Effects of low concentrations of ozone gas exposure on percutaneous oxygen saturation and inflammatory responses in a mouse model of Dermatophagoides farinae-induced asthma.

Ozone gas is widely used in hospitals as well as homes to control COVID-19 infection owing to its cost-effectiveness. Safety standard value and the tolerable value of ozone gas are set at 0.05 ppm and 0.1 ppm, respectively, in developed countries; however, this value was principally determined for healthy individuals, and the risks associated with ozone gas inhalation in patients with pulmonary diseases remains unknown. Recently, we demonstrated that 0.1 ppm ozone gas exposure significantly aggravates the symptoms of acute lung injury in mice. In the present study, we further examined the influence of ≤ 0.1 ppm ozone gas exposure on percutaneous oxygen saturation (SpO2) and pro-inflammatory responses in a mouse model of asthma. Female BALB/c mice were subjected to repetitive intranasal sensitization of Dermatophagoides farinae to generate a mouse model of asthma. Inhalation exposure of ozone gas (0.1, 0.03, 0.01 ppm), generated using an ultraviolet lamp, was performed for five consecutive days immediately before the final sacrifice. There were no abnormal findings in control mice exposed to 0.1 ppm ozone; however, 0.1 ppm ozone exposure significantly reduced the SpO2 level in asthmatic mice. Histological evaluation and gene expression analysis revealed that pro-inflammatory cytokine levels were significantly increased in mice exposed to 0.1 ppm ozone, indicating that 0.1 ppm ozone exposure affects the development of asthma symptoms. Notably, 0.03 and 0.01 ppm ozone exposure did not have any effects even in asthmatic mice. Our findings indicate that the tolerable level of ozone gas should be adjusted for individuals based on a history of respiratory disorders.

Reduction of severe acute respiratory syndrome coronavirus-2 infectivity by admissible concentration of ozone gas and water.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the global coronavirus disease 2019 (COVID-19) pandemic. Because complete elimination of SARS-CoV-2 appears difficult, decreasing the risk of transmission is important. Treatment with 0.1 and 0.05 ppm ozone gas for 10 and 20 hr, respectively, decreased SARS-CoV-2 infectivity by about 95%. The magnitude of the effect was dependent on humidity. Treatment with 1 and 2 mg/L ozone water for 10 s reduced SARS-CoV-2 infectivity by about 2 and 3 logs, respectively. Our results suggest that low-dose ozone, in the form of gas and water, is effective against SARS-CoV-2.

Vaporized Hydrogen Peroxide and Ozone Gas Synergistically Reduce Prion Infectivity on Stainless Steel Wire.

Prions are infectious agents causing prion diseases, which include Creutzfeldt-Jakob disease (CJD) in humans. Several cases have been reported to be transmitted through medical instruments that were used for preclinical CJD patients, raising public health concerns on iatrogenic transmissions of the disease. Since preclinical CJD patients are currently difficult to identify, medical instruments need to be adequately sterilized so as not to transmit the disease. In this study, we investigated the sterilizing activity of two oxidizing agents, ozone gas and vaporized hydrogen peroxide, against prions fixed on stainless steel wires using a mouse bioassay. Mice intracerebrally implanted with prion-contaminated stainless steel wires treated with ozone gas or vaporized hydrogen peroxide developed prion disease later than those implanted with control prion-contaminated stainless steel wires, indicating that ozone gas and vaporized hydrogen peroxide could reduce prion infectivity on wires. Incubation times were further elongated in mice implanted with prion-contaminated stainless steel wires treated with ozone gas-mixed vaporized hydrogen peroxide, indicating that ozone gas mixed with vaporized hydrogen peroxide reduces prions on these wires more potently than ozone gas or vaporized hydrogen peroxide. These results suggest that ozone gas mixed with vaporized hydrogen peroxide might be more useful for prion sterilization than ozone gas or vaporized hydrogen peroxide alone.

Application of ozone for degradation of mycotoxins in food: A review.

Mycotoxins such as aflatoxins (AFs), ochratoxin A (OTA) fumonisins (FMN), deoxynivalenol (DON), zearalenone (ZEN), and patulin are stable at regular food process practices. Ozone (O3 ) is a strong oxidizer and generally considered as a safe antimicrobial agent in food industries. Ozone disrupts fungal cells through oxidizing sulfhydryl and amino acid groups of enzymes or attacks the polyunsaturated fatty acids of the cell wall. Fusarium is the most sensitive mycotoxigenic fungi to ozonation followed by Aspergillus and Penicillium. Studies have shown complete inactivation of Fusarium and Aspergillus by O3 gas. Spore germination and toxin production have also been reduced after ozone fumigation. Both naturally and artificially, mycotoxin-contaminated samples have shown significant mycotoxin reduction after ozonation. Although the mechanism of detoxification is not very clear for some mycotoxins, it is believed that ozone reacts with the functional groups in the mycotoxin molecules, changes their molecular structures, and forms products with lower molecular weight, less double bonds, and less toxicity. Although some minor physicochemical changes were observed in some ozone-treated foods, these changes may or may not affect the use of the ozonated product depending on the further application of it. The effectiveness of the ozonation process depends on the exposure time, ozone concentration, temperature, moisture content of the product, and relative humidity. Due to its strong oxidizing property and corrosiveness, there are strict limits for O3 gas exposure. O3 gas has limited penetration and decomposes quickly. However, ozone treatment can be used as a safe and green technology for food preservation and control of contaminants.

Hypothesis: The electrical properties of coronavirus.

To help investigate the relationship between inflammatory and other symptoms of coronavirus and the protein-protein interactions (PPI) that occur between viral proteins and protein molecules of the host cell, I propose that the electrostatic discharge (ESD) exists including corona discharge to lead to ozone gas. I cite evidence in support of this hypothesis. I hope that the proposed will inspire new studies in finding effective treatments and vaccines for individuals with coronavirus disease in 2019. I suggest possible future studies that may lend more credibility to the proposed.

UV-assisted chemiresistors made with gold-modified ZnO nanorods to detect ozone gas at room temperature.

Two kinds of flexible ozone (O3) sensors were obtained by placing pristine ZnO nanorods and gold-modified ZnO nanorods (NRs) on a bi-axially oriented poly(ethylene terephthalate) substrate. The chemiresistive sensor is operated at typically 1 V at room temperature under the UV-light illumination. The ZnO nanorods were prepared via a hydrothermal route and have a highly crystalline wurtzite structure, with diameters ranging between 70 and 300 nm and a length varying from 1 to 3 µm. The ZnO NRs were then coated with a ca. 10 nm gold layer whose presence was confirmed with microscopy analysis. This sensor is found to be superior to detect ozone at a room temperature. Typical figures of merit include (a) a sensor response of 108 at 30 ppb ozone for gold-modified ZnO NRs, and (b) a linear range that extends from 30 to 570 ppb. The sensor is stable, reproducible and selective for O3 compared to other oxidizing and reducing gases. The enhanced performance induced by the modification of ZnO nanorods with thin layer of gold is attributed to the increased reaction kinetics compared to pristine ZnO NRs. The sensing mechanism is assumed to be based on the formation of a nano-Schottky type barrier junction at the interface between gold and ZnO. Graphical abstract Room temperature, flexible UV-enhanced gold modified ZnO nanorods can detect ppb levels of ozone.

Evaluation of therapeutic potential of intraperitoneal ozone gas in combination with insulin above cranial and spinal neuropathy in rats with diabetes mellitus.

OBJECTIVE: This study aimed to investigate the therapeutic effect of ozone in combination with insulin on cranial and spinal neuropathy in rats with diabetes mellitus (DM). MATERIALS AND METHODS: Sixty adult male Sprague Dawley rats were randomly divided into the following six groups (n = 10): control (C), ozone (O), diabetic (D), ozone-treated diabetic (DO), insulin-treated diabetic (DI), and ozone, insulin-treated diabetic (DOI). DM was induced by a single intraperitoneal (ip) streptozotocin injection (60 mg/kg), followed by 3 IU (ip) insulin administration for 60 days. Next, 1.1 mg/kg (50 µg/ml) ozone was administered to the O, DO, and DOI groups for 60 days. After inducing diabetes, the total oxidant status (TOS) and total antioxidant status (TAS) were measured; the oxidative stress index (OSI) was calculated. The brain and spinal cord tissues were obtained for histopathological evaluation. This cross sectional study was conducted in Dumlupinar University Laboratory Animals Research Center e.g 11.03.2015 ‒ 15.05.2015. RESULTS: TAS was higher in the DO, DI, and DOI groups than in the D group. TOS and OSI were lower in the DO, DI, and DOI groups than in the D group. Little pathological alterations with degenerated axons and vascular congestion were observed in the DO, DI, and DOI groups compared with the D group. CONCLUSION: Ozone with insulin can stimulate the endogenous antioxidant defense mechanism in diabetic neuropathy, thereby preventing reactive oxygen species-induced damage and protecting against cranial and spinal neuropathies (Fig. 6, Ref. 29).

Ozone and Laser Effects on Dentin Hypersensitivity Treatment: A Randomized Clinical Study.

INTRODUCTION: The aim of this study was to evaluate and compare the clinical efficacy of diode laser and ozone gas in the treatment of dentin hypersensitivity (DHS). METHODS: One hundred thirty-two teeth from 44 patients with moderate DHS were randomized into 3 groups according to a split-mouth design. In the diode laser group, the operator irradiated the superficial dentin exposed with an 808-nm wavelength and incremental power from 0.2 to 0.6 W with a 20-second interval. In the ozone gas group, the operator applied a high dose of ozone (32 g/m3) for 30 seconds using a silicon cup. In the placebo group, no therapy was applied. The dentin sensitivity level was evaluated upon enrollment (T0), immediately after treatment (T1), 3 months post-treatment (T2), and 6 months post-treatment (T3) with a cold air blast challenge and tactile stimuli. The pain severity was quantified according to the visual analogue scale. The Wilcoxon signed rank test was used to scrutinize potential statistical disparities among the treatments. Statistical significance was predetermined at P < .05. RESULTS: A significant decrease of DHS was observed in the ozone gas group and the `diode laser group immediately after treatment and after 3 and 6 months of the therapy. After 6 months from the therapy, the sensitivity values in the teeth treated with ozone gas remained statistically lower than those treated with diode lasers (P < .05). CONCLUSIONS: A laser diode and ozone gas are both efficient as dentin sensitivity treatment. Ozone maintains an invariable effectiveness after 6 months.

Ozonation using a stainless-steel membrane contactor: Gas-liquid mass transfer and pharmaceuticals removal from secondary-treated municipal wastewater.

A tubular porous stainless steel membrane contactor was characterized in terms of ozone-water mass transport, as well as its application in removing 23 pharmaceuticals (PhACs) detected in the secondary-treated municipal wastewater, under continuous mode operation. The volumetric mass transfer coefficient (KLa) was evaluated based on liquid flow rate, gas flow rate, and ozone gas concentration. The KLa values were substantially improved with an increment in liquid flow rate (1.6 times from 30 to 70 dm3 h-1) and gas flow rate (3.6 times from 0.30 to 0.85 Ndm3 min-1) due to the improved mixing in the gas-liquid interface. For the lowest liquid flow rate (30 dm3 h-1), the water phase boundary layer (82%) exhibited the major ozone transfer resistance, but it became almost comparable with membrane resistance for the highest liquid flow rate (70 dm3 h-1). Additionally, the influence of the specific ozone dose (0.39, 0.53, and 0.69 g O3 g DOC-1) and ozone inlet gas concentration ( [Formula: see text]  = 27, 80, and 134 g Nm-3) were investigated in the elimination of 23 PhACs found in secondary-treated municipal wastewater. An ozone dose of 0.69 g O3 g DOC-1 and residence time of 60 s resulted in the removal of 12 out of the 23 compounds over 80%, while 17 compounds were abated above 60%. The elimination of PhACs was strongly correlated with kinetic reaction constants values with ozone and hydroxyl radicals (kO3 and kHO•), leading to a characteristic elimination pattern for each group of contaminants. This study demonstrates the high potential of membrane contactors as an appealing alternative for ozone-driven wastewater treatment.

Ozonation for Pseudomonas paracarnis control: biofilm removal and preservation of chicken meat during refrigerated storage.

Ozone has been studied to control microorganisms in food, as well as to control biofilm. In this context, the goals of this work were to determine the effect of ozonated water in the removal of Pseudomonas paracarnis biofilm and the effect of ozone gas and ozonated water on inactivating P. paracarnis in deboned chicken breast meat and its effect on product color. AISI 304 coupons were used as a surface for biofilm formation. The coupons were immerged into minimal medium for Pseudomonas inoculated with the P. paracarnis overnight culture (1% w/v) followed by incubation at 25 °C for 7 days. To obtain ozonized water, two different systems were used: system with microbubble generator (MB) and system with porous stone diffuser (PSD). The inlet ozone concentration was 19 mg/L and flow rate of 1 L/min. The coupons were subjected to ozonized water for 10 and 20 min. The chicken breast meat was exposed to gaseous ozone and ozonized water for 40 min. After the ozonation process, chicken meat samples were stored at 8 °C, for 5 days. More expressive removals of biofilm were obtained when using ozonized water obtained in the system with microbubble generator (MB for 20 min-reduction of 2.3 log cycles) and system with porous stone diffuser (PSD for 10 min-reduction of 2.7 log cycles; PSD for 20 min-reduction of 2.6 log cycles). The treatment of chicken meat with ozone gas resulted in lower counting of Pseudomonas, when compared with the control treatments and with ozonized water, both immediately after ozonation (day 1) and after 5 days of storage. The luminosity in the chicken meat samples treated with ozonized water was higher than that verified in the control treatments and with ozone gas, immediately after ozonation (day 1). A similar trend was observed in hue angle and color difference, in which the highest values were obtained for treatment with ozonized water. Based on the results obtained in this study, it was concluded that ozonated water can be used to remove P. paracarnis biofilm from stainless steel under static conditions and gaseous ozone is more efficient in the inactivation of P. paracarnis from chicken breast meat, when compared to ozonated water.

Comparison between ozone and CHX gel application for reduction of pain and incidence of dry socket after lower third molar removal.

OBJECTIVES: The aim of this study is to evaluate the efficacy between ozone gas and 1% chlorhexidine (CHX) gel in the incidence of dry socket after surgical extraction of impacted lower third molars. MATERIAL AND METHODS: Overall, 30 patients of both genders were included in the study, with indication of surgical extraction of lower third molar, positioned similarly after being clinically and radiographically checked by X-ray and orthopantomography. Each patient was subjected to both groups in separate sessions: treated with ozone gas and with CHX gel 1%. Data on pain intensity, number of taken analgesics-painkillers, and dry socket were recorded for 48 h and at Day 7. RESULTS: Ozone gas and CHX gel effectively reduced pain intensity and prevented dry socket. The number of taken analgesics 48 h and 7 days after surgery showed no statistical significance. The same was observed for the distribution of pain. Only one patient reported the occurrence of dry socket 7 days after the surgical extraction. CONCLUSIONS: Ozone gas and CHX 1% gel are both efficient in decreasing postoperative symptoms and incidence rates of dry socket, but in comparison to each other, the use of ozone gas is showing a bit better prevention capability.

Healing refractory diabetic foot ulcers (DFUs) by ozone therapy and silver dressing: A case report.

INTRODUCTION AND IMPORTANCE: Refractory diabetic foot ulcers (DFUs) are still a major health problem and can lead to death. CASE PRESENTATION: The present case reports a 45-year-old man with an 8-year history of type 2 diabetes who has had left refractory DFU for a year on the left heel with a size of 6 × 3 × 1 cm. The patient's ulcers were infected with Staphylococcus aureus. Despite the routine DFU care (normal saline dressing twice a day and intravenous antibiotic therapy), the patient did not recover from DFU using standard methods. The patient was referred to our wound management team. In the first step, the necrotic tissues of his foot ulcer were irrigated and debrided using mechanical debridement and saline. Next, the patient underwent a 70 µg/dL dose of ozone therapy over a 30-day period in 10 sessions (one 20-minute session every 3 days). Between each session, the patient's wound was wrapped in silver-containing gauze bandages. After two months, the patient's DFUs healed, and he was discharged from our service in good condition. CLINICAL DISCUSSION: DFU can lead to infection, amputation, and even patient death. Therefore, effective treatment methods are very important for managing DFUs. CONCLUSION: This case report study was shown that the ozone therapy is an effective approach to improve the healing of refractory DFUs and prevent foot amputation. Therefore, wound-care teams can utilize it as an adjunct to the standard methods of DFU treatment.

Disinfection of polyvinyl siloxane impression material using ozone gas, 0.1% riboflavin, glutaraldehyde, and microwave irradiation and their effect on physical properties.

AIM: To assess the antimicrobial effect of ozone gas (OG) 0.1% riboflavin (RF), glutaraldehyde (GaH), and microwave irradiation (MI) on Polyvinyl siloxane impression material formerly colonized with E. coli, P. Aeruginosa, E. faecalis, and S.aureus and their effect on the physical properties MATERIAL AND METHODS: One hundred disk-shaped specimens (diameter 10 mm and thickness 3 mm) were developed by using polyvinylsiloxane impression material and inoculated by the American Type Culture Collection (ATCC) of E. coli, P. aeruginosa, E. faecalis, and S.aureus in an in-vitro setup. The samples were arbitrarily isolated into five groups and subjected for 3 min to the designated disinfection modality. Group 1 Control, group 2: GaH, group 3: 0.1% RF, group 4: MI, and group 5 OG. Following decontamination, the physical properties (contact angle, strain-in-compression, and tear strength) of impression materials were evaluated. Statistical analysis for CFU/mL (log10) for exposed E. coli, P. aeruginosa, E. faecalis, and S.aureus was performed by using analysis of variance (ANOVA) and Tukey's multiple comparison tests at a p-value of less than 0.05. RESULTS: The most effective antimicrobial efficacy for impression disinfection against all scrutinized microbial colonies were displayed by group 5 OG and the lowest disinfection effectiveness was unveiled by the control group with no treatment. The intragroup comparison revealed that impression disinfection with GaH, MI, and ozone corroborated analogous antimicrobial efficacy(p > 0.05). The disinfecting capacity of the impression material with 0.1% RF was significantly less than MI, GaH, and OG (p < 0.05). CONCLUSION: Disinfection of polyvinyl siloxane impression material with ozone gas, microwave irradiation, and glutaraldehyde demonstrated reasonable antimicrobial efficiencies against E. coli, P. aeruginosa, E. faecalis, and S.aureus with no detrimental effects on the physical properties of impression material. More studies are advocated to extrapolate the findings of the present study.

Applicability of on-site disinfection of personal protective equipment by ozone gas.

On-site disinfection techniques are beneficial during a pandemic when there is a marked shortage of personal protective equipment (PPE), as experienced during the coronavirus disease 2019 outbreak. Ozone gas has been considered an alternative on-site disinfectant during a pandemic because it has antimicrobial activities, can be produced from air by electricity without the need for storage, and can be easily deactivated after use. However, ozone gas might become distributed at the lower layer because it has a larger molecular weight than air. This study aimed to reveal the applicability of ozone gas for the on-site disinfection of PPE. The lockers meant for changing dresses were used as ozone gas exposure boxes, and the distribution of ozone was assayed. Considering that the determined ozone levels were not consistent in the types of ozone analysers, we studied the chemical and biological activities of ozone, which were evenly detected in the locker. The gown in the locker was also uniformly exposed to ozone. Results showed that ozone gas could be used for the on-site disinfection of PPE in a closed box, such as a locker. This finding is valuable during a pandemic when PPE is in short supply.

Ozone gas applied through nebulization as adjuvant treatment for lung respiratory diseases due to COVID-19 infections: a prospective randomized trial.

The objective of this study was to provide lung disinfection by nebulizing ozone gas with distilled water and olive oil for patients who have clinical symptoms due to coronavirus disease 2019 (COVID-19). The study attempted to reduce the viral load of COVID-19 in the lungs of patients, to provide a faster response to medical treatment. Between August 2020 and September 2020, 30 patients who met the study criteria were prospectively evaluated. There were 2 groups with 15 patients in each group: patients in control group were not treated with ozone and only received standard COVID-19 treatment; patients in ozone group received lung disinfection technique with ozone and standard COVID-19 treatment. A statistically significant difference was found in the length of stay in hospital, change in C-reactive protein, polymerase chain reaction results after 5 days, and computed tomography scores between two groups. There was no statistically significant difference in D-dimer, urea, lactate dehydrogenase, lymphocyte, leukocyte, and platelet between two groups. According to the data, we think that the lung disinfection technique applied with ozone inhalation reduces the rate of pneumonia in COVID-19 patients and makes the patients respond faster to the treatment and become negative according to the polymerase chain reaction tests. The study was approved by the Ethical Committee of the Istanbul Medipol University Clinical Trials (approval No. 0011) on July 2, 2020.

Inactivation of multiple human pathogens by Fathhome's dry sanitizer device: Rapid and eco-friendly ozone-based disinfection.

SARS-CoV-2 spread rapidly, causing millions of deaths across the globe. As a result, demand for medical supplies and personal protective equipment (PPE) surged and supplies dwindled. Separate entirely, hospital-acquired infections have become commonplace and challenging to treat. To explore the potential of novel sterilization techniques, this study evaluated the disinfection efficacy of Fathhome's ozone-based, dry-sanitizing device by dose and time response. Inactivation of human pathogens was tested on non-porous (plastic) surfaces. 95.42-100% inactivation was observed across all types of vegetative microorganisms and 27.36% inactivation of bacterial endospores tested, with no residual ozone detectable after completion. These results strongly support the hypothesis that Fathhome's commercial implementation of gas-based disinfection is suitable for rapid decontamination of a wide variety of pathogens on PPE and other industrially relevant materials.

Prospective Comparative Observational Study of Safety and Efficacy of Topical Ozone Gas Therapy in Healing of Diabetic Foot Ulcers versus Only Conventional Wound Management.

The prevalence of diabetic foot ulcers (DFUs) in India is 11.6%. DFU accounts for major cost expenditure, morbidity, and mortality. 1 Ozone gas has antimicrobial and antioxidant properties. We studied efficacy of topical ozone gas therapy in promoting healing of DFU. This is an observational comparative cohort study, n = 160, There were two groups of patients namely: those who received Conventional wound management alone C and those who received topical ozone therapy in addition to conventional wound management O + C therapy groups (81 each). Study group, i.e., O + C received five alternate day sessions of ozone therapy by bagging method for 30 minutes each session. Both groups were observed for 30 days for wound healing parameters like reduction of wound surface area, wound diameter, presence and character of discharge, granulation tissue, healing wound edges, microbial negativity, and requirement of revision (re-debridement and/or amputation) surgery. Mean baseline ulcer surface area is 17.43 ± 8.6 cm 2 for C and 17.87 ± 9.2 cm 2 (range 1-50 cm 2 ) in O + C group. Percentage change in ulcer surface after 21 days in O + C group is 32.37% compared with 17.15% in C group, which is statistically significant ( p = 0.01). Rates of microbial negativity and ulcer healing were significantly faster in ozone group. There was a statistically significant decrease in hospital stay, number of revision surgeries required, and mortality in ozone group. Topical ozone gas was well tolerated. Our study supports the efficacy of ozone therapy in DFU healing and reduction in the chances of infection and revision (re-debridement and/or amputation) surgery. More research is needed for dose, duration, and exposure time standardization.

Ozone potential to fight against SAR-COV-2 pandemic: facts and research needs.

The greatest challenge the world is facing today is to win the battle against COVID-19 pandemic as soon as possible. Until a vaccine is available, personal protection, social distancing, and disinfection are the main tools against SARS-CoV-2. Although it is quite infectious, the SARS-CoV-2 virus itself is an enveloped virus that is relatively fragile because its protective fatty layer is sensitive to heat, ultraviolet radiation, and certain chemicals. However, heat and liquid treatments can damage some materials, and ultraviolet light is not efficient in shaded areas, so other disinfection alternatives are required to allow safe re-utilization of materials and spaces. As of this writing, evidences are still accumulating for the use of ozone gas as a disinfectant for sanitary materials and ambient disinfection in indoor areas. This paper reviews the most relevant results of virus disinfection by the application of gaseous ozone. The review covers disinfection treatments of both air and surfaces carried out in different volumes, which varies from small boxes and controlled chambers to larger rooms, as a base to develop future ozone protocols against COVID-19. Published papers have been critically analyzed to evaluate trends in the required ozone dosages, as a function of relative humidity (RH), contact time, and viral strains. The data have been classified depending on the disinfection objective and the volume and type of the experimental set-up. Based on these data, conservative dosages and times to inactivate the SARS-CoV-2 are estimated. In small chambers, 10-20 mg ozone/m3 over 10 to 50 min can be sufficient to significantly reduce the virus load of personal protection equipment. In large rooms, 30 to 50 mg ozone/m3 would be required for treatments of 20-30 min. Maximum antiviral activity of ozone is achieved at high humidity, while the same ozone concentrations under low RH could result inefficient. At these ozone levels, safety protocols must be strictly followed. These data can be used for reducing significantly the viral load although for assuring a safe disinfection, the effective dosages under different conditions need to be confirmed with experimental data.

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial.

BACKGROUND: Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia. METHODS: The trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT). RESULTS: A total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients). The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p = 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease. No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/FiO2, reduction in LDH and requirement of oxygen therapy ≤ 5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0-1] in the SoC arm vs. 2 [1-3] the O3-AHT arm; p = 0.018). No adverse events related O3-AHT treatment was observed. CONCLUSION: In mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in a composite clinical endpoint. Larger Randomized prospective studies alone or in combination with steroids are needed to confirm our results.

Treatment of an Endo-Perio Lesion with Ozone Gas in a Patient with Aggressive Periodontitis: A Clinical Case Report and Literature Review.

The pulp and periodontium have obvious relationships that have been described in many studies. Pulp infections may affect periodontal tissues and vice versa. Teeth with endo-perio lesions have a worse prognosis than isolated endodontic or periodontal lesions. Elimination of endodontic and periodontal infections is essential for successful treatment, so co-operation between endodontists and periodontists is necessary. In this clinical case, a 44-year-old male presented with primary periodontal disease with secondary endodontic involvement in his lower right canine because of aggressive periodontitis. There was 10 mm of clinical attachment loss and 8 mm periodontal pocket mesial from the tooth and bone radiolucency periapical and lateral from the root. Periodontal therapy was followed by endodontic treatment. Periodontal therapy included root scaling and planing, treatment of the periodontal pocket with ozone gas, systemic antibiotics, oral hygiene instructions, and chlorhexidine rinsing. Endodontic therapy included root canal instrumentation with rotary endodontic files, irrigation, root canal treatment with ozone gas, and obturation with lateral compaction. Radiographs at a 6-month follow-up appointment showed complete healing of the periapical lesion and alveolar bone lateral to the root. Using an interdisciplinary approach to treat endo-perio lesions provides favorable clinical outcomes. Ozone therapy is beneficial for the successful treatment of endo-perio lesions with narrow periodontal pockets in patients with aggressive periodontitis and poor prognosis.