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Jeyaraman M, Jeyaraman N, Ramasubramanian S, Balaji S, Nallakumarasamy A, Patro BP, Migliorini F. Ozone therapy in musculoskeletal medicine: a comprehensive review. Eur J Med Res 2024; 29:398. [PMID: 39085932 PMCID: PMC11290204 DOI: 10.1186/s40001-024-01976-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/14/2024] [Indexed: 08/02/2024] Open
Abstract
Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, 600077, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, 600077, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, 600002, India
| | - Sangeetha Balaji
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, 600002, India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)-Karaikal, Puducherry, 605006, India
| | - Bishnu Prasad Patro
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy.
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Izadi M, Jafari-Oori M, Eftekhari Z, Jafari NJ, Maybodi MKE, Heydari S, Vahedian-Azimi A, Atkin SL, Jamialahmadi T, Sahebkar A. Effect of Ozone Therapy on Diabetes-related Foot Ulcer Outcomes: A Systematic Review and Meta-analysis. Curr Pharm Des 2024; 30:2152-2166. [PMID: 38982924 DOI: 10.2174/0113816128302890240521065453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/26/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE This study aimed to assess the effectiveness of ozone therapy in treating Diabetes-related Foot Ulcer (DFU) and its outcomes. METHODS A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and ProQuest databases for published studies evaluating the use of ozone as an adjunct treatment for DFU, from inception to December 21, 2022. The primary outcome measure was the change in wound size after the intervention compared to pretreatment. Secondary outcomes included time to complete ulcer healing, number of healed patients, adverse events, amputation rates, and hospital length of stay. Quantitative data synthesis for the meta-analysis was performed using a random-effects model and generic inverse variance method, while overall heterogeneity analysis was conducted using a fixed-effects model. Interstudy heterogeneity was assessed using the I2 index (>50%) and the Cochrane Q statistic test. Sensitivity analysis was performed using the leave-one-out method. RESULTS The meta-analysis included 11 studies comprising 960 patients with DFU. The results demonstrated a significant positive effect of ozone therapy on reducing foot ulcer size (Standardized Mean Difference (SMD): -25.84, 95% CI: -51.65 to -0.04, p = 0.05), shortening mean healing time (SMD: -38.59, 95% CI: -51.81 to -25.37, p < 0.001), decreasing hospital length of stay (SMD: -8.75, 95% CI: -14.81 to -2.69, p < 0.001), and reducing amputation rates (Relative Risk (RR): 0.46, 95% CI: 0.30-0.71, p < 0.001), compared to standard treatment. CONCLUSION This meta-analysis indicates that ozone therapy has additional benefits in expediting complete DFU healing, reducing the amputation rates, and decreasing hospital length of stay, though its effects do not differ from standard treatments for complete ulcer resolution. Further research is needed to address the heterogeneity among studies and to better understand the potential beneficial effects of ozone therapy.
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Affiliation(s)
- Morteza Izadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehdi Jafari-Oori
- Faculty of Nursing, Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Zohre Eftekhari
- Biotechnology Department, Pasteur Institute of Iran, Tehran, Iran
| | - Nematollah Jonaidi Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Soleyman Heydari
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Nursing Faculty, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Stephen L Atkin
- Royal College of Surgeons in Ireland-Bahrain, Adliya, Manama, Kingdom of Bahrain
| | - Tannaz Jamialahmadi
- International UNESCO Center for Health-related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Chirumbolo S, Tirelli U, Franzini M, Pandolfi S, Ricevuti G, Vaiano F, Valdenassi L. Ozone in the adjunct medical treatment. The round personality of a molecule with hormetic properties. Hum Exp Toxicol 2023; 42:9603271231218926. [PMID: 38073286 DOI: 10.1177/09603271231218926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Ozone, an allotrope of oxygen, is enjoying an increasing interest in the setting and management of the medical adjunct treatment, which is called, maybe too simplistically, "ozone therapy". Ozone is not a medicine, so the word therapy does not properly fit this gaseous molecule. Like many natural compounds, for example plant flavonoids, even ozone interacts with aryl hydrocarbon receptors (AhRs) and, at low doses, it works according to the paradoxical mechanism of hormesis, involving mitochondria (mitohormesis). Ozone, in the hormetic range, exerts cell protective functions via the Nrf2-mediated activation of the anti-oxidant system, then leading to anti-inflammatory effects, also via the triggering of low doses of 4-HNE. Moreover, its interaction with plasma and lipids forms reactive oxygen species (ROS) and lipoperoxides (LPOs), generally called ozonides, which are enabled to rule the major molecular actions of ozone in the cell. Ozone behaves as a bioregulator, by activating a wide population of reactive intermediates, which usually target mitochondria and their turnover/biogenesis, often leading to a pleiotropic spectrum of actions and behaving as a tuner of the fundamental mechanisms of survival in the cell. In this sense, ozone can be considered a novelty in the medical sciences and in the clinical approach to pharmacology and medical therapy, due to its ability to target complex regulatory systems and not simple receptors.
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Affiliation(s)
- Salvatore Chirumbolo
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | | | - Marianno Franzini
- Italian Scientific Society of Oxygen Ozone Therapy (SIOOT) and High Master School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy
| | - Sergio Pandolfi
- Italian Scientific Society of Oxygen Ozone Therapy (SIOOT) and High Master School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy
| | | | - Francesco Vaiano
- Italian Scientific Society of Oxygen Ozone Therapy (SIOOT) and High Master School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy
| | - Luigi Valdenassi
- Italian Scientific Society of Oxygen Ozone Therapy (SIOOT) and High Master School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy
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Harapan B, Harapan T. The role of ozone therapy in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19): a review. Med Gas Res 2023; 13:165-171. [PMID: 37077113 DOI: 10.4103/2045-9912.369237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has rapidly swept across the world. As new knowledge regarding treatment options for COVID-19 has emerged, the use of ozone therapy in the context of SARS-CoV-2 infection as an integrative therapeutic option supplementary to standard treatment regimen has been assessed in the present literature. We reviewed, critically analyzed, and summarized all present published literature on ozone therapy in association with COVID-19 via the PubMed database. Various reports and studies on the use of ozone (major autohemotherapy, rectal ozone insufflation, ozone inhalation) in patients affected by COVID-19 indicate that ozone therapy may reduce morbidity and accelerate recovery, while exhibiting a high safety profile with no relevant adverse effects. Current literature suggests that integrating ozone therapy into the existing standard of care and best available therapy for the treatment of COVID-19 patients offers major advantages in terms of superior clinical outcome parameters and amelioration of laboratory results. Further prospective studies are warranted to guide the next steps in the clinical application of ozone therapy and examine its impact on the course of COVID-19.
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Orlandin JR, Pinto Santos SI, Machado LC, Neto PF, Bressan FF, Godoy Pieri NC, Recchia K, de Paula Coutinho M, Ferreira Pinto PA, Santucci A, Travagli V, Ambrosio CE. Evaluation of targeted oxidative stress induced by oxygen-ozone in vitro after ischemic induction. Redox Rep 2022; 27:259-269. [DOI: 10.1080/13510002.2022.2143104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Rodrigues Orlandin
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, Siena, Italy
| | - Sarah Ingrid Pinto Santos
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | - Luciana Cristina Machado
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | - Paulo Fantinato Neto
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | - Fabiana Fernandes Bressan
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | - Naira Caroline Godoy Pieri
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | - Kaiana Recchia
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | - Meline de Paula Coutinho
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
| | | | - Annalisa Santucci
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, Siena, Italy
| | - Valter Travagli
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, Siena, Italy
| | - Carlos Eduardo Ambrosio
- Veterinary Medicine Department, Faculty of Animal Science & Food Engineering, University of San Paulo, San Paulo, Brazil
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Franzini M, Valdenassi L, Pandolfi S, Ricevuti G, Tirelli U, Vaiano F, Chirumbolo S. Comments on the optimal use of medical ozone in clinics versus the Ozone High Dose Therapy (OHT) approach. TRANSLATIONAL MEDICINE COMMUNICATIONS 2022; 7:26. [PMID: 36533116 PMCID: PMC9734312 DOI: 10.1186/s41231-022-00132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/29/2022] [Indexed: 06/01/2023]
Affiliation(s)
- Marianno Franzini
- International Scientific Society of Oxygen Ozone Therapy (SIOOT), Gorle, BG Italy
| | - Luigi Valdenassi
- International Scientific Society of Oxygen Ozone Therapy (SIOOT), Gorle, BG Italy
| | - Sergio Pandolfi
- International Scientific Society of Oxygen Ozone Therapy (SIOOT), Gorle, BG Italy
| | | | - Umberto Tirelli
- Department of Drug Science, University of Pavia, Pavia, Italy
- Tirelli Clinical Group, Pordenone, Italy
| | - Francesco Vaiano
- International Scientific Society of Oxygen Ozone Therapy (SIOOT), Gorle, BG Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, Unit of Human Anatomy, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy
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Setyo Budi D, Fahmi Rofananda I, Reza Pratama N, Sutanto H, Sukma Hariftyani A, Ratna Desita S, Zinedinita Rahmasari A, Pudy Asmarawati T, Agung Waskito L, Dyah Kencono Wungu C. Ozone as an adjuvant therapy for COVID-19: A systematic review and meta-analysis. Int Immunopharmacol 2022; 110:109014. [PMID: 35803132 PMCID: PMC9250927 DOI: 10.1016/j.intimp.2022.109014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Ozone adjuvant in COVID-19 management showed conflicting results in prior studies. Here, we aimed to comprehensively evaluate benefits and side effects of ozone as adjuvant therapy in COVID-19 patients. METHODS Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and ProQuest for articles investigating ozone as adjuvant therapy in COVID-19. Clinical and laboratory outcomes, mortality, length of hospital stay, intensive care unit (ICU) admission, and adverse events were assessed. RESULTS Thirteen studies were included in this review. Case-control studies, but not randomized controlled trials (RCTs), showed a decrease in mortality following ozone therapy (OR = 0.24 (95% CI [0.07-0.76]), p = 0.02, I2 = 0%, fixed-effect). However, ozone therapy did not improve the length of hospital stay (SMD = -0.99 (95 %CI -2.44 to 0.45), p = 0.18, I2 = 84%, random-effects) and ICU admission (RR = 0.57 (95 %CI [0.05-6.71]), I2 = 73%, p = 0.65, random-effects). Consecutive case control studies suggested that ozone therapy significantly improved levels of D-dimer (p = 0.0060), lactate dehydrogenase (LDH; p = 0.0209), C-reactive protein (CRP; p = 0.0040) and interleukin (IL)-6 (p = 0.0048) as compared to standard therapy alone. CONCLUSIONS The beneficial effect of ozone in COVID-19 management seems to be limited to the improvements of laboratory parameters among severe patients, including the reduction of IL-6, LDH, CRP, and D-dimer levels. Meanwhile, other study endpoints, such as mortality, length of stay and ICU admission, were not improved following ozone therapy, although it may partly be due to a shorter duration of viral clearance. Furthermore, no serious adverse event was reported following ozone therapy, suggesting its high safety profile. (PROSPERO ID: CRD42021278018).
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Affiliation(s)
| | | | | | - Henry Sutanto
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands,Department of Physiology and Pharmacology, State University of New York (SUNY) Downstate Health Sciences University, NY, USA
| | | | | | | | - Tri Pudy Asmarawati
- Department of Internal medicine, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Langgeng Agung Waskito
- Department of Internal medicine, Faculty of Medicine, Universitas Airlangga, Indonesia,Institute of Tropical Disease, Universitas Airlangga, Indonesia,Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Institute of Tropical Disease, Universitas Airlangga, Indonesia; Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Indonesia.
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Pasek J, Szajkowski S, Cieślar G. Local Ozone Therapy in Complex Treatment of Venous Leg Ulcers: Ozone therapy for venous leg ulcers. INT J LOW EXTR WOUND 2022:15347346221104611. [PMID: 35637162 DOI: 10.1177/15347346221104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A significant health problem in many countries of the world is the occurrence of hard to heal leg ulcers. In recent years modern methods of physical medicine in comprehensive treatment have been used often including ozone therapy. The study included 54 patients, 25 male and 29 female in age between 39 and 87 years (mean age: 66.7 ± 11.9 years) with venous leg ulcers who underwent a cycle of local ozone therapy. The progress in wound healing was evaluated by computerized planimetry and pain intensity was assessed with use a visual analog scale (VAS) . As a result of the applied local ozone therapy a statistically significant reduction of the ulcer area was achieved from median 7.1 (5.6-9.4) cm2 to 4.4 (3-7) cm2 (P = .000001), which was on median 38.74 (27.27-51.42)% compared to the baseline values before the start of the therapy. In 2 patients (3.7%) the ulcers were completely healed. 18 patients (33.3%) achieved a reduction in ulcer area of more than 50% of the baseline value and the remaining 34 patients (63%) also achieved a reduction in ulcer area. A statistically significant in the percentage of surface area was observed in the group of 19 patients suffering from > 5 years of age compared to the group of 35 patients suffering from ≤5 years (median 50 (32.03-67.16)% versus 33.96 (23.71-45); P = .033178), while percentage changes in ulcer surface area did not differ significantly between all other subgroups of patients. There was also a statistically significant reduction in the intensity of pain in VAS scale in all patients, median 6 (5-7) points before treatment versus 4.4 (3-7) points after treatment, P = .000001). Local ozone therapy of venous leg ulcers accelerate the healing process of ulcers in objective planimetric assessment and reduce the intensity of pain ailments.
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Affiliation(s)
- Jarosław Pasek
- Faculty of Health Sciences, Jan Długosz University in Częstochowa, Częstochowa, Poland
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
| | - Sebastian Szajkowski
- Department of Osteopathic Medicine, Department of Physiotherapy, Medical University of Mazovia in Warsaw, Warszawa, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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Complementary and Alternative Therapies in Oncology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095071. [PMID: 35564468 PMCID: PMC9104744 DOI: 10.3390/ijerph19095071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Cancer is the second leading cause of death worldwide, after cardiovascular diseases. Increasing patients’ awareness and providing easier access to public information result in greater interest in alternative anticancer or unproven supportive therapies. Fear of cancer and limited trust in the treating physician are also important reasons leading patients to seek these methods. Trust and good communication are essential to achieving truthful collaboration between physicians and patients. Given the popularity of CAM, better knowledge about these alternative practices may help oncologists discuss this issue with their patients. This article objectively reviews the most common unconventional therapies used by cancer patients.
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