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.

El día 16 de noviembre 2012 se celebró en Madrid esta Jornada organizada por el Grupo de Opioides de la Sociedad Española del Dolor, con la coordinación de la Dra. Dolores Rodrigo.La Jornada comenzó con una mesa redonda dedicada a la perspectiva actual del uso de los opioides, con intervenciones acerca de la diferenciación farmacocinética y clínica de los diferentes opioides, así como las claves de las interacciones farmacológicas, por parte del Prof. Cecilio Álamo.El tema siempre controvertido del uso de los opioides en el dolor crónico no oncológico, presentado por el Dr. Robaina, seguido de una revisión exhaustiva de los aspectos legales relacionados, por el Dr. Manuel G. Nart, y la coordinación entre la atención primaria y la asistencia especializada, presentado por la Dra. Francisca García Martínez.La revisión de los efectos secundarios de los opioides, junto con las recomendaciones para su prevención en la clínica, fue presentada por la Dra. Luz Cánovas y el Dr. Manuel López.La mañana finalizó con un mano a mano entre dos especialistas en dolor, el Dr. Cruciani y el Dr. De Andrés, que defendieron dos tesis opuestas, la utilización de los opioides en el dolor irruptivo no oncológico o exclusivamente en dolor oncológico. El Dr. Javier de Andrés nos sorprendió con una presentación original que captó la atención, con imágenes alusivas del 7.º arte y con una excelente base científica.La tarde estuvo dedicada a la presentación y discusión de casos clínicos, centrados en el dolor no oncológico por parte del Dr. Margarit y del Dr. Vara y en dolor oncológico, presentados por la Dra. M.ª Pilar y la Dra. Adela Fauli.Este tipo de foros científicos especializados permiten la presentación y discusión entre las diferentes publicaciones y experiencias personales que enriquecen y orientan la práctica diaria.

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