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.

Osteoarthritis (OA) is one of the most disabling and incapacitating diseases on the autonomy of older people, affecting their quality of life. OA produces great impact on pain, function and use of resources, being considered as an important problem of Public Health. OA is a degenerative and progressive disease without treatment nowadays. The goals in OA treatment are to ameliorate symptoms and diminish articular damage. In knee OA, there is destruction of cartilage and subchondral bone, with the consequent narrowing of articular space. Knee OA is multifactorial. Besides the bio mechanic factors, trauma and obesity; it is believed that inflammation plays an important role. Future treatments should act on the regulation of inflammation to diminish progression of OA. There is evidence on several studies and years of experience that state that Ozone acts on the modulation of inflammation. The objective of this paper is to review the main pathophysiological mechanisms involved in knee OA, and to postulate ozone as a promising and ideal conservative treatment, since it could act on several therapeutic targets, besides inflammation.

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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 clinically characterize calcifying tendonitis of the shoulder (CT) through a prospective quasi-experimental beforeand-after study, which provides a level of demonstrable evidence to support the decision-making and demonstrate the effectiveness of acetic acid iontophoresis and ultrasound in the treatment of CT. Methods: Prospective, quasi-experimental before-after intervention study was conducted on 44 patients who referred to the rehabilitation department, Santísima Trinidad's General Foundation hospital, Salamanca, from June 2014 to April 2016. Outcome measures: 1) Pain: measured by visual analogical scale (VAS); 2) calcification size: in millimetres, both measured radiologically at the beginning/end of treatment; 3) Intervention: Iontophoresis with 5% acetic acid at 4.7 mA × 10 minutes and continuous ultrasound 1 W/cm 2 /1 MHz × 5 minutes over calcification.Results: Mean age of the subjects was 54.2 years (n = 44), 65.9% female (n = 29), (95% with supraspinatus tendon (n = 38) and 5% with subscapularis (n = 2); 55% had complication in left shoulder (n = 22), 45% in right shoulder (n = 18) and 4.5% bilateral (n = 2). Regarding the occupation, 59.1% had (n = 26) administrative positions and 40.9% manual jobs (n = 18). On personal history: 34.09% were smoker (n = 15), 4.5% had diabetes (n = 2) and calcium intake secondary to osteoporosis was recorded for 2.27% (n = 1) of the subjects. Regarding radiological type: 68.18% formative (n = 30), 38.72% resorptive (n = 14) were observed. Average number of sessions was 19 and 9.01% (n = 4) of the subjects had treatment complications as intolerance/erythema/burn. Average initial pain was 7.7 points (VAS scale), significantly decreased (P = 0.0000) post treatment to 2.2. Initial average size of calcification was 10 mm and significantly decreased (P = 0.0000) post treatment to 3 mm. With respect to the change of calcification: success/cure rate was 56.8% (n = 25), improvement rate was 25% (n = 11); failure rate was 18.2% (n = 8). Conclusions: CT is common in middle-aged working females. It affects supraspinatus tendon. It is associated with smoking. Occupational risk factors are awkward positions and lifting weights. Iontophoresis with 5% acetic acid and ultrasound is a safe, simple and inexpensive technique, capable to reduce pain and calcification, with a recommended degree of scientific evidence (2B).

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.

Musculoskeletal (MSK) disorders are very prevalent in a rehabilitation setting. These disorders involve muscle, tendon, ligaments, as well as nerves, and are related to overuse due to work or sports, and degeneration due to aging. These conditions are usually diagnosed based on clinical signs and symptoms; however, a more accurate diagnosis is required. The imaging techniques for diagnosis include radiography, magnetic resonance imaging (MRI), and ultrasounds (US). In this review article, US is proposed to be an effective technique in diagnosing MSK pathologies, which, in hands of a Rehabilitation specialist, constitute a dynamic, accurate, economic, and cost-effective tool.