SARS-CoV-2: Can sunlight exposure reduce the risk of developing severe consequences of COVID-19?

Herein it is proposed that sufficient exposure to sunlight (UVB) modulates host gene expression, offering protection against severe consequences of COVID-19. This could be in addition to sunlight (UVB)-mediated protection by directly inactivating the virus and limiting the viral load. It is suggested that inhibition of CCR2, DPP9, HSPA1L, IFNAR2, OAS1, and TYK2 may, in part, explain UVB-mediated protection against severe consequences of COVID-19.

Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.

BACKGROUND: Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia. OBJECTIVES: To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. We updated the searches on 1 June 2020. SELECTION CRITERIA: We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age. DATA COLLECTION AND ANALYSIS: We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death. MAIN RESULTS: We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two. Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] -0.14, 95% CI -0.22 to -0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] -2.20 days, 95% CI -2.60 to -1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD -0.04, -0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence). Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI -0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI -0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI -0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes. Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI -0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies.

Accurate surface ultraviolet radiation forecasting for clinical applications with deep neural network.

Exposure to appropriate doses of UV radiation provides enormously health and medical treatment benefits including psoriasis. Typical hospital-based phototherapy cabinets contain a bunch of artificial lamps, either broad-band (main emission spectrum 280-360 nm, maximum 320 nm), or narrow-band UV B irradiation (main emission spectrum 310-315 nm, maximum 311 nm). For patients who cannot access phototherapy centers, sunbathing, or heliotherapy, can be a safe and effective treatment alternative. However, as sunlight contains the full range of UV radiation (290-400 nm), careful sunbathing supervised by photodermatologist based on accurate UV radiation forecast is vital to minimize potential adverse effects. Here, using 10-year UV radiation data collected at Nakhon Pathom, Thailand, we developed a deep learning model for UV radiation prediction which achieves around 10% error for 24-h forecast and 13-16% error for 7-day up to 4-week forecast. Our approach can be extended to UV data from different geographical regions as well as various biological action spectra. This will become one of the key tools for developing national heliotherapy protocol in Thailand. Our model has been made available at https://github.com/cmb-chula/SurfUVNet .

Light as a potential treatment for pandemic coronavirus infections: A perspective.

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.

«98% Anti UV¼ ou bronzeamento natural: novas técnicas ecológicas do corpo? / «98% Anti UV¼ or natural bronze: new ecological techniques of the body?

Neste ensaio refletimos sobre o corpo e sua aparência, considerando-se o contato com o sol, as práticas de proteção solar e as técnicas de bronzeamento. De um lado, os investimentos em torno da proteção contra os raios ultravioletas, não apenas com a proteção de cremes solares, mas de roupas que prometem proteção de 98% da superfície coberta. De outro lado, o bronzeamento natural feito na praia ou em clínicas especializadas. Essas técnicas e práticas aportam elementos para nossa reflexão sobre a ecologia corporal ao nos permitir pensar a respeito da relação entre o corpo íntimo e social, as aparências, o desejo, as significações sociais construídas pela medicina, cosmetologia e pelo lazer.

In this paper we reflect on the body and its appearance, considering the contact with the sun and the tanning and protection practices. On the one hand, investments around protection against ultraviolet rays, not only with the protection of solar creams, but with clothes that promise protection of 98% of the surface covered. On the other hand, the natural tanning done in specialized clinics. These practices provide elements for our reflection on body ecology by allowing us to think about the relationship between the intimate and social body, appearances, desire, social meanings built by medicine, cosmetology and leisure.

Does sunlight protect us from cancer?

The Ultraviolet (UV) radiation contained in sunlight is a powerful mutagen and immune suppressant which partly explains why exposure to solar UV is the biggest risk factor for the development of cutaneous tumours. Evidence is building that sunlight may be protective against some internal malignancies. Because patients with these tumours are often vitamin D deficient, this has led some to propose that vitamin D supplementation will be beneficial in the treatment of these cancers. However, the results from already completed trials have been disappointing which has given weight to the argument that there must be something else about sunlight that explains its cancer-protecting properties.

A brief report on the history of phototherapy.

From ancient times, light has played a significant role in the treatment of diseases. The modern discoveries (eg, ultraviolet radiation) and modern inventions (eg, the electric generator or the electric lightbulb), as well as balneologic experiences of the treatment with sunlight, contributed to the transition from heliotherapy to artificial light phototherapy at the end of the 19th century. Nils Ryberg Finsen (1860-1904) was the founder of modern phototherapy. He is famous for applying an electric carbon arc torch in treating patients with lupus vulgaris using ultraviolet radiation. Subsequently, phototherapy using artificial light sources gained importance in the treatment of skin diseases with a noninfectious etiology. William Henry Goeckerman (1884-1954) chose an ultraviolet B light to treat psoriasis. Improvement in the effectiveness of dermatologic phototherapy occurred in 1947, when methoxypsoralen was isolated. During the 20th century, phototherapy was applied to new therapeutic areas, such as neonatology, psychiatry, and ophthalmology.

Ultraviolet B radiation therapy for psoriasis: Pursuing the optimal regime.

Psoriasis is a chronic and common disease mediated by resident memory T cells that negatively affects a broad range of people worldwide. One of the oldest and most commonly used treatments is phototherapy. We reviewed the existing literature on the four main ultraviolet B (UVB) modalities of phototherapy in the management of psoriasis: heliotherapy, broadband UVB, narrowband UVB, and excimer laser and lamp. Despite the many studies done on these therapies, there is significant variation in their prescription and use. Phototherapy remains one of the most effective and safest treatments for psoriasis. We provide an updated comprehensive overview of UVB phototherapy for psoriasis to help physicians optimize their choice of modality and dosing regimen to ensure optimal outcomes for psoriasis patients. © 2016 Elsevier Inc. All rights reserved.

Photodynamic Therapy for Actinic Keratoses: A Randomized Prospective Non-sponsored Cost-effectiveness Study of Daylight-mediated Treatment Compared with Light-emitting Diode Treatment.

Daylight-mediated photodynamic therapy (DL-PDT) is considered as effective as conventional PDT using artificial light (light-emitting diode (LED)-PDT) for treatment of actinic keratoses (AK). This randomized prospective non-sponsored study assessed the cost-effectiveness of DL-PDT compared with LED-PDT. Seventy patients with 210 AKs were randomized to DL-PDT or LED-PDT groups. Effectiveness was assessed at 6 months. The costs included societal costs and private costs, including the time patients spent in treatment. Results are presented as incremental cost-effectiveness ratio (ICER). The total costs per patient were significantly lower for DL-PDT (€132) compared with LED-PDT (€170), giving a cost saving of €38 (p = 0.022). The estimated probabilities for patients' complete response were 0.429 for DL-PDT and 0.686 for LED-PDT; a difference in probability of being healed of 0.257. ICER showed a monetary gain of €147 per unit of effectiveness lost. DL-PDT is less costly and less effective than LED-PDT. In terms of cost-effectiveness analysis, DL-PDT provides lower value for money compared with LED-PDT.

Vitamin D and atopic dermatitis in childhood.

Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD.

Can skin exposure to sunlight prevent liver inflammation?

Liver inflammation contributes towards the pathology of non-alcoholic fatty liver disease (NAFLD). Here we discuss how skin exposure to sunlight may suppress liver inflammation and the severity of NAFLD. Following exposure to sunlight-derived ultraviolet radiation (UVR), the skin releases anti-inflammatory mediators such as vitamin D and nitric oxide. Animal modeling studies suggest that exposure to UVR can prevent the development of NAFLD. Association studies also support a negative link between circulating 25-hydroxyvitamin D and NAFLD incidence or severity. Clinical trials are in their infancy and are yet to demonstrate a clear beneficial effect of vitamin D supplementation. There are a number of potentially interdependent mechanisms whereby vitamin D could dampen liver inflammation, by inhibiting hepatocyte apoptosis and liver fibrosis, modulating the gut microbiome and through altered production and transport of bile acids. While there has been a focus on vitamin D, other mediators induced by sun exposure, such as nitric oxide may also play important roles in curtailing liver inflammation.

Comparing the effects of sun exposure and vitamin D supplementation on vitamin D insufficiency, and immune and cardio-metabolic function: the Sun Exposure and Vitamin D Supplementation (SEDS) Study.

BACKGROUND: Adults living in the sunny Australian climate are at high risk of skin cancer, but vitamin D deficiency (defined here as a serum 25-hydroxyvitamin D (25(OH)D) concentration of less than 50 nmol/L) is also common. Vitamin D deficiency may be a risk factor for a range of diseases. However, the optimal strategies to achieve and maintain vitamin D adequacy (sun exposure, vitamin D supplementation or both), and whether sun exposure itself has benefits over and above initiating synthesis of vitamin D, remain unclear. The Sun Exposure and Vitamin D Supplementation (SEDS) Study aims to compare the effectiveness of sun exposure and vitamin D supplementation for the management of vitamin D insufficiency, and to test whether these management strategies differentially affect markers of immune and cardio-metabolic function. METHODS/DESIGN: The SEDS Study is a multi-centre, randomised controlled trial of two different daily doses of vitamin D supplementation, and placebo, in conjunction with guidance on two different patterns of sun exposure. Participants recruited from across Australia are aged 18-64 years and have a recent vitamin D test result showing a serum 25(OH)D level of 40-60 nmol/L. DISCUSSION: This paper discusses the rationale behind the study design, and considers the challenges but necessity of data collection within a non-institutionalised adult population, in order to address the study aims. We also discuss the challenges of participant recruitment and retention, ongoing engagement of referring medical practitioners and address issues of compliance and participant retention. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry: ACTRN12613000290796 Registered 14 March 2013.

Perspectives of the antipsoriatic heliotherapy in Poland.

Statistical analysis of the daily course of exposures to TL-01 tube radiation for 93 psoriatic patients from the Medical University of Lódz during 20-day phototherapy shows that the dose of 1 J/cm(2) represents a unit of single exposure necessary for psoriasis healing. This value is converted to the antipsoriatic effective dose of 317.9 J/m(2) using the TL-01 lamp irradiance spectrum and the antipsoriatic action spectrum. It is proposed that the daily exposure of 317.9 J/m(2) serves as the standard antipsoriatic dose (SAPD) providing a link between the cabinet and the out-door exposures and it could be used for planning heliotherapy in Poland. A model is proposed to calculate ambient antipsoriatic doses for 3 h exposures around the local noon (9 am-12 am GMT) based on satellite measurements of ozone and cloud characteristics. The model constants are determined by a comparison with pertaining antipsoriatic doses measured by the Brewer spectrophotometer in central Poland. It is found that 3 h exposures to solar radiation in the period 15 May-15 September provides the mean (2005-2013) doses in the range 2.7-3.1 SAPD over Poland. Thus, heliotherapy could be treated as an alternative to the cabinet phototherapy for almost 4 months. It seems that the most effective site for antipsoriatic heliotherapy is the south/east part of Poland (the Bieszczady Mountains). The heliotherapy could be carried out in existing national health centers equipped with the standard easy-to-use biometers for on-line monitoring of UV level and controlling duration of sunbathing to avoid erythema risks. It is even possible to control the antipsoriatic heliotherapy by a patient himself, using low-cost hand-held instruments measuring UV index.

Space-based estimation of the solar UV-B doses for psoriasis heliotherapy in Poland using OMI data for the period 2005-2011.

A UV model is proposed to reconstruct the biologically weighted doses at the ground-level, erythemal, vitamin D(3), and antipsoriatic effective doses, based on the space data from the Ozone Monitoring Instrument on board of NASA EOS Aura spacecraft for the period 2005-2011. The model is training using the results of spectral UV measurements carried out at Belsk, Poland. The model outcome is verified using the UV spectra measured at Hradec Kralove, Czech Republic. The model uncertainty is almost the same for all examined action spectra and comparable to that found in earlier studies on differences between the satellite overpasses and ground-based erythemal data. Antipsoriatic doses, taken during 2h exposure periods near local noon, are reconstructed for selected sites in Poland to find if heliotherapy would be an alternative to standard treatment of psoriasis by tube irradiation in medical cabinets. Mountain-resort in the southern Poland, Zakopane, and rural-site in Central Poland, Belsk, are among the best location of potential heliotherapy centers in Poland for late spring/summer season. Leba, resort on the Baltic Sea coast, is a potential heliotherapy center in June and July. The methodology to disclose possible heliotherapy periods over the territory of Poland could be extended to any region. It would help to prepare an optimal schedule of antipsoriatic heliotherapy that accounts for local weather conditions and medical standards of using UV cabinets.

Analyzing UV-B narrowband solar irradiance: comparison with erythemal and vitamin D production irradiances.

The heliotherapy and the phototherapy are mainly focused on taking benefit of the therapeutic effects of the ultraviolet (UV) irradiance on different skin diseases. The use of UV-B narrowband lamps, with emissions centered at 311 nm, has spread out among the dermatologist community because of its high therapeutic effect in comparison with its low erythema dose. For cloudless sun exposure, the balance of solar erythemal and solar narrowband (NB)-equivalent irradiances depends on several factors such as the solar zenith angle (SZA), the total ozone column (TOC) and the altitude. For SZA below 55°, the ratio of solar UV-B narrowband and erythemal irradiances increases with the SZA whereas the ratio of vitamin D production and erythemal irradiances decreases with the SZA with the maximum around midday. Furthermore, the solar NB ratio also increases with the TOC because the shorter wavelengths of the erythemal action spectrum are more affected by the ozone absorption processes. Considering the daily variations of the ratio between narrowband and erythemal irradiance, sun exposures avoiding midday hours are recommended in order to prevent negative side-effects. However to accumulate great NB doses and sufficient vitamin D in winter months is difficult because the time exposures may be longer than the day duration.

Effectiveness of heliotherapy for psoriasis clearance in low and mid-latitudinal regions: a theoretical approach.

The action spectrum for psoriasis clearance is reconstructed taking into account the results obtained in the early 1980s. The antipsoriatic action spectrum is used for weighting the medical cabinet UV spectra, and the solar spectra measured in San Diego (USA) and Belsk (Poland). The mean cumulative antipsoriatic effective dose of 450 mJ cm(-2), due to TL-01 (UVB narrowband) tubes, is taken by a patient with skin phototype II during routine 20 phototherapy sessions carried out in a phototherapy cabinet in the Medical University of Lódz. Thus, the daily mean dose of value 22.5 mJ cm(-2) is proposed as the threshold for daily solar dose for numbers of out-door exposures to clear psoriasis. We assume that the heliotherapy will last a whole month with every day 2h exposition to the direct sunlight around local noon. The heliotherapy will be successful if weather conditions permit at least 20 days with the daily exposure over the threshold. The minimum cumulative ambient erythemal dose, necessary for psoriasis clearance, is estimated as 144 standard erythema dose (SED) for the whole heliotherapy period. We find that heliotherapy could be effectively used in March through October (San Diego) and in June through August (Belsk). Thus, the heliotherapy against psoriasis is possible not only at southern resorts but even at the mid-latitude sites.

Ponto de corte para adequação da concentração sérica de 25 hidroxivitamina D em adultos e idosos: estudo de base populacional - ISA-Capital / Cutoff or adequacy of serum 25-hydroxyvitamin D in adults and elderly populationbased study ISA-Capital

Introdução - A concentração sérica de vitamina D pode variar em indivíduos de diferentes grupos etários e de diversas regiões geográficas e pode ser influenciada pela exposição solar, estação do ano, bem como pelos valores de IMC e paratormônio (PTH). A classificação utilizada para definir concentração sérica adequada de vitamina D refere valores de 25(OH)D acima de 30 ng/mL. Porém, essa classificação pode estar inapropriada para a população brasileira, devido às particularidades climáticas e alimentares. Objetivo - Verificar as concentrações séricas médias de 25(OH)D e PTH e sua relação com IMC, exposição solar e estação do ano e identificar os valores de corte da 25(OH)D associados à elevação do paratormônio (PTH) em adultos e idosos de amostra representativa da população do município de São Paulo. Métodos - Para esta dissertação foi desenvolvido um artigo original. O artigo original descreve o estudo transversal realizado com indivíduos do estudo ISA-Capital, estudo multicêntrico e de base populacional, onde foram investigados 589 indivíduos, de ambos os sexos, dos grupos etários: 20 a 59 (adultos) e 60 e mais (idosos). Foram coletadas amostras de sangue, para dosagens de 25(OH)D e PTH. Os indivíduos que aceitaram participar da coleta de sangue, também responderam um questionário sobre exposição solar. A análise estatística incluiu a curva ROC, testes t de Student, correlação e ANOVA. Os cálculos foram realizados pelo software SPSS versão 17.0. e p 0,05 foi considerado significante. Resultados - No artigo original observou-se idade média de 54,83 (19,21) anos, sendo 61,3 por cento do sexo feminino e 38,7 por cento do sexo masculino. A concentração sérica média de 25(OH)D foi 50,02 (22,69) ng/mL, já entre os grupos foi de 47,48 (23,03) (adultos) e 52,68 (22,06) ng/mL (idosos) havendo diferença significativa entre eles (p=0,005). Observou-se variação sazonal da concentração sérica de 25(OH)D e correlação positiva entre 25(OH)D e IMC (r = 0,114, p = 0,006)...