Clinical effectiveness of medical ozone therapy in COVID-19: the evidence and gaps map.

Ozone therapy (OT), a medical procedure, has been showing good results during the coronavirus disease (COVID-19). We aimed to build an evidence and gaps map (EGM) of OT in the COVID-19 ranking the articles found according to levels of evidence and outcomes. The EGM brings bubbles of different sizes and different colors according to the articles. The OT intervention used was major or minor autohemotherapy, rectal insufflation and ozonized saline solution. EGM was based on 13 clinical studies using OT for COVID-19 involving a total of 271 patients. We found 30 outcomes related to OT in COVID-19. Our EGM divided the outcomes into six groups: 1-clinical improvement; 2-hospitalization; 3-inflammatory, thromboembolic, infectious, or metabolic markers; 4-radiological aspects, 5-viral infection and 6-adverse events. Major autohemotherapy was present in 19 outcomes, followed by rectal insufflation. Improvement in clinical symptoms of COVID-19, improvement of respiratory function, improvement of oxygen saturation, reduction in hospital internment, decrease in C-reactive protein, decrease in ferritin, decrease in lactate dehydrogenase, decrease in interleukin 6, decrease in D-dimer, radiological improvement of lung lesions and absence of reported adverse events were related in the papers. The most commonly used concentrations of OT in major autohemotherapy and in rectal insufflation were 40 µg/mL and 35 µg/mL, respectively. Here, we bring the first EGM showing the efficacy and safety of OT in the treatment of COVID-19. OT can be used as integrative medical therapy in COVID-19 at a low cost and improve the health conditions of the patients.

Mapa de Evidência: aplicação clínica da ozonioterapia no tratamento da COVID-19 / Mapa de Evidencia: aplicación clínica de la ozonoterapia en el tratamiento del COVID-19 / Mapa de Evidências Efetividade Clínica da Homeopatia

Este mapa de evidências apresenta uma síntese gráfica de estudos clínicos sobre a aplicação da Ozonioterapia em casos de COVID-19. A partir de uma ampla busca bibliográfica 11 estudos clínicos foram incluídos no mapa e categorizados por tipo de intervenção e por desfechos. Os estudos avaliaram o efeito de 4 tipos de intervenção com Ozonioterapia: auto-hemoterapia maior, auto-hemoterapia menor, insuflação retal e solução salina ozonizada; para 6 grupos de desfechos relacionados à COVID-19: Melhora clínica; Internação hospitalar; Marcadores inflamatórios, tromboembólicos, infecciosos ou metabólicos; Aspectos radiológicos; Infecção viral; e Eventos adversos. Os círculos localizados nas intersecções entre as intervenções e os desfechos representam os estudos identificados e a quantidade. A cor do círculo representa o desenho do estudo: Verde para os Ensaios Clínicos Randomizados (RCTs), Amarelo para os Ensaios Clínicos não Randomizados (Non RCTs) e Estudos Clínicos quasi-experimental, e Vermelho para os Relatos de Caso e Estudos de Casos e Controle.

This evidence map presents a graphical summary of clinical studies on the application of Ozone Therapy in cases of COVID-19. From a wide bibliographic search, 11 clinical studies were included in the map and categorized by type of intervention and outcomes. The studies evaluated the effect of 4 types of intervention with Ozone Therapy: Major Autohemotherapy, Minor Autohemotherapy, Rectal Insufflation and Ozonized Saline; for 29 outcomes related to COVID-19, which on the map are divided into 6 groups: 1- clinical improvement; 2-hospitalization; 3- inflammatory, thromboembolic, infectious or metabolic markers; 4- radiological aspects, 5- viral infection and 6- adverse events. Circles located at the intersections between interventions and outcomes represent the identified studies and quantity. The color of the circle represents the study design: Green for Randomized Clinical Trials (RCTs), Yellow for Non-Randomized Clinical Trials (Non RCTs) and Quasi-experimental Clinical Studies, and Red for Case Reports and Case-Control Studies.

The role of ozone treatment as integrative medicine. An evidence and gap map.

Introduction: The Brazil has one of the largest public health systems in the world and in the 1980's, Traditional, Complementary and Integrative Medicine were introduced. In 2018, the treatment with ozone became a complementary integrative practice showing several benefits. However, its effectiveness needs to be researched. The objective of this evidence gap map is to describe contributions of Integrative Medicines-Ozone treatment in different clinical conditions, to promote evidence-based practice. Methods: We applied the methodology developed by Latin American and Caribbean Center on Health Sciences Information based on the 3iE evidence gap map. The EMBASE, PubMed and Virtual Health Library databases, using the MeSH and DeCS terms for the treatment with Ozone were used. Results: 26 systematic reviews were characterized, distributed in a matrix containing 6 interventions (parenteral oxygen/ozone gas mixture; parenteral ozonated water; systemic routes; topical application ozonated water; topical oxygen/ozone gas mixture; and topical ozonated oil) and 55 outcomes (cancer, infection, inflammation, pain, quality of life, wound healing and adverse effects). 334 associations between intervention and outcome were observed, emphasizing the parenteral oxygen/ozone gas mixture intervention (192 associations, 57%). Conclusions: The evidence gap map presents an overview of contributions of Ozone treatment in controlling pain, infections, inflammation and wound healing, as well as increasing the quality of life, and it is directed to researchers and health professionals specialized in Ozone treatment. No serious adverse effects were related. Therefore, this treatment may be even more widely known as an integrative treatment, considering its low cost, efficiency and safety. Future studies should adopt economic impact assessments and the organization of health services.

Mapa de evidências: efetividade Clínica da ozonioterapia médica / Mapa de evidencias: efetividad clínica de la ozonioterapia médica / Evidence map: clinical effectiveness of ozone therapy

Este mapa apresenta uma visão geral das evidências e lacunas existentes sobre os efeitos da Ozonioterapia Médica para diversas condições clinicas e de saúde das pessoas. A partir de uma ampla busca bibliográfica de estudos publicados e não publicados entre 2000 e meados de 2019, foram incluídas no mapa 14 revisões sistemáticas. Todos os estudos foram avaliados, caracterizados e categorizados pela Sociedade Brasileira de Ozonioterapia Médica (SOBOM) e contou com o apoio da World Federation of Ozone Therapy (WFOT).

Este mapa presenta una visión general de la evidencia y las lagunas existentes sobre los efectos de la Ozonoterapia Médica para diversas condiciones clínicas y de salud de las personas. A partir de una amplia búsqueda bibliográfica de estudios publicados y no publicados entre 2000 y mediados de 2019, se incluyeron 14 revisiones sistemáticas en el mapa.Todos los estudios fueron evaluados, caracterizados y categorizados por la Sociedad Brasileña de Ozonioterapia Médica (SOBOM) y tuve el apoyo de la World Federation of Ozone Therapy (WFOT).

This map provides an overview of the evidence and gaps that exist on the effects of Medical Ozone Therapy for various clinical and health conditions of people. From a broad bibliographic search of published and unpublished studies between 2000 and mid-2019, 14 systematic reviews were included in the map. All studies were evaluated, characterized and categorized by the Brazilian Society of Medical Ozone Therapy (SOBOM) with support from the World Federation of Ozone Therapy (WFOT).