve cell function and
enhance the body’s healing process [4]. In effect, light stimu-
lates healing, modulates the immune system, and reduces in-
flammation, edema, and pain [4]. PBMT is non-invasive, cost-
effective, and has no known adverse effects.
Empirical use of PBMT in children, adults, and elderly patients
with pneumonia, asthma, chronic bronchitis, or pulmonary fi-
brosis resulted in reduced chest pain and heaviness, normal-
ization of respiratory function, shortened recovery times, and
improved immunological and radiological parameters. In these
patients, PBMT used in combination with conventional med-
ical treatment was safe and appeared to produce a synergis-
tic effect in healing [6–10]. Recent publications recommend
the use of supportive PBMT in COVID-19 patients [11–13].
ARDS is a critical complication of COVID-19 infection and sup-
portive PBMT can ameliorate ARDS and promote lung heal-
ing [11,13–18]. Animal models of acute inflammation of the
respiratory system suggest that transcutaneous PBMT over
the lungs is effective against cytokine storm and ARDS via its
anti-inflammatory action at multiple levels [14–18].
The theory of supportive PBMT for COVID-19 is based on la-
ser light reaching lung tissue, which relieves inflammation and
promotes healing. The World Association for Laser Therapy
recommended treatment doses for low-level laser therapy, or
PBMT for superficial to deep tissue lesions in musculoskeletal
disorders in 2010 [19].
The minimum observed therapeutic dose for a bio-stimulatory
effect of red and near-infrared (NIR) lasers is 0.01 J/cm2 [20].
NIR Laser light at a power of 1 W/cm2 projected through bo-
vine tissue ranging in thickness from 1.8 to 9.5 cm resulted
in effective power densities at 3.4 cm and 6.0 cm [21]. In vet-
erinary practice, feline and canine pneumonia is frequent
-
ly treated with laser doses of 6–10 J/cm2 [22]. These animals
have a thicker chest wall and furry skin, making penetration
more challenging than in humans. Therefore, the range used
in cats and dogs approximates an effective dose for humans.
Our previous experience in treating asthma [23] and musculo-
skeletal pain and injuries suggested that the anti-inflammato-
ry effects of PBMT could benefit the severe inflammatory con
-
dition in COVID-19 patients. The laser machine used in this
case is an US Food and Drug Administration (FDA)-cleared sys-
tem for pain management and inflammation reduction in deep
joints of the body. The combination of 808 and 905 nm, both
NIR wavelengths, provides penetration to depths of 4–5.4 cm.
This laser machine is used for deeper tissues like hips and pel-
vic joints that are surrounded by thick muscles. The therapeu-
tic dose with this machine is 4.5 J/cm2 over the skin to reach
these deep targets of the pelvis. Based on our calculations, we
used 7.2 J/cm2 over the skin to deliver just over 0.01 J/cm2 of
laser energy to the lung. The 7.2 J/cm2 dosage penetrates the
chest wall (1.6 to 6 cm in humans) and reaches the lung tis-
sue with sufficient energy for bio-stimulation. Scapular pro-
traction in the prone position reduces the bone and muscle
tissue the laser must penetrate, thereby increasing laser en-
ergy to the lung fields.
Here, we report the first use of PBMT as a supportive treat-
ment in a severe case of COVID-19 pneumonia.
CaseReport
A 57-year-old African American man with a history of hyperten-
sion and asthma presented with shortness of breath, severe de-
hydration, acute renal failure, and C. difficile-positive diarrhea.
A physical examination revealed labored breathing, weakness,
and fatigue. Chest X-rays demonstrated worsening bilateral lung
infiltrates. Oxygen requirements in the hospital ranged from 2
to 6 L/min oxygen. The patient had been in the ICU for respi-
ratory depression with SpO
2
of 80% requiring 48 h on 6 L/min
oxygen. The diagnosis of SARS-CoV-2 was confirmed for this
patient by reverse transcription-polymerase chain reaction by
nasopharyngeal swab on an Abbott ID system. Patient con-
sent was obtained for an FDA-guided and International Review
Board-approved trial of laser treatment for COVID-19 (Lowell
General Hospital Federal-wide Assurance number 0001427).
The inclusion criteria consisted of a positive COVID-19 test,
the ability to self-prone, and requiring at least 1 L/min oxygen.
Sigman S.A. et al.:
A 57-year-old African American man with severe COVID-19 pneumonia…
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The patient was treated with an FDA-cleared Multiwave Locked
System (MLS) Therapy Laser (ASA Laser, Italy.) The MLS laser
utilizes a mobile scanner with 2 synchronized laser diodes, one
in pulse mode (adjustable to 1–2000 Hz), emitting at 905 nm,
and another in pulsed mode emitting at 808 nm. The 2 laser
beams work simultaneously and synchronously. This laser is
used in pain centers for treatment of musculoskeletal pain
and inflammation. Laser parameters were set as outlined in
Table 1 and Figure 1. The laser scanner was adjusted to 20 cm
above the skin, as recommended by the manufacturer. Each
lung was scanned for 14 min from apex to base over 250 cm2
of the posterior thorax (Table 1, Figures 1, 2).
Specific prone positioning was used with the patient’s hands
under his head for maximal scapular protraction. The laser field
was focused to the medial border of the scapula opening the
lung fields, thereby minimizing the chest wall thickness for
theoretical improvement of laser penetration to lung tissue.
Prior to laser treatment, the patient was bedridden, with SpO
2
92–95% on 2–4 L/min oxygen. He had completed his antibiotic
course and was not receiving any pharmacotherapeutic or IV
support. He experienced severe paroxysmal coughing episodes
and had failed a physical therapy trial. The patient tolerated
the prone position for laser treatment for a total of 28 min.
Within 5 min of laser treatment, his oxygen saturation rose
from 94% to 100% in the first session. Following treatment,
he returned to his bed and resumed the semi-sitting position
and SpO2 remained at 98% for the rest of the day.
The patient tolerated all 4 daily treatments and noted significant
improvement in breathing immediately after each treatment.
Paroxysmal coughing spells resolved after the third treatment.
Upon completion of the fourth treatment, the patient was able
Table 1. Laser parameters for COVID-19 pneumonia patients.
808 nm (GaAlAs)
diode
905 nm (GaAs)
diode
Mode of
radiation Pulsed Pulsed
Frequency
1500 Hz,
(Duty Cycle 50%)
(1 Hz÷2 kHz)
1500 Hz
(90 kHz Modulated
at 1 Hz÷2 kHz)
Pulse duration 333 μs
(500 ms÷250 μs) 100 ns
Peak power 3 W 75W×3
Average power 1.5 W 11.25×3=33.75 mW
Spot size 19.625 cm2
Area On each lung
25×10=250 cm2
Dose 7.1–7.2 J/cm2
Distance from
the skin 20 cm
Treatment time 14 minutes each lung
Total energy 3600 J
1794.24 each lung
Total time 28 minutes
Sessions Once daily for 4 days
The table explains the technical parameters for the dosage
of laser energy and treatment time used in this case report.
GaAlAs – Gallium Aluminum Arsenide Diode; GaAs – Gallium
Arsenide Diode. The two diodes are part of a single laser system,
the Multiwave Locked System (MLS). For patients with dark skin
color, there is a pigment adjustment selection button on the
laser console. When the pigment selection is activated, laser
intensity is reduced by 50% and the software automatically
recalculates the required dose.
Figure 1. Orientation of the laser beams during laser treatment
while in the prone position. The apex of the lung lies
above the first rib. The lungs extend from the C7 to
T10 vertebra, which is also from the apex of the lung
to the inferior border. Laser parameters with both
diodes operating synchronously and simultaneously,
and the propagation axes are coincident. 1) 808 nm
(GaAlAs) diode: Peak Power: 3 W, Laser Mode: Pulsed,
Frequency: 1500 Hz, Pulse Duration: 333 μs,
Scanning Area: 25×10=250 cm2, Dose: 7.2 J/cm2;
2) 905 nm (GaAs) diode: Peak Power: 75 W×3, Laser
Mode: Pulsed, Frequency: 1500 Hz, Pulse Duration:
100 ns, Area: 25×10=250 cm2, Dose: 113.4 mJ/cm2;
Total Energy: 3600 J. Treatment Time: (28 minutes),
14 minutes each lung, Sessions: Once daily for 4
days. Therapeutic Protocol: PBMT-COVID-19 By
Dr. S. Mokmeli.
Sigman S.A. et al.:
A 57-year-old African American man with severe COVID-19 pneumonia…
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to ambulate in the room with physical therapy. On the day fol-
lowing his final treatment, the patient was discharged to an
acute rehabilitation facility on 1 L/min oxygen. On the day af
-
ter arrival to the acute rehabilitation facility, the patient was
able to complete 2 trials of stair climbing with physical thera-
py and was in the process of weaning to room air.
The patient’s response to PBMT was evaluated by comparing
different scoring tools before and after laser therapy. The pa-
tient showed improvement in all evaluation criteria (Table 2).
The Pneumonia Severity Index (PSI) [24] calculates the prob-
ability of morbidity and mortality among patients with com-
munity-acquired pneumonia (CAP). Prior to treatment, the pa-
tient’s PSI score was Class V (142), which requires ICU treatment
and predicts intubation and ventilator use. After PBMT, PSI de-
creased to Class II (67), which signifies outpatient treatment.
The SMART-COP score [25], which is an acronym for Systolic
blood pressure, Multilobar infiltrates, Albumin, Respiratory rate,
Tachycardia, Confusion, Oxygen, and pH, evaluates pneumo-
nia severity and predicts the need for intensive respiratory or
vasopressor support (IRVS) in CAP. The pretreatment SMART-
COP score was 5, placing him in the high-risk group, and sig-
nifying a 1 in 3 chance of needing IRVS. Following PBMT, the
SMART-COP decreased to 2, implying minimal risk for need-
ing IRVS.
The Brescia-COVID Respiratory Severity Scale [26] is a stepwise
algorithm for managing patients with confirmed COVID-19.
Before treatment, the patient’s score was 4 out of 4, which
requires a trial of high-flow nasal cannula (HFNC), reassess-
ment, and intubation if the score remains >2. Following PBMT,
the patient’s Brescia-COVID score was 0, which simply requires
patient monitoring.
The CAP tool score [27] is a short and sensitive question-
naire evaluating changes in respiratory symptoms and well-
being during the treatment of community-acquired pneumo-
nia. Scores <75% indicate symptomatic distress. The patient’s
pretreatment CAP score was 36.68% and increased to 82.84%
after treatment. His CAP Respiratory Score improved from
67.52%, before treatment to 87.17% at the time of discharge.
The CAP Well-Being score increased from 0% before treatment
to 73.07% after treatment. This patient demonstrated substan-
tial improvement in all 3 measures of respiratory symptoms.
The Radiographic Assessment of Lung Edema (RALE)
score [28,29] evaluates lung edema on CXR in ARDS patients.
To quantify the extent of infection, a severity score was calcu-
lated [29]. A score of 0 to 4 was assigned to each lung depend-
ing on the percent lung consolidation or ground-glass opacity,
with 0 signifying no lung involvement, 1 indicating <25% lung
involvement, 2 indicating 25–50% lung involvement, 3 indicat-
ing 50–75% lung involvement, and 4 indicating >75% involve-
ment. The scores for each lung were added together to pro-
duce the final severity score [29]. The RALE score was 8 (>75%
involvement of both lungs) and improved to 5 upon treatment
completion (Figure 3).
His white blood cell count decreased from 10.7 to 6.5 and his
C-reactive protein decreased from 15.1 to 1.23 after treatment.
The oxygen requirement before treatment was 2–4 L/min with
an oxygen saturation (SpO2) of 93–94%. The oxygen require-
ment after treatment improved to 1 L/min with an SpO2 of
97–100% at the time of discharge.
Discussion
This case report showed that 4 daily sessions of adjunct PBMT
were beneficial in a patient with severe COVID-19 symptoms.
The patient’s positive response to treatment was supported
by radiological findings, pulmonary severity scores, oxygen
requirements, blood and inflammatory markers, and patient
questionnaires. On follow-up, his clinical recovery in total was
3 weeks, whereas the median time for COVID-19 is typical-
ly 6–8 weeks [30].
Figure 2. Laser scanner configuration while the patient is in the
prone position with scapular protraction. The laser
scanner was adjusted 20 cm above the skin as per
manufacturer’s guidelines. The patient is shown here
with his hands under his head for maximum scapular
protraction. The red light is the laser machine’s guide
beam on the skin. Infrared lasers with wavelengths of
808 and 905 nm are not visible to human eyes. The 2
sources are coupled in a single system in the MLS laser
system.
Sigman S.A. et al.:
A 57-year-old African American man with severe COVID-19 pneumonia…
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APPROVED GALLEY PROOF
The therapeutic effects of PBMT on pneumonia are thought
to occur via local and systemic effects that reduce inflamma-
tory cytokines, cellular infiltrates, edema and fibrosis, and in-
crease anti-inflammatory cytokines and processes, and promote
healing. Local PBMT affects the entire body when photoprod-
ucts are distributed via the vasculature to reach distant tar-
gets. Activated photoproducts lead to alleviation of inflam-
mation and immunomodulatory effects, and stimulate wound
healing and tissue regeneration [4]. Animal studies illustrate
the potency of PBMT.
Transcutaneous PBMT in murine models for pulmonary fibrosis
and ARDS significantly reduced pro-inflammatory cytokines,
inflammatory cells, and collagen fiber deposition in lung pa-
renchyma [14–18]. In contrast, the anti-inflammatory cytokine
interleukin-10, serum monocytes, and lung macrophages were
significantly increased following PBMT [15,17]. The molecular
basis of MLS laser anti-inflammatory effects has been demon-
strated in murine and in vitro models [31–33]. In particular, it
has been shown to inhibit inflammasome activation, inhibit-
ing interleukin-1b and interleukin-18, whose downstream sig-
naling induces the production of interleukin-6, interleukin-8,
tumor necrosis factor a (TNF-a), and interferon-g, which are im-
plicated in ARDS caused by COVID-19 infection [14–18,31–33].
Table 2. Evaluation criteria before and after photobiomodulation therapy in a COVID-19 patient.
Parameters Before
treatment
After
treatment Normal range or evaluation criteria
PSI Class V
(142)
Class II
(67)
Risk Class (Points): Disposition
Class I (<50): Outpatient
Class II (51–70): Outpatient
Class III (71–90): Outpatient/brief Inpatient
Class IV (91–130): Inpatient
Class V (>130): Inpatient
SMART-COP 5 2
0 points: Very low risk of needing IRVS
1 point: Low risk (1 in 20) of needing IRVS
2 points: Moderate risk (1 in 10) of needing IRVS
3 points: High risk (1 in 6) of needing IRVS
³4 points: High risk (1 in 3) of needing IRVS; Consider ICU admission
Brescia-COVID 4 0
0 – monitor
1 – add O2 and monitor
2 – CXR, ABG, O2 therapy, monitor
>2 – HFNC and reassess. If still >2, intubate.
CAP total 36.68 82.82 Calculated based on (CAP) score questionnaire:
75–100%
CAP respiratory 67.52 87.17 75–100%
CAP well-being 0.0 73.07 75–100%
RALE 8 5
Lungs score dependent on extent of involvement based on consolidation or
ground-glass opacities for each lung, total score is the sum of the score of
the lungs: 0 – no involvement; 1 – <25% of lung involved; 2 – 25–50% of lung
involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved.
WBC 10.7 6.5 4.5–11
CRP 15.1 1.23 3 mg/mL
O2 Requirement 2–3 L/min 1 L/min 0 L/min
SpO293–94% 100% ³94%
PSI – Pneumonia Severity Index; SMART-COP – Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia,
Confusion, Oxygen, and pH; CAP – Community-Acquired Pneumonia; RALE – Radiographic Assessment of Lung Edema; SpO2 – Oxygen
saturation; WBC – White Blood Cells; CRP – C-Reactive Protein; IRVS – Intensive Respiratory or Vasopressor Support; CXR – Chest x-ray;
ABG – Arterial Blood Gas; HFNC – High-Flow Nasal Cannula.
Sigman S.A. et al.:
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Figure 3. Radiographic Assessment of Lung Edema (RALE) by CXR showed reduced ground-glass opacities and consolidation following
PBMT. Lung radiographic score is dependent on extent of involvement based on consolidation or ground-glass opacities
for each lung. Total score is the sum of both lungs. Scores classification: 0 – no involvement; 1 – <25% of lung involved;
2 – 25–50% of lung involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved. RALE score before laser therapy
(04-27-2020)=8. Laser therapy started on (04-29-2020). RALE score after laser therapy (05-03-2020)=5.
Human trials have shown local and systemic effects of PBMT
when applied to quadriceps muscle in patients with chron-
ic obstructive pulmonary disease [10]. Beneficial effects ex-
tended beyond improved muscular performance, to statisti-
cally significant reductions in dyspnea and fatigue [10]. Our
patient also reported subjective feelings of improved respira-
tory function and strength.
Our patient was only placed in the prone position for the du-
ration of laser treatment. Treatments lasted exactly 28 min
for each of the 4 days. Physiological evidence and clinical tri-
al data support the use of prone position ventilation in se-
lected patients with moderate-to-severe ARDS. For patients
to benefit, the use of long prone positioning sessions of 12 h
to 18 h per session are necessary [34,35]. An increase in SpO
2
from 94% to 100% occurred within the first 5 min of treat-
ment, and the patient maintained good saturation thereaf-
ter. This finding shows the rapid effect of PBMT treatment on
oxygen saturation. It is unlikely that prone positioning alone
was the reason for improved oxygenation, given the minimal
time in that position.
A strength of this case report is that we collected patient symp-
tom data before and after treatment. All 4 pulmonary scor-
ing tools and the 3 patient questionnaires demonstrated the
benefit of treatment. To the best of our knowledge, this was
the first time that PBMT was used as adjunctive treatment for
pneumonia in a COVID-19 patient. Irradiation over the posteri-
or projection of the lungs, using the scanning method, has no
risk of contamination since the scanning laser does not phys-
ically touch the patient. A deficiency of our study is the lack of
inflammatory markers and blood tests. Future studies should
include measurements before and after treatment of interleu-
kin-6, interleukin-10, TNF-a, as well as additional inflammatory
markers. A limitation of this case report is that this is a single
patient and we were unable to carry out any statistical analysis.
Conclusions
This report has presented a patient with severe COVID-19 pneu-
monia associated with ARDS who was given supportive treat-
ment with PBMT. Based on this case report, as well as clinical
experience of PBMT in respiratory tract diseases in humans,
we consider PBMT to be a feasible adjunct modality for the
treatment of COVID-19. There is published experimental work
demonstrating the anti-inflammatory effect of PBMT on lung
tissue. We suggest that the use of adjunct PBMT in the early
stages of severe ARDS seen in COVID-19 patients can enhance
healing and reduce the need for prolonged ventilator support
and ICU stay. The urgent current medical situation calls for
PMBT pilot studies and clinical trials to evaluate its effect on
COVID-19 pneumonia. This patient is part of an ongoing in-
vestigational randomized controlled trial.
Sigman S.A. et al.:
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APPROVED GALLEY PROOF
References:
1. Liang T: Handbook of COVID-19 prevention and treatment. Zhejiang University
School of Medicine, March 2020
2. Huang C, Wang Y, Li X et al: Clinical features of patients infected with 2019
novel coronavirus in Wuhan, China [published correction appears in Lancet.
2020 Jan 30;]. Lancet, 2020; 395(10223): 497–506
3. Anders JJ, Lanzafame RJ, Arany PR: Low-level light/laser therapy versus pho-
tobiomodulation therapy. Photomed Laser Surg, 2015; 33(4): 183–84
4. Cotler HB, Chow RT, Hamblin MR, Carroll J: The use of low-level laser ther-
apy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol, 2015; 2(5):
00068
5. Hamblin MR: Mechanisms and applications of the anti-inflammatory ef-
fects of photobiomodulation. AIMS Biophys, 2017; 4(3): 337–61
6. Amirov NB [Parameters of membrane permeability, microcirculation, ex-
ternal respiration, and trace element levels in the drug-laser treatment of
pneumonia]. Ter Arkh, 2002; 74(3): 40–43 [in Russsian]
7. Derbenev VA, Mikhailov VA, Denisov IN: Use of low-level laser therapy
(LLLT) in the treatment of some pulmonary diseases: Ten-year experience.
Proceedings of the SPIE, Volume 4166; 1999 Oct 28–31; Florence, Italy. SPIE
digital library 2000; 323–25
8. Ostronosova NS: [Outpatient use of laser therapy in bronchial asthma.] Ter
Arkh, 2006; 78(3): 41–44 [in Russsian]
9. Mehani SHM: Immunomodulatory effects of two different physical therapy
modalities in patients with chronic obstructive pulmonary disease. J Phys
Ther Sci, 2017; 29(9): 1527–33
10. Miranda EF, de Oliveira LV, Antonialli FC et al: Phototherapy with combi-
nation of super-pulsed laser and light-emitting diodes is beneficial in im-
provement of muscular performance (strength and muscular endurance),
dyspnea, and fatigue sensation in patients with chronic obstructive pul-
monary disease. Lasers Med Sci, 2015; 30(1): 437–43
11. Enwemeka CS, Bumah VV, Masson-Meyers DS: Light as a potential treat-
ment for pandemic coronavirus infections: A perspective. J Photochem
Photobiol B, 2020; 207: 111891
12. Fekrazad R: Photobiomodulation and antiviral photodynamic therapy as
a possible novel approach in COVID-19 management. Photobiomodul
Photomed Laser Surg, 2020; 38(5): 255–57
13. Mokmeli S, Vetrici M: Low-level laser therapy as a modality to attenuate
cytokine storm at multiple levels, enhance recovery, and reduce the use of
ventilators in COVID-19. Can J Respir Ther, 2020; 56: 1–7
14. Aimbire F, Lopes-Martins RA, Albertini R et al: Effect of low-level laser
therapy on hemorrhagic lesions induced by immune complex in rat lungs.
Photomed Laser Surg, 2007; 25(2): 112–17
15. de Brito AA, da Silveira EC, Rigonato-Oliveira NC et al: Low-level laser ther-
apy attenuates lung inflammation and airway remodeling in a murine mod-
el of idiopathic pulmonary fibrosis: Relevance to cytokines secretion from
lung structural cells. J Photochem Photobiol B, 2020; 203: 111731
16. Cury V, de Lima TM, Prado CM et al: Low-level laser therapy reduces acute
lung inflammation without impairing lung function. J Biophotonics, 2016;
9(11–12): 1199–207
17. da Cunha Moraes G, Vitoretti LB, de Brito AA et al: Low-level laser therapy
reduces lung inflammation in an experimental model of chronic obstructive
pulmonary disease involving P2X7 receptor. Oxid Med Cell Longev, 2018;
2018: 6798238
18. Miranda da Silva C, Peres Leal M, Brochetti RA et al: Low-level laser ther-
apy reduces the development of lung inflammation induced by formalde-
hyde exposure. PLoS One, 2015; 10(11): e0142816
19. WALT: Dosage recommendations. Recommended treatment doses for low-
level laser therapy. Available at URL: https://waltza.co.za/documentation-
links/recommendations/dosage-recommendations/; https://waltza.co.za/
wp-content/uploads/2012/08/Dose_table_904nm_for_Low_Level_Laser_
Therapy_WALT-2010.pdf
20. Tunér J, Hode L: Laser therapy, clinical practice and scientific background.
Grängesberg, Sweden: Prima Books AB; 2002
21. Hudson DE, Hudson DO, Wininger JM, Richardson BD: Penetration of laser
light at 808 and 980 nm in bovine tissue samples. Photomed Laser Surg,
2013; 31(4): 163–68
22. Arza RA: Upper and lower respiratory conditions. In: Riegel RJ, Godbold JC
(eds.), Laser therapy in veterinary medicine. Hoboken: John Wiley & Sons,
Inc., 2017; 150–60
23. Vatankhah Z, Mokmeli S, Boshbishe S: Evaluation of the effect of low-lev-
el laser therapy (LLLT) in the treatment of asthma, added to convention-
al drug therapy (crossover, case control clinical trial). Photodiagnosis and
Photodynamic Therapy, 2008; 5(Suppl. 1): S22
24. Community-Acquired Pneumonia Severity Index (PSI) for Adults; Community-
Acquired Pneumonia Severity Index (PSI) for Adults Calculator. https://www.
merckmanuals.com/medical-calculators/CommunityAcqPneumonia.htm
25. Charles PG, Wolfe R, Whitby M et al: SMART-COP: A tool for predicting the
need for intensive respiratory or vasopressor support in community-ac-
quired pneumonia. Clin Infect Dis, 2008; 47(3): 375–84
26. Duca A, Piva S, Focà E et al: Calculated decisions: Brescia-COVID Respiratory
Severity Scale (BCRSS)/algorithm. Emerg Med Pract, 2020; 22(5 Suppl.):
CD1–2
27. El Moussaoui R, Opmeer BC, Bossuyt PM et al: Development and valida-
tion of a short questionnaire in community acquired pneumonia. Thorax,
2004; 59(7): 591–95
28. Zimatore C, Pisani L, Lippolis V et al: The radiographic assessment of lung
edema (RALE) score has excellent diagnostic accuracy for ARDS. Eur Respir
J, 2019; 54(Suppl. 63): OA3299
29. Wong HYF, Lam HYS, Fong AH et al: Frequency and distribution of chest
radiographic findings in patients positive for COVID-19. Radiology, 2020;
296(2): E72–78
30. Phua J, Weng L, Ling L et al: Intensive care management of coronavirus dis-
ease 2019 (COVID-19): challenges and recommendations [published cor-
rection appears in Lancet Respir Med. 2020 May;8(5): e42]. Lancet Respir
Med, 2020; 8(5): 506–17
31. Micheli L, Cialdai F, Pacini A et al: Effect of NIR laser therapy by MLS-MiS
source against neuropathic pain in rats: In vivo and ex vivo analysis. Sci
Rep, 2019; 9(1): 9297
32. Micheli L, Di Cesare Mannelli L, Lucarini E et al: Photobiomodulation ther-
apy by NIR laser in persistent pain: An analytical study in the rat. Lasers
Med Sci, 2017; 32(8): 1835–46
33. Monici M, Cialdai F, Ranaldi F et al: Effect of IR laser on myoblasts: A pro-
teomic study. Mol Biosyst, 2013; 9(6): 1147–61
34. Henderson WR, Griesdale DE, Dominelli P, Ronco JJ: Does prone position-
ing improve oxygenation and reduce mortality in patients with acute re-
spiratory distress syndrome? Can Respir J, 2014; 21(4): 213–15
35. Guérin C, Reignier J, Richard JC et al: Prone positioning in severe acute re-
spiratory distress syndrome. N Engl J Med, 2013; 368(23): 2159–68
Sigman S.A. et al.:
A 57-year-old African American man with severe COVID-19 pneumonia…
© Am J Case Rep, 2020; 21: e926779
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APPROVED GALLEY PROOF
... Therapeutic technique and LLLT dosing The Multiwave locked system (MLS) LASER therapy used in these studies uses a mobile scanner with 2 laser diodes, emitted in pulsed mode at 905 nm and 808 nm, respectively, the two wavelengths of t LASER working simultaneously and being synchronized. The scanner is positioned above the lung area at about 20 cm, each lung being scanned from the top to the base (21). The LASER field was focused on the median edge of the scapula, opening the lung fields, thus reducing the thickness of the chest wall to theoretically improve laser penetration into lung tissue (21). ...
... The scanner is positioned above the lung area at about 20 cm, each lung being scanned from the top to the base (21). The LASER field was focused on the median edge of the scapula, opening the lung fields, thus reducing the thickness of the chest wall to theoretically improve laser penetration into lung tissue (21). The therapeutic dose used according to calculations performed by Dr. Soheila Mokmeli, co-author of the main study conducted with Dr. Scott Sigman-main investigator and lead author of the first use of LASER therapy in the treatment of a patient with COVID-19 induced pneumonia, was just over 0.01 J/cm 2 of LASER energy in the lungs. ...
... The therapeutic dose used according to calculations performed by Dr. Soheila Mokmeli, co-author of the main study conducted with Dr. Scott Sigman-main investigator and lead author of the first use of LASER therapy in the treatment of a patient with COVID-19 induced pneumonia, was just over 0.01 J/cm 2 of LASER energy in the lungs. This dose was able to penetrate the chest wall into the lung tissue creating an antiinflammatory effect that theoretically blocked the effects of the cytokine storm seen in COVID pneumonia (21,22). ...
Article
Full-text available
Introduction. An unprecedented public health crisis has been triggered worldwide by SARS-CoV-2’s high contagiosity and it’s mortality rates of 1-5%. Although the majority of COVID-19 cases have a good outcome, there is a small percentage that develop severe pneumonia and citokine storm and may be in the need of mechanical ventilation. Methods. Identifying the exact drivers of the excessive inflammation and the biomarkers that can predict a hyperinflammatory response to SARS-CoV-2 would be extremly helpful in finding efficient anti-inflammatory interventions that may stop the progression to acute respiratory distress syndrome (ARDS). Results. In the search for such interventions we have identified the promising effect of low level LASER therapy (LLLT) on lung inflammation from COVID-19 pneumonia. Due to its well known anti-inflammatory effect and modulatory activity on immune cells, laser therapy may be able to decrease lung and systemic inflammation without affecting lung function in acute lung lesions, relieve respiratory symptoms, normalize respiratory function and stimulate the healing process of lung tissue. The recovery time may also be significantly shortened and all blood, immunological and radiological parameters may improve. Conclusions. This findings need further confirmation from clinical trials but we are hopeful for their contribution on the global battle against COVID-19 pandemic.
... Therapeutic technique and LLLT dosing The Multiwave locked system (MLS) LASER therapy used in these studies uses a mobile scanner with 2 laser diodes, emitted in pulsed mode at 905 nm and 808 nm, respectively, the two wavelengths of t LASER working simultaneously and being synchronized. The scanner is positioned above the lung area at about 20 cm, each lung being scanned from the top to the base (21). The LASER field was focused on the median edge of the scapula, opening the lung fields, thus reducing the thickness of the chest wall to theoretically improve laser penetration into lung tissue (21). ...
... The scanner is positioned above the lung area at about 20 cm, each lung being scanned from the top to the base (21). The LASER field was focused on the median edge of the scapula, opening the lung fields, thus reducing the thickness of the chest wall to theoretically improve laser penetration into lung tissue (21). The therapeutic dose used according to calculations performed by Dr. Soheila Mokmeli, co-author of the main study conducted with Dr. Scott Sigman-main investigator and lead author of the first use of LASER therapy in the treatment of a patient with COVID-19 induced pneumonia, was just over 0.01 J/cm 2 of LASER energy in the lungs. ...
... The therapeutic dose used according to calculations performed by Dr. Soheila Mokmeli, co-author of the main study conducted with Dr. Scott Sigman-main investigator and lead author of the first use of LASER therapy in the treatment of a patient with COVID-19 induced pneumonia, was just over 0.01 J/cm 2 of LASER energy in the lungs. This dose was able to penetrate the chest wall into the lung tissue creating an antiinflammatory effect that theoretically blocked the effects of the cytokine storm seen in COVID pneumonia (21,22). ...
Article
Introduction. An unprecedented public health crisis has been triggered worldwide by SARS-CoV-2’s high contagiosity and it’s mortality rates of 1-5%. Although the majority of COVID-19 cases have a good outcome, there is a small percentage that develop severe pneumonia and citokine storm and may be in the need of mechanical ventilation. Methods. Identifying the exact drivers of the excessive inflammation and the biomarkers that can predict a hyperinflammatory response to SARS-CoV-2 would be extremly helpful in finding efficient anti-inflammatory interventions that may stop the progression to acute respiratory distress syndrome (ARDS). Results. In the search for such interventions we have identified the promising effect of low level LASER therapy (LLLT) on lung inflammation from COVID-19 pneumonia. Due to its well known anti-inflammatory effect and modulatory activity on immune cells, laser therapy may be able to decrease lung and systemic inflammation without affecting lung function in acute lung lesions, relieve respiratory symptoms, normalize respiratory function and stimulate the healing process of lung tissue. The recovery time may also be significantly shortened and all blood, immunological and radiological parameters may improve. Conclusions. This findings need further confirmation from clinical trials but we are hopeful for their contribution on the global battle against COVID-19 pandemic. Keywords: SARS-CoV-2, pneumonia, low LASER level therapy, anti-inflammatory effect, citokine storm
... There is, therefore, potentially a need to adjust the PBM treatment dose, based on gender, for certain treatment targets, in the same way that such adjustments were suggested and done for different skin pigmentation in previous studies. 20,21,40 In a study by Karsten Aletta et al., 20 in situ calibration and computer modeling were conducted during treatment regimen planning to adjust the dose and wavelength of PBM light to address the requirements of the South African population who presented with a wide range of skin phototypes. ...
... Interestingly, a recent use of PBM for a dark-skin patient with an acute COVID-19 lung disease demonstrated effective outcomes from this treatment, whereby the laser machine was purported to automatically double the amount of photon energy to adjust for dose equivalence requirements to the skin tone. 40 There is therefore an argument to be made that similar requirements for an adjustment of dose according to gender to achieve optimal treatment outcomes should be considered. ...
Article
Background: The influence of gender is significant in the manifestation and response to many diseases and in the treatment strategy. Photobiomodulation (PBM) therapy, including laser acupuncture, is an evidence-based treatment and disease prevention modality that has shown promising efficacy for a myriad of chronic and acute diseases. Anecdotal experience and limited clinical trials suggest gender differences exist in treatment outcomes to PBM therapy. There is preliminary evidence that gender may be as important as skin color in the individual response to PBM therapy. Aim: To conduct a literature search of publications addressing the effects of gender differences in PBM therapy, including laser acupuncture, to provide a narrative review of the findings, and to explore potential mechanisms for the influence of gender. Methods: A narrative review of the literature on gender differences in PBM applications was conducted using key words relating to PBM therapy and gender. Results: A total of 13 articles were identified. Of these articles, 11 have direct experimental investigations into the response difference in gender for PBM, including laser acupuncture. A variety of cadaver, human, and experimental studies demonstrated results that gender effects were significant in PBM outcome responses, including differences in tendon structural and mechanical outcomes, and mitochondrial gene expression. One cadaver experiment showed that gender was more important than skin tone. The physiologic mechanisms directing gender differences are explored and postulated. Conclusions: The review suggests that to address the requirements of a proficient precision medicine-based strategy, it is important for PBM therapy to consider gender in its treatment plan and dosing prescription. Further research is warranted to determine the correct dose for optimal gender treatment, including gender-specific treatment plans to improve outcomes, taking into account wavelength, energy exposure, intensity, and parameters related to the deliverance of treatment to each anatomical location.
... The patient's response to the PBMT-sMF treatment was evaluated by monitoring SpO 2 [16,17] from the time of admission to the hospital (baseline), until discharge from the hospital, 10 days after the start of treatment, immediately after the end of the treatment, and 4 months after the end of the treatment with PBMT-sMF. In addition, we evaluated the progression of the imaging findings in the chest X-ray from the first X-ray at baseline, until 10 days after the start of the treatment, and 4 months after the end of the treatment with PBMT-sMF. ...
... In addition, our findings corroborate a previous case report that demonstrated that PBMT treatment in a patient with severe COVID-19 was beneficial in reducing inflammatory markers and improving respiratory indices and radiological findings [16]. Moreover, another previous case report demonstrated improvements in respiratory indices, oxygen requirements, and radiological findings in a patient with severe COVID-19 treated with PBMT [17]. It is important to highlight that the aforementioned case reports only showed short-term improvements in patients, while our study demonstrated that patients treated with PBMT-sMF for 45 days also had better clinical findings at the long-term evaluation (4 months after the treatment). ...
Article
Full-text available
Introduction: Photobiomodulation therapy, alone (PBMT) or combined with a static magnetic field (PBMT-sMF), has been demonstrated to be effective in the regeneration of tissues, modulation of inflammatory processes, and improvement in functional capacity. However, the effects of PBMT-sMF on the pulmonary system and COVID-19 patients remain scarce. Therefore, in this case report, we demonstrated the use of PBMT-sMF for peripheral oxygen saturation, pulmonary function, massive lung damage, and fibrosis as a pulmonary complication after COVID-19. Case report: A 53-year-old Mexican man who presented with decreased peripheral oxygen saturation, massive lung damage, and fibrosis after COVID-19 received PBMT-sMF treatment once a day for 45 days. The treatment was irradiated at six sites in the lower thorax and upper abdominal cavity and two sites in the neck area. We observed that the patient was able to leave the oxygen support during the treatment, and increase his peripheral oxygen saturation. In addition, the patient showed improvements in pulmonary severity scores and radiological findings. Finally, the patient presented with normal respiratory mechanics parameters in the medium-term, indicating total pulmonary recovery. Conclusions: The use of PBMT-sMF may potentially lead to safe treatment of and recovery from pulmonary complications after COVID-19, with regard to the structural and functional aspects.
... Our findings are consistent with observations made by Sigman et al. in their case study of a 57-year-old African-American man in 2020 with a history of hypertension, asthma, and acute renal failure who was hospitalized for severe COVID-19 with SpO 2 = 80%. They suggested that the use of PBM therapy early in the disease improves recovery, prevents lung tissue damage and ICU admission, while significantly reducing recovery time and oxygen requirements (45). ...
Article
Full-text available
Background Because the major event in COVID-19 is the release of pre- and inflammatory cytokines, finding a reliable therapeutic strategy to inhibit this release, help patients manage organ damage and avoid ICU admission or severe disease progression is of paramount importance. Photobiomodulation (PBM), based on numerous studies, may help in this regard, and the present study sought to evaluate the effects of said technology on cytokine reduction. Methods This study was conducted in the 2nd half of 2021. The current study included 52 mild-to-moderately ill COVID-19, hospitalized patients. They were divided in two groups: a Placebo group and a PBM group, treated with PBM (620-635 nm light via 8 LEDs that provide an energy density of 45.40 J/cm ² and a power density of 0.12 W/cm ² ), twice daily for three days, along with classical approved treatment. 28 patients were in Placebo group and 24 in PBM group. In both groups, blood samples were taken four times in three days and serum IL-6, IL-8, IL-10, and TNF-α levels were determined. Results During the study period, in PBM group, there was a significant decrease in serum levels of IL-6 (-82.5% +/- 4, P<0.001), IL-8 (-54.4% ± 8, P<0.001), and TNF-α (-82.4% ± 8, P<0.001), although we did not detect a significant change in IL-10 during the study. The IL-6/IL-10 Ratio also improved in PBM group. The Placebo group showed no decrease or even an increase in these parameters. There were no reported complications or sequelae due to PBM therapy throughout the study. Conclusion The major cytokines in COVID-19 pathophysiology, including IL-6, IL-8, and TNF-α, responded positively to PBM therapy and opened a new window for inhibiting and managing a cytokine storm within only 3-10 days.
... In particular, HILT has demonstrated versatility and efficacy in the treatment of different musculoskeletal diseases, and it is considered to have anti-inflammatory, anti-edema, and analgesic effects. [59,60] Sigman et al. [61] reported the first case of PBM therapy in a patient with COVID-19. All evaluation criteria improved after the patient was treated four times, including the Pneumonia Severity Index and the SMART-COP score. ...
Article
Full-text available
Photobiomodulation (PBM) therapy is a therapeutic method that can produce a range of physiological effects in cells and tissues using certain wavelengths. The reparative benefits of PBM therapy include wound healing, bone regeneration, pain reduction, and the mitigation of inflammation. Advances in the development of laser instruments, including the use of high-intensity lasers in physiotherapy, have recently led to controllable photothermal and photomechanical treatments that enable therapeutic effects to be obtained without damaging tissue. The combination of PBM therapy with acupuncture may provide new perspectives for investigating the underlying therapeutic mechanisms of acupuncture and promote its widespread application.
... A case report 194 by Sigman et al. (2020) used a combination of 808 and 905 nm PBM to treat a 57-year-old man with a severe case of 195 COVID-19 pneumonia. The patient's radiological findings, respiratory rates and oxygen requirements improved signif-196 icantly after treatment, with no need for the predicted ventilator treatment [80]. These clinical reports all support the 197 use of PBMT to treat COVID-19 and reduce the pressure on health services. ...
Article
Full-text available
Researchers from across the world are seeking to develop effective treatments for the ongoing coronavirus disease 2019 (COVID-19) outbreak, which arose as a major public health issue in 2019, and was declared a pandemic in early 2020. The pro-inflammatory cytokine storm, acute respiratory distress syndrome (ARDS), multiple-organ failure, neurological problems, and thrombosis have all been linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fatalities. The purpose of this review is to explore the rationale for using photobiomodulation therapy (PBMT) of the particular wavelength 1068 nm as a therapy for COVID-19, investigating the cellular and molecular mechanisms involved. Our findings illustrate the efficacy of PBMT 1068 nm for cytoprotection, nitric oxide (NO) release, inflammation changes, improved blood flow, and the regulation of heat shock proteins (Hsp70). We propose, therefore, that PBMT 1068 is a potentially effective and innovative approach for avoiding severe and critical illness in COVID-19 patients, although further clinical evidence is required.
... The advantages of using photobiomodulation in lung tissue can be summarized as the reduction in macrophage activation, alleviating the effect of the cytokine storm with a consequent increase in ATP, intensifying the healing process of alveolar cells [66,67]. ...
Article
The post-COVID-19 condition or ‘long COVID’ is a clinical and scientific challenge for society. In this regard, patients after COVID-19 recovery show a vast range of sequels including muscular, articular lesions, neurological, dermatological, and pulmonary issues. These clinical consequences are issues in the present and for the future. In this case, rehabilitation therapies based on photobiomodulation and combined therapies arise as excellent tools to solve it. Herein, we describe and discuss the perspectives on the use of light-based therapies such as photobiomodulation, photodynamic therapy and combined vacuum and laser therapy for rehabilitation of patients who present some sequelae of the COVID-19 infection. We did not intend to produce a comprehensive review; instead we highlight the most important and clinical protocols against these sequels. Moreover, the principles and mechanism of action of each light-based technique proposed were reported and discussed.
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Preliminary studies also show that many of the fatalities of COVID-19 are due to over-activity of the immune system, and photobiomodulation (PBM) therapy mainly accelerates wound healing and reduces pain and inflammation. Therefore, this systematic review and meta-analysis was conducted to evaluate the probable effect of the PBM therapy on the lung inflammation or ARDS and accelerate the regeneration of the damaged tissue. We systematically searched major indexing databases, including PubMed/Medline, ISI web of science (WOS), Scopus, Embase, and Cochrane central, using standard terms without any language, study region, or type restrictions. Of the 438 studies found through initial searches, 13 met the inclusion criteria. After applying the exclusion criteria, the main properties of 13 articles on 384 animals included in this meta-analysis with a wide range of species include rat (n = 10) and rabbit (n = 3). The analysis revealed that PBM therapy reduced TNFα (SMD:-3.75, 95% CI: -4.49, -3.02, P < 0.00001, I2 = 10%), IL-1β (SMD:-4.65, 95% CI: -6.15, -3.16, P < 0.00001, I2 = 62%), and IL-6 (SMD:-4.20, 95% CI: -6.42, -1.97, P = 0.0002, I2 = 88%) significantly compared with the model controls. Hence, PBM therapy increased IL-10 significantly compared with the model controls (SMD:-4.65, 95% CI: -6.15, -3.16, P < 0.00001, I2 = 62%). PBM therapy also reduced MPO activity (SMD:-2.13, 95% CI: -3.38, -0.87, P = 0.0009, I2 = 64%) and vascular permeability (SMD:-2.59, 95% CI: -4.40, -0.77, P = 0.0052, I2 = 71%) in the lung using the Evans blue extravasation technique significantly compared with the model controls. This systematic review and meta-analysis revealed that the PBM therapy does utilize beneficial anti-inflammatory effect, modulation of the immune system, lung permeability, or bronchoalveolar lavage on lung damage in both animal models and clinical studies. However, animal model and clinical studies appear limited considering the quality of the included evidences; therefore, large clinical trials are still required.
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A non-randomized 50-person case study of COVID-19 positive patients was conducted employing (for the first time) a regimen of whole-organ deep-tissue transdermal dynamic photobiomodulation (PBM) as a primary (or exclusive) therapeutic modality in the treatment of coronavirus. Therapy sessions comprised algorithmically alternating red (650 nm) and near infrared (850 nm) LEDs with average irradiance of 11 mW/cm² dynamically sequenced at multiple pulse frequencies. Delivered via 3-D bendable polymeric pads maintaining orthogonal optical incidence to body contours over 1,000 cm², a single 84-min session concurrently delivered 20 kJ to the sinuses and 15 kJ to each lung at skin temperatures below 42 °C. Therapeutic outcomes observed include significant reductions in the duration and severity of disease symptoms. Acute conditions including fever, body aches, and respiratory distress comprising paroxysmal coughing; lung congestion, dyspnea and hypoxia; sinus congestion; acute eye inflammation; and extreme malaise were eliminated in 41/50 patients within 4-days of commencing PBM treatments with 50/50 patients fully recovering within three-weeks with no supplemental oxygen requirements. SpO2 concentrations improved as much as 9 points (average 2.5 points) across the entire study population. The PBM sessions required to completely resolve COVID-19 conditions appears mono- tonically correlated to the time-to-treatment (TTTx) — the delay between the onset of a patient's symptoms and commencing PBM therapy. In contrast, acute inflammatory symptoms were resolved within 4-days irrespective of TTTx. This article is protected by copyright. All rights reserved.
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The global pandemic COVID-19 is a contagious disease and its mortality rates ranging from 1% to 5% are likely due to acute respiratory distress syndrome (ARDS), and cytokine storm. A significant proportion of patients who require intubation succumb to the disease, despite the availability of ventilators and the best treatment practices. Researchers worldwide are in search of anti-inflammatory medicines in the hope of finding a cure for COVID-19. Low-level laser therapy (LLLT) has strong, anti-inflammatory effects confirmed by meta-analyses, and it may be therapeutic to ARDS. LLLT has been used for pain management, wound healing, and other health conditions by physicians, physiotherapists, and nurses worldwide for decades. In addition, it has been used in veterinary medicine for respiratory tract disease such as pneumonia. Laser light with low-power intensity is applied to the surface of the skin to produce local and systemic effects. Based on the clinical experience, peer-reviewed studies, and solid laboratory data in experimental animal models, LLLT attenuates cytokine storm at multiple levels and reduces the major inflammatory metabolites. LLLT is a safe, effective, low-cost modality without any side-effects that may be combined with conventional treatment of ARDS. We summarize the effects of LLLT on pulmonary inflammation and we provide a protocol for augmenting medical treatment in COVID-19 patients. LLLT combined with conventional medical therapy has the potential to prevent the progression of COVID-19, minimize the length of time needed on a ventilator, enhance the healing process, and shorten recovery time. Key Words: COVID-19; ARDS; cytokine storm; low level laser therapy; anti-inflammatory; ventilator; photobiomodulation
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The recent outbreak of COVID-19, which continues to ravage communities with high death tolls and untold psychosocial and catastrophic economic consequences, is a vivid reminder of nature's capacity to defy contemporary healthcare. The pandemic calls for rapid mobilization of every potential clinical tool, including phototherapy—one of the most effective treatments used to reduce the impact of the 1918 “Spanish influenza” pandemic. This paper cites several studies showing that phototherapy has immense potential to reduce the impact of coronavirus diseases, and offers suggested ways that the healthcare industry can integrate modern light technologies in the fight against COVID-19 and other infections. The evidence shows that violet/blue (400–470 nm) light is antimicrobial against numerous bacteria, and that it accounts for Niels Ryberg Finsen's Nobel-winning treatment of tuberculosis. Further evidence shows that blue light inactivates several viruses, including the common flu coronavirus, and that in experimental animals, red and near infrared light reduce respiratory disorders, similar to those complications associated with coronavirus infection. Moreover, in patients, red light has been shown to alleviate chronic obstructive lung disease and bronchial asthma. These findings call for urgent efforts to further explore the clinical value of light, and not wait for another pandemic to serve as a reminder. The ubiquity of inexpensive light emitting lasers and light emitting diodes (LEDs), makes it relatively easy to develop safe low-cost light-based devices with the potential to reduce infections, sanitize equipment, hospital facilities, emergency care vehicles, homes, and the general environment as pilot studies have shown.
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The Brescia-COVID respiratory severity scale/algorithm is a stepwise management approach to COVID-19 patients based on clinical severity. The BCRSS was rapidly developed in Brescia, Italy, during that nation's COVID-19 crisis. The scale has not been validated or tested in other populations. The BCRSS uses patient examination features along with the need for escalating levels of respiratory support (NIV, intubation, proning) to suggest treatment recommendations. The scale simplifies the clinical summary of a patient's status, and allows clinicians to compare patients to one another and to track the trend of a patient's level of respiratory severity over time.
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Background Current COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking. Purpose To describe the time course and severity of the CXR findings of COVID-19 and correlate these with real time reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-Cov-2 nucleic acid. Materials and Methods Retrospective study of COVID-19 patients with RT-PCR confirmation and CXRs admitted across 4 hospitals evaluated between January and March 2020. Baseline and serial CXRs (total 255 CXRs) were reviewed along with RT-PCRs. Correlation with concurrent CTs (total 28 CTs) was made when available. Two radiologists scored each CXR in consensus for: consolidation, ground glass opacity (GGO), location and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score. Results There were 64 patients (26 men, mean age 56±19 years). Of these, 58, 44 and 38 patients had positive initial RT-PCR (91%, [CI: 81-96%]), abnormal baseline CXR (69%, [CI: 56-80%]) and positive initial RT-PCR with abnormal baseline CXR (59 [CI:46-71%]) respectively. Six patients (9%) showed CXR abnormalities before eventually testing positive on RT-PCR. Sensitivity of initial RT-PCR (91% [95% CI: 83-97%]) was higher than baseline CXR (69% [95% CI: 56-80%]) (p = 0.009). Radiographic (mean 6 ± 5 days) and virologic recovery (mean 8 ± 6 days) were not significantly different (p= 0.33). Consolidation was the most common finding (30/64, 47%), followed by GGO (21/64, 33%). CXR abnormalities had a peripheral (26/64, 41%) and lower zone distribution (32/64, 50%) with bilateral involvement (32/64, 50%). Pleural effusion was uncommon (2/64, 3%). The severity of CXR findings peaked at 10-12 days from the date of symptom onset. Conclusion Chest x-ray findings in COVID-19 patients frequently showed bilateral lower zone consolidation which peaked at 10-12 days from symptom onset.
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{I'm not the author or editor of this book. Just helping the editors to distribute this book to people who need it. Thanks! -- Ligen YU} Editor’s Note: Faced with an unknown virus, sharing and collaboration are the best remedy. The publication of this Handbook is one of the best ways to mark the courage and wisdom our healthcare workers have demonstrated over the past two months. Thanks to all those who have contributed to this Handbook, sharing the invaluable experience with healthcare colleagues around the world while saving the lives of patients. Thanks to the support from healthcare colleagues in China who have provided experience that inspires and motivates us. Thanks to Jack Ma Foundation for initiating this program, and to AliHealth for the technical support, making this Handbook possible to support the fight against the epidemic. The Handbook is available to everyone for free. However, due to the limited time, there might be some errors and defects. Your feedback and advice are highly welcomed! Prof. Tingbo LIANG Editor-in-Chief of the Handbook of COVID-19 Prevention and Treatment, Chairman of The First Affiliated Hospital, Zhejiang University School of Medicine
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