To date, there is no definitive treatment for the new SARS-CoV-2 pandemic. Three evolutionary stages in SARS-CoV-2 infection are recognized (early infection, pulmonary phase, and systemic hyper inflammation), with characteristic clinical signs and symptoms. There are 80 international experimental trials underway seeking effective treatment for the COVID-19 pandemic. Of these, there are only three that consider ozone therapy (major auto hemotherapy) as an alternative option. There is no study that evaluates rectal ozone insufflation, despite being a safe, cheap, risk-free technique. That technique is a systemic route of ozone administration (95-96%) and that could be extrapolated to the use of SARS-CoV-2, given the excellent results observed in the management of Ebola. Ozone has four proven biological properties that could allow its use as an alternative therapy in the different phases of SARS-CoV-2 infection. Ozone could inactivate the virus by direct (O3) or indirect oxidation (ROS and LOPs) and could stimulate the cellular and humoral immune systems, being useful in the early COVID-19 infection phase (stages 1 and 2a). Ozone improves gas exchange, reduces inflammation, and modulates the antioxidant system, so it would be useful in the hyper inflammation or "cytokine storm" phase, and in the hypoxemia and/or multi-organ failure phase (stage 2b and stage 3). Given the current pandemic, it is urgent to carry out an experimental study that confirms or rules out the biological properties of ozone and thus allows it to be an alternative or compassionate therapy for the effective management of SARS-Cov-2 infection. The Ethical Committee at our Hospital has authorized the use of this technique for compassionate management of SARS-CoV-2 infection, considering the four biological Ozone properties exposed previously.

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The aim of this study is to evaluate the effectiveness of rectal ozone (O 3) in COVID-19 patients with severe pneumonia admitted at Hospital Universitario Santa Cristina, Madrid. In a before-and-after study, four patients admitted with severe bilateral pneumonia due to COVID-19 were treated with rectal ozone and confirmed with (+) RT-PCR for SARS-CoV-2 and evaluated afterwards. The analyzed outcome variables were as follows: (a) clinical improvement (O 2 saturation and O 2 supply); (b) biochemical improvement (fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP); (c) radiological improvement. The treatment protocol consisted of 5 sessions (1 session/day) of intra-rectal ozone, applied in a volume of 100 mL and a concentration of 35 μg/mL. The Protocol was previously approved by the Hospital's Health Care Ethics Committee (CEAS) (Report 15/4/2020) for compassionate use in the face of this exceptional pandemic situation, and prior informed consent was obtained from the patient/legal representative. The patients improved oxygen saturation, as observed by the lower number of desaturations and the lower supply of O 2. Biomarkers of inflammation decreased (fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP). Finally, the radiological signs of bilateral viral pneumonitis improved between 1 and 2 grades based on Taylor's radiological scale. Rectal ozone decreases O 2 supply and improves O 2 saturation, decreases inflammation biomarkers, and improves Taylor's radiological grade in patients with severe COVID-19 pneumonia. Rectal ozone is a safe, effective, cheap, and simple alternative capable of acting on the SARS-CoV-2 virus, and it is presented as an adjunctive therapeutic option to consider in the management of severe bilateral COVID-19 pneumonia.

Objectives: To evaluate the effect of Ozone on pain, function, quality of life, minimal joint space and knee arthroplasty delay in a case series of patients with knee osteoarthritis (OA). Methods:Prospective quasi-experimental before-after study on 52 out of 120 patients with knee osteoarthritis (OA) Kellgren-Lawrence (K-L) grade 2 or more, who attended Santa Cristina's University Hospital, from January 2012 to June 2016. The Ozone protocol consisted of four sessions (1 session/week) of an intra-articular infiltration of a medical mixture of oxygen-ozone (95% -5%) at a 20 µg/mL concentration. Pain and quality of life (QoL) were measured by visual analogical scale (VAS) and western ontario and Mc master universities index for osteoarthritis (WOMAC), and minimal internal/external joint space width were measured by plain posterior-anterior weight-bearing knee radiographies at the beginning / end of treatment.Results: Mean age 70.36 years. Women 80.8% (n = 42), men 19.2% (n = 10). The severity of OA according to Kellgren-Lawrence scale was 3°(n = 36; 69.2%). Pain measured by VAS significantly decreased (P < 0.0001) from 8.1 to 2.5. The WOMAC-pain, WOMAC-stiffness and WOMAC-function subscales decreased significantly (P < 0.0001) from 16.5 to 4.9 points, 3.2 to 2 and 48 to 17.6, respectively. With respect to minimal joint space, the internal compartment measured 4.17 mm and increased significantly to 4.44 mm (P = 0.0003); while the external compartment was 6.02 mm and improved significantly to 6.26 mm (P = 0.0032) after the treatment protocol. After a mean of 10 months follow-up to a maximum of 28 months, none of knee OA patients underwent knee arthroplasty replacement. Conclusions:Ozone treatment is capable of producing pain relief, recovery of function and radiological improvement on minimal joint space in knee OA patients. Based on the results of our study, it is assumed that Ozone could slow/revert OA progression, due to the increase in the minimal internal and external joint space width. Ozone treatment delays the need for total knee arthroplasty.