The evaluation of new therapeutic resources against coronavirus disease 2019 (COVID‐19) represents a priority in clinical research considering the minimal options currently available. To evaluate the adjuvant use of systemic oxygen‐ozone administration in the early control of disease progression in patients with COVID‐19 pneumonia. PROBIOZOVID is an ongoing, interventional, randomized, prospective, and double‐arm trial enrolling patient with COVID‐19 pneumonia. From a total of 85 patients screened, 28 were recruited. Patients were randomly divided into ozone‐autohemotherapy group (14) and control group (14). The procedure consisted in a daily double‐treatment with systemic Oxygen–ozone administration for 7 days. All patients were treated with ad interim best available therapy. The primary outcome was delta in the number of patients requiring orotracheal‐intubation despite treatment. Secondary outcome was the difference of mortality between the two groups. Moreover, hematological parameters were compared before and after treatment. No differences in the characteristics between groups were observed at baseline. As a preliminary report we have observed that one patient for each group needed intubation and was transferred to ITU. No deaths were observed at 7–14 days of follow up. Thirty‐day mortality was 8.3% for ozone group and 10% for controls. Ozone therapy did not significantly influence inflammation markers, hematology profile, and lymphocyte subpopulations of patients treated. Ozone therapy had an impact on the need for the ventilatory support, although did not reach statistical significance. Finally, no adverse events related to the use of ozone‐autohemotherapy were reported. Preliminary results, although not showing statistically significant benefits of ozone on COVID‐19, did not report any toxicity.

This pilot study found that treatment with sildenafil reduced pulmonary vascular resistance and improved the BODE index and quality of life, without a significant effect on gas exchange.

P ulmonary hypertension (PH) is a hemodynamic and pathophysiological state defined as increased mean pulmonary artery pressure ≥25 mm Hg at rest (assessed by right heart catheterization [RHC]).1 PH can be precapillary (pulmonary wedge pressure ≤15 mm Hg, normal or reduced cardiac output) where the changes occur in the pulmonary arterial circulation or postcapillary (pulmonary wedge pressure >15 mm Hg) where the left ventricle (LV) or the mitral valve is likely to be involved. Clinical Perspective on p 114In precapillary PH, increased pressure in the pulmonary arteries overloads the right ventricle (RV), causing hypertrophy and failure. [2][3][4] Most measures that predict survival in PH relate directly to RV function (eg, right atrial pressure and cardiac index) or correlate with measures related to RV function (eg, exercise capacity and functional class [FC]).5-7 Until recently, little was known about the RV; however, improved imaging techniques have allowed prognostic factors beyond the traditional variables of 6-minute walk distance (6MWD) and FC to be studied to identify factors more directly linked to RV function.During the past 2 decades, several treatments targeting the pathophysiological mechanisms of pulmonary arterial hypertension (PAH) have been introduced.

Our results underline the relevance of early microvascular assessment in patients at risk of developing a severe complication such as PAH that can amplify the systemic microvascular impairment in SSc. More severe NVC abnormalities should lead to strict cardiopulmonary surveillance and a complete NVC study is indicated.