Ozonated oil in wound healing: what has already been proven?

Integrating human expertise & automated methods for a dynamic and multi-parametric evaluation of large language models' feasibility in clinical decision-making

BACKGROUND

Recent enhancements in Large Language Models (LLMs) such as ChatGPT have exponentially increased user adoption. These models are accessible on mobile devices and support multimodal interactions, including conversations, code generation, and patient image uploads, broadening their utility in providing healthcare professionals with real-time support for clinical decision-making. Nevertheless, many authors have highlighted serious risks that may arise from the adoption of LLMs, principally related to safety and alignment with ethical guidelines.

OBJECTIVE

To address these challenges, we introduce a novel methodological approach designed to assess the specific feasibility of adopting LLMs within a healthcare area, with a focus on clinical nursing, evaluating their performance and thereby directing their choice. Emphasizing LLMs' adherence to scientific advancements, this approach prioritizes safety and care personalization, according to the "Organization for Economic Co-operation and Development" frameworks for responsible AI. Moreover, its dynamic nature is designed to adapt to future evolutions of LLMs.

METHOD

Through integrating advanced multidisciplinary knowledge, including Nursing Informatics, and aided by a prospective literature review, seven key domains and specific evaluation items were identified as follows:A Peer Review by experts in Nursing and AI was performed, ensuring scientific rigor and breadth of insights for an essential, reproducible, and coherent methodological approach. By means of a 7-point Likert scale, thresholds are defined in order to classify LLMs as "unusable", "usable with high caution", and "recommended" categories. Nine state of the art LLMs were evaluated using this methodology in clinical oncology nursing decision-making, producing preliminary results. Gemini Advanced, Anthropic Claude 3 and ChatGPT 4 achieved the minimum score of the State of the Art Alignment & Safety domain for classification as "recommended", being also endorsed across all domains. LLAMA 3 70B and ChatGPT 3.5 were classified as "usable with high caution." Others were classified as unusable in this domain.

CONCLUSION

The identification of a recommended LLM for a specific healthcare area, combined with its critical, prudent, and integrative use, can support healthcare professionals in decision-making processes.

Effects of andiroba oil (Carapa guianensis aublet) on the immune system in inflammation and wound healing: A scoping review

ETHNOPHARMACOLOGICAL RELEVANCE

Andiroba seed oil (Carapa guianensis Aubl.) is widely used by traditional populations in tropical countries, especially in the Brazilian Amazon, because of its anti-inflammatory, antirheumatic, antiseptic, healing and antipyretic properties, among others, which makes it useful for the treatment, mainly, of skin afflictions and wounds.

AIM OF THE STUDY

To describe the modulation of the immune system by andiroba oil (Carapa guianensis Aubl.) in inflammation and wound healing.

MATERIALS AND METHODS

A scoping review was performed, following the recommendations of the Joanna Briggs Institute (JBI) and PRISMA for Scoping Reviews (PRISMA-ScR). As inclusion criteria, in vitro, in vivo, ex vivo, and clinical studies were selected, in Portuguese, English, or Spanish, in thirteen databases of published studies, gray literature, and references of the included studies, which deal with immune modulation by andiroba oil in the context of the various therapeutic applications that make use of its anti-inflammatory and wound healing properties. The selection of information sources was carried out by two independent reviewers between November 2022 and January 2023. The process of data extraction and evidence analysis was conducted by four pairs of independent reviewers between January and February 2023.

RESULTS

22 sources of evidence were included in this scoping review, mostly scientific articles published between 2005 and 2021 with in vivo sampling. The evidence suggests that andiroba oil reduces inflammation and promotes the healing of wounds of multiple etiologies by reducing leukocyte infiltration, increasing phagocytic activity, enhancing interleukin and inflammatory cytokine activity, promoting fibroblast recovery, increasing growth factors, reducing apoptotic cells, promoting reepithelialization, as well as promoting angiogenesis, reducing edema, and stimulating the production of glucocorticoids that alleviate pain. Additionally, different formulations of the oil (such as nanoemulsions, films and gels) are more effective in modulating inflammation and wound healing compared to in natura oil.

CONCLUSIONS

Evidence in the literature suggests that andiroba oil (Carapa guianensis Aubl.) has positive effects on immune modulation in inflammation and wound healing, which makes it a biocompound with high therapeutic potential.

A Comparative Study of the Chemical Properties and Antibacterial Activity of Four Different Ozonated Oils for Veterinary Purposes

Infectious skin diseases are quite common in veterinary medicine. These diseases can be caused by both bacteria and pathogenic fungi. Antimicrobial drugs are usually used for treatment. An alternative to these drugs could be ozonated oils with antibacterial and antifungal properties. Four different ozonated oils (linseed, hemp seed, sunflower, and olive) were tested in order to develop an optimal pharmaceutical form for the treatment of skin infections in animals. Chemical parameters such as acid and acidity value, iodine and peroxide value, viscosity, and infrared spectres were analysed. The ozonation of oils resulted in changes in their chemical composition. The antimicrobial activity of the tested oils was evaluated by determining the minimum inhibitory concentrations and zones of inhibition in agar. After ozonation, the acid content increased in all the tested oils. The highest acidity was found in linseed oil (13.00 ± 0.11 mg KOH/g; 6.1%). Hemp oil, whose acidity was also significant (second only to linseed oil), was the least acidified by ozonation (11.45 ± 0.09 mg KOH/g; 5.75%). After ozonation, the iodine value in oils was significantly reduced (45-93%), and the highest amounts of iodine value remained in linseed (47.50 ± 11.94 g Iodine/100 g oil) and hemp (44.77 ± 1.41 Iodine/100 g oil) oils. The highest number of peroxides after the ozonation of oils was found in sunflower oil (382 ± 9.8 meqO2/kg). It was found that ozonated hemp and linseed oils do not solidify and remain in liquid form when the temperature drops. The results showed a tendency for the reference strains of S. aureus, E. faecalis, and E. coli to have broader zones of inhibition (p < 0.001) than clinical strains. Overall, ozonated linseed oil had the highest antibacterial activity, and ozonated olive oil had the lowest, as determined by both methods. It was found that ozonated linseed oil was the most effective on bacteria, while the most sensitive were S. aureus ATCC 25923, MRSA, and S. pseudointermedius (MIC 13.5 mg/mL, 4.6 mg/mL, and 13.5 mg/mL, respectively, and sterile zones 20.67 ± 0.98 mm, 20.25 ± 0.45 mm, and 18.25 ± 0.45 mm, respectively). The aim and new aspect of this work is the characterisation of selected ozonated vegetable oils, especially hemp oil, according to chemical and antibacterial parameters, in order to select suitable candidates for preclinical and clinical animal studies in the treatment of bacterial or fungal skin infections in terms of safety and efficacy.

Topical application of ozonated sunflower oil accelerates the healing of lesions of cutaneous leishmaniasis in mice under meglumine antimoniate treatment

Besides being scarce, the drugs available for treating cutaneous leishmaniasis have many adverse effects. Ozone is an option to enhance the standard treatment due to the wound-healing activity reported in the literature. In this study, we evaluated the efficiency of ozonated sunflower oil as an adjuvant in treating cutaneous lesions caused by Leishmania amazonensis. BALB/c mice were infected with L. amazonensis, and after the lesions appeared, they were treated in four different schedules using the drug treatment with meglumine antimoniate (Glucantime®), with or without ozonated oil. After thirty days of treatment, the lesions' thickness and their parasitic burden, blood leukocytes, production of NO and cytokines from peritoneal macrophages and lymph node cells were analyzed. The group treated with ozonated oil plus meglumine antimoniate showed the best performance, improving the lesion significantly. The parasitic burden showed that ozonated oil enhanced the leishmanicidal activity of the treatment, eliminating the parasites in the lesion. Besides, a decrease in the TNF levels from peritoneal macrophages and blood leukocytes demonstrated an immunomodulatory action of ozone in the ozonated oil-treated animals compared to the untreated group. Thus, ozonated sunflower oil therapy has been shown as an adjuvant in treating Leishmania lesions since this treatment enhanced the leishmanicidal and wound healing effects of meglumine antimoniate.

Ozone therapy improves early stages of osseointegration in ovariectomized rats

OBJECTIVE

the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats.

METHODOLOGY

ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg - OZ Group (n=15) - and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05).

RESULTS

our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32).

CONCLUSION

it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.

Conventional Frenectomy With Topical Ozonated Oil Application

The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the gingival border, there may be issues with plaque removal, and the overall gingiva may be affected. In addition, the maxillary frenum may provide aesthetic difficulties or interfere with the aesthetic outcome in cases of midline diastema, which may result in a recurrence after treatment. A labial frenectomy, a frequently performed surgical operation in the specialty of dentistry, is used to address such an abnormal frenum. This article describes a case study of a maxillary labial frenectomy using a traditional scalpel approach and topical application of ozonated olive oil.

Association of ambient air pollution and pregnancy rate among women undergoing assisted reproduction technology in Fujian, China: A retrospective cohort study

BACKGROUND

Previous studies have reported the impact of ambient air pollutants on assisted reproduction. They concentrated on highly polluted environments and individual pollutants. It is unclear whether these effects continue at lower levels and as mixed effects. We aimed to study the influence of lower pollutant concentrations on pregnancy rates and identify vulnerable populations.

METHODS

We conducted a retrospective cohort study involving 9465 patients with infertility who received treatment from a local hospital between 2015 and 2021. Daily average levels of six pollutants (PM2.5, PM10, NO2, CO, SO2, and O3) were collected from air quality monitoring stations. We employed generalized linear regression models (logistic, linear, and lasso), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) to assess the impact of pollutants on pregnancy rates. Additionally, stratified analyses were performed to identify potentially vulnerable populations.

RESULTS

Findings from the generalized linear models revealed a significant negative correlation between interquartile range increment exposure to PM2.5 (OR = 1.17, 95 % CI = 1.09-1.26), PM10 (OR = 1.18, 95 % CI = 1.11-1.26), NO2 (OR = 1.21, 95 % CI = 1.13-1.30), CO (OR = 1.02, 95 % CI = 1.00-1.03), SO2 (OR = 1.11, 95 % CI = 1.05-1.17) and pregnancy rate when considering the effects of individual pollutants. The WQS index exhibited a negative correlation with pregnancy rates and the number of oocytes retrieved (aOR = 1.20, 95 % CI = 1.08-1.34). BKMR analyses indicated an overall significant trend of decreasing pregnancy rates as pollutant concentrations increased across percentiles. Stratified analysis unveiled heightened sensitivity to pollutants among individuals aged ≥35 years.

CONCLUSIONS

By comparing results obtained from diverse models, we observed that exposure to lower levels of air pollutants led to decreased pregnancy rates. Notably, PM10, NO2, SO2, and CO emerged as the four most prominent pollutants in this context. Moreover, stratified analyses highlighted that individuals aged ≥35 years exhibited heightened susceptibility to pollutants.

The Role of Postoperative Dressing in Hypospadias Surgery: A Systematic Review and Meta-analysis of the Pediatric Literature

This study aimed to describe the available dressings and their management in patients undergoing hypospadias repair and compare postoperative outcomes with and without dressing and between the different dressing types. A comprehensive electronic literature search of PubMed, Embase, and Cochrane Library was conducted to obtain studies, published in the period 1990 to 2021, reporting on the dressing used following hypospadias surgery. All information regarding the dressing was considered as primary endpoints, whereas surgical outcomes were assessed as secondary outcomes. Thirty-one studies containing 1,790 subjects undergoing hypospadias repair were included. Dressings were divided into three categories: nonadherent to the wound, adherent to the wound, and glue-based dressings. Most authors preferred to remove/change the dressing in the ward and the median time of removal/change was 6.56 postoperative days. The dressing removal appeared as the most frequent factor generating parental anxiety. The median rate of wound-related complications was 8.18%, of urethroplasty complications 9.08% and of reoperations 8.18%. Meta-analysis of outcomes showed higher risk of reoperations using conventional dressing, with no differences in urethroplasty and wound-related complications rates between conventional and glue-based dressings. Furthermore, the use of dressing reported increased risk of wound-related complications compared with no dressing, without significant differences regarding occurrence of urethroplasty complications and reoperations. The current evidence confirmed that there is no difference in outcomes of hypospadias repair depending on a certain dressing type. To date, surgeon's preference remains the main factor determining the choice for a specific dressing or for no dressing at all.

Topical Ozone Accelerates Diabetic Wound Healing by Promoting Re-Epithelialization through the Activation of IGF1R-EGFR Signaling

Ozonated oil increases the healing of chronic diabetic wounds, but the underlying mechanisms remain unclear. We investigated the effect of topical ozonated oil on wound healing in mice with diabetes with diet-induced obesity and further elucidated the role of EGFR and IGF1R signaling in diabetic wound healing. We found that topical ozonated oil accelerated wound healing; increased phosphorylation of IGF1R, EGFR, and VEGFR; and improved vascularization at the wound leading edge in mice with diabetes with diet-induced obesity. Exposure of normal epidermal keratinocytes to ozonated medium (20 μM for 2 hours daily) increased cell proliferation and migration distance by increasing phosphorylation of IGF1R and EGFR and downstream phosphoinositide 3-kinase, protein kinase B, and extracellular signal-regulated kinase. These findings shed light on the mechanism for topical ozone action in chronic wounds and support its potential therapeutic application.

Topical Hyperbaric Oxygen Therapy Versus Local Ozone Therapy in Healing of Venous Leg Ulcers

BACKGROUND

the treatment of venous leg ulcers still poses a difficult interdisciplinary medical problem. The aim of this study was to compare the therapeutic efficacy of local hyperbaric oxygen therapy with local ozone therapy in the treatment of venous leg ulcers.

MATERIALS

this study included 114 patients; 60 males (52.63%) and 54 females (47.36%) of ages ranging between 39 and 88 years (mean age: 68.9 ± 9.8 years) with venous leg ulcers, who underwent topical hyperbaric oxygen therapy (group I) and local ozone therapy (group II). In each of the study groups, the patients underwent 30 therapeutic procedures lasting 30 min each. The progress in wound healing was evaluated by computerized planimetry, and the intensity of pain was assessed with the use of the Visual Analogue Scale (VAS).

RESULTS

in both groups of treated patients, a statistically significant (p = 0.000001) reduction in the area of treated ulcers was achieved. In group I, the wound area decreased by an average of 69.67 ± 22.52%, from 7.55 ± 2.99 cm² to 2.78 ± 2.43 cm², and in group II, by an average of 41.33 ± 21.31%, from 7.36 ± 2.82 cm² to 4.62 ± 2.76 cm². In both groups of patients, a statistically significant (p = 0.000001) reduction in the intensity of pain ailments was observed: in group I, by an average of 0.55 ± 0.54 points, and in group II, by an average of 2.33 ± 0.82 points on the VAS scale.

CONCLUSIONS

local hyperbaric oxygen therapy and local ozone therapy cause a statistically significant reduction in the surface area of venous leg ulcers as well as in the intensity of pain. Better results were observed after the application of local hyperbaric oxygen therapy procedures.

Therapeutic Utilization of Zinc Supplementation Concurrent with Ozone Therapy Ameliorates Diabetic Foot Ulcer and Attenuates Serum Level of C-reactive Protein- A Case Report Study

Non-healing diabetic foot ulcer (DFU) is one of the main complications in diabetic patients. This case reported a 65-year-old male with a neuropathic ulcer in the right foot came to Ahwaz Wound Clinic after the wound had not healed with routine treatments. In addition to the routine treatment program, we used tropical ozone therapy and autohemotherapy (blood ozone therapy) for 2 months. Zinc supplementation (50 mg) was also administered daily during the treatment. The DFU was clearly healed with diminishing inflammation and wound closing, and there were no side effects. Additionally, the C-reactive protein level was obviously decreased during the treatment indicating effective suppression of infection. This way indicates a helpful new intervention approach to the treatment of DFU.

Topical Ozone Therapy—A Novel Modality in the Treatment of a Complicated Wound after Knee Joint Ligament Operation as a Consequence of Traffic Accident—Case Report

Background and objectives: For many years, medicine has been looking for effective methods to be used in the treatment of chronic wounds. Pharmacological treatment is insufficient and does not give expected results of treatment. In the comprehensive treatment of wounds, physical medicine methods have been used, which are characterized by high efficiency and safety as well as relatively low costs of the therapy. Efficient application of a novel therapeutic modality in the form of topical ozone therapy in the treatment of a difficult-to-heal wound of the left knee joint after surgery due to the rupture of the anterior cruciate ligament and damage to the medial meniscus because of a previous road accident in a 61-year-old female patient is presented. Methods: Topical ozone therapy treatment in the form of the “Ozone bag” with the use of an oxygen-ozone mixture (2.86% ozone and 97.14% of oxygen) with a concentration of 40 µg/mL was applied to the wound area. The therapeutic cycle consisted of two series of 10 treatment sessions lasting 20 min each, performed every day for 5 days a week, and carried out for 6 weeks. Results: Topical ozone therapy caused complete healing of the complicated wound remaining after orthopaedic surgery, which allowed the patient to live independently without experiencing pain, to move without elbow crutches, and to perform daily activities independently and ultimately to return to work.

Estimation of Effectiveness of Local Reactive Oxygen Species for Stimulation of Regenerative Processes in Experimental Burn Wound

The aim of this work was the comparative estimation of the efficiency of different variants of local ozone therapy in experimental burn wound. We conducted the experiments on 45 white Wistar rats being randomized for three groups. Every rat got contact thermal trauma (III degree; 20 bsp) of dorsal body surface on the area 20%. Rats of the first group received a Levomecol treatment of wound, animals of the second group were locally treated by ozonized oil, and the third group rats received a combination of ozone and oxygen gas mixture intracutaneously, and the wounds were treated with Levomecol locally. The character and particularities of post-traumatic regeneration were studied by histological investigation. Local treatment with reactive oxygen species at an early period after burning is revealed to lead to more pronounced manifestation of reparative processes in burn wounds (production of granulation tissue, epidermis regeneration) than when applying Levomecolointment, and that is accompanied by more pronounced initial manifestation of scab rejection. Applying reactive oxygen species in ointment compositions at these stages of treatment with the conjuncture of infected wounds does not contribute marked initiation of reparative processes and can even force the inflammation processes.

Topical Role of Ozonated Aloe vera Oil in Radiation Dermatitis: Expression of TGF-β and Collagen Density

BACKGROUND: The effect of ozonated Aloe vera in the treatment of radiation dermatitis has not been studied, while long-term use of topical steroids can cause some side effects. AIM: The aim of the study was to analyze the effect of topical administration of ozonated Aloe vera oil on the expression of TGF-β and collagen density in the treatment of radiation dermatitis. METHODS: 36 Sprague Dawley rats were randomized into six groups, namely, K1 (negative control-without therapy), K2 (positive control-hydrocortisone cream 2.5%), P1 (Aloe vera oil), P2, P3, and P4 (ozonized Aloe vera oil 300/600/1200 mg/ml). Termination and immunohistopathological analysis of TGF-β expression and collagen density were performed after 7 days of treatment. RESULTS: Measurement of TGF-β expression by ANNOVA test showed a significant difference between groups p = 0.001. The Post Hoc LSD test showed significant differences between groups K1 and P1, P2, P3, and P4 also between groups K2 and P2, P3, and P4. Measurement of collagen density by Kruskal–Wallis test showed a significant difference between the treatment groups p < 0.001. Post hoc Mann–Whitney test of collagen density found a significant difference between groups K1 and P1, P2, P3, and P4 also between groups K2 and P2, P3, and P4. Spearman’s rho correlation test showed a strong and unidirectional relationship between TGF-β and collagen (p < 0.001 and r = 0.722). CONCLUSION: Topical ozonated Aloe vera oil increased TGF-β expression and collagen density in radiation dermatitis.

Liposomal Ozonated Oil in Ocular Infections: A Review of Preclinical and Clinical Studies, Focusing on Its Antiseptic and Regenerative Properties

Ozonated oil has shown antimicrobial, anti-inflammatory and regenerative properties that make it useful in the prevention of infectious diseases and also as an adjuvant in wound-healing management. This review brings together most aspects of the use of liposomal ozonated oil for ocular infections and regeneration of the ocular surface. A search was performed in PubMed, Medline, Web of Science and Cochrane Library for studies published by June 2021. Search terms were combined to sort out papers on the properties and use of ozonated oil in ocular infections. A total of 25 publications were selected for this review on the composition, mechanism of action, restorative action, and preclinical and clinical studies of liposomal ozonated oil focused on ocular infections. In patients with complicated corneal pathology, liposomal ozonated oil has been found to restore corneal ulcers and improve keratitis. In patients with ocular pathologies involving inflammation and infections, liposomal ozonated oil has been found to improve and almost completely restore the signs of vernal, granulomatous and even adenoviral conjunctivitis. Liposomal ozonated oil has also been found to be effective in reducing ocular microbial flora. In conclusion, liposomal ozonated oil has an antiseptic and regenerative effect on corneoconjunctival tissues. It has demonstrated efficacy and safety profile for its use in ocular infections and can be considered as a suitable supportive strategy both alone and combined with other antimicrobial agents.

Local Ozone Therapy in Complex Treatment of Venous Leg Ulcers: Ozone therapy for venous leg ulcers

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.

A single-center prospective pilot open-label study to assess the efficacy of topical application of an oxygen-enriched oil for the treatment of angular cheilitis

PURPOSE

The aim of this pilot study was to clarify the acceptability and clinical efficacy of an oxygen-enriched oil-based gel for treatment of angular cheilitis.

METHODS

A class IIb medical preparation, packaged in appropriate syringes, was tested. Patients were instructed how to use the gel for 10 days: finger rub application (3 times daily) on the dried lesion after meals, without eating, drinking, or speaking for at least 30 min thereafter. The Wilcoxon signed-rank test was used to assess whether there were any differences in the distributions of reported pain and lesion dimension. A microbiological examination was also performed with oral swabs; chi-squared test was used to compare the difference in the presence of microorganisms before and after treatment.

RESULTS

Thirty patients were treated. A significant improvement in reported outcome and a significant reduction in the initially measured largest dimension of the lesion were observed after use of the clinical protocol. Additionally, a significant reduction in the pathogen count was found.

CONCLUSION

Even if with limitations, data showed that this medical preparation facilitated prompt recovery from reported pain, without adverse reactions. Further work with a larger study population, and possibly a randomized control medication, will be needed.

Effectiveness of Ozone Therapy as an Adjunct Treatment for Lower-Limb Ulcers: A Systematic Review

OBJECTIVE

To evaluate the effectiveness of topical ozone therapy as an adjuvant treatment in the healing of lower limb ulcers through a systematic literature review.

DATA SOURCES

Three databases were used to search for studies conducted in the period up to and including September 2020: PubMed, Scopus, and the Web of Science.

STUDY SELECTION

The search identified 44 studies, 7 of which met the eligibility criteria and were evaluated.

DATA EXTRACTION

Study design, study location, number of patients, patient age, type of control, wound type, intervention type, equipment used to generate ozone (ozone generation), evaluation methodology, and main results were extracted from each study.

DATA SYNTHESIS

A total of 506 patients 18 years or older with chronic wounds, such as venous or diabetic ulcers, on the lower limbs were enrolled. The majority of studies addressed diabetic foot ulcers.

CONCLUSIONS

The ozone therapy protocols demonstrated a healing effect in all included studies, and none reported adverse effects. This reinforces the need for more controlled and randomized clinical trials to determine the effectiveness of this treatment and establish clinical criteria for its use.

Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017-2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient's age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1-36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

An evaluation of the effect of ozone therapy on tissues surrounding dental implants

BACKGROUND

Dental implant surgery despite its growing popularity poses several challenges like include tissue inflammation, pain discomfort and tissue injury.

OBJECTIVE

To evaluate the effect of ozone therapy on inflammation, pain and wound healing after implant surgery.

METHODS

A clinical study was conducted on 60 systematically healthy patients- 30 patients treated with ozone (Experimental group) and 30 patients without ozone treatment (control group). In the control group osteotomy procedure was performed with saline irrigation and in the experimental group irrigation was done with ozonated water at 25 µg/mL concentration, along with ozone gas. Clinical assessment was done by evaluating C-reactive Protein (CRP) for inflammation, pain using Visual Analogue Scale (VAS) score and tissue wound healing using wound healing index. Side effects, if any, were noted.

RESULTS

Postoperative increment in CRP levels was 0.10 and 0.63 mg/dl in Experimental and control groups respectively (p < 0.001). At 24-hr, 48-hr and 7 day post-operative intervals mean VAS scores for pain were significantly higher in Control group as compared to that in Experimental Group (p < 0.001). At day 7, mean VAS scores for pain were 3.50 ± 0.63 and 37.70 ± 4.17 in Experimental and Control groups respectively (p < 0.001). Mean tissue healing indices were significantly higher on Day 7 and Day 14 in Experimental Group (4.23 ± 0.43 and 4.97 ± 0.18) as compared to that in control group (3.07 ± 0.45 and 4.03 ± 0.18) (p < 0.001). No potential side effects were noted in either of two groups.

CONCLUSION

Ozone therapy accelerated the tissue wound healing, minimized tissue inflammation and decreased pain.

Evaluation of a New Tubular Finger Oxygen-Enriched Oil Inside-Coated Dressing Device in Pediatric Patients Undergoing Distal Hypospadias Repair: A Prospective Randomized Clinical Trial Part II

Background: This study was the second part of a prospective randomized clinical trial and aimed to evaluate the use of a tubular finger oxygen-enriched oil inside-coated dressing device and its effect on the post-operative outcome of children undergoing distal hypospadias repair. Methods: A prospective single-blinded randomized clinical trial was carried out between September 2019 and September 2020. We included all patients with distal hypospadias, who received Snodgrass urethroplasty and preputioplasty. The patients were randomized in two groups according to the type of dressing: tubular finger oxygen-enriched oil inside-coated device (G1) and elastic net bandage with application of oxygen-enriched oil-based gel (G2). The patients were evaluated at 7, 14, 21, 30, and 60 post-operative day (POD). Results: Sixty-four patients (median age 14 months) were included in the study and randomized in two groups, each of 32 patients. Post-operative preputial edema rate was significantly lower in G1 (3/32, 9.3%) compared with G2 (10/32, 31.2%) (p = 0.001). The median duration of preputial edema was significantly shorter in G1 compared with G2 (6 vs. 10.5 days) (p = 0.001). Penile diameter measurements at 4th, 7th, 14th POD proved that entity and duration of post-operative swelling were objectively decreased using the new dressing. The wound healing was significantly faster in G1 compared with G2 (14.2 vs. 18.5 days) (p = 0.001). The post-operative complications rate was significantly lower in G1 (0%) compared with G2 (3/32, 9.3%) (p = 0.001). Foreskin dehiscence occurred in two G2 patients (6.2%) whereas, breakdown of urethroplasty and preputioplasty occurred in one G2 patient (3.1%) due to scratching injuries. The dressing management was subjectively assessed by nurses to be easier in G1 patients compared with G2 ones (median score 1.2 vs. 3.5) (p = 0.001). The median treatment costs were significantly lower in G1 compared with G2 (55 vs. 87 eur) (p = 0.001). No adverse skin reactions occurred. Conclusions: Post-operative dressing using tubular finger oxygen-enriched oil inside-coated device was highly effective, easy to manage, cheaper and associated with a lower rate of foreskin and urethral complications compared with the standard dressing method in pediatric patients undergoing distal hypospadias repair. It was also clinically safe without allergy or intolerance to the product.

Evaluation of efficacy of oxygen-enriched oil-based gel dressing in patients who underwent surgical repair of distal hypospadias: a prospective randomised clinical trial

Purpose

This study aimed to evaluate the efficacy of oxygen-enriched oil-based gel dressing on wound healing and postoperative outcome in children who underwent distal hypospadias repair.

Methods

We included all patients with distal hypospadias, who underwent Snodgrass urethroplasty and preputioplasty over an 18-months period. The patients were randomized in two groups according to the type of medication: oxygen-enriched oil-based gel (G1) and hyaluronic acid cream (G2). After discharge, parents changed the dressing twice a day for 2–3 weeks postoperatively. The patients were evaluated at 7, 14, 21, 30, 60 and 180 postoperative days and thereafter annually.

Results

One-hundred and fourteen patients (median age 18 months) were included in the study and randomized in two groups, each of 57 patients. The wound healing was significantly faster in G1 compared with G2 (p = 0.001). G1 reported significantly higher SWAS and modified HOPE scores compared with G2 (p = 0.001) at all steps of follow-up. No adverse skin reactions occurred. Foreskin dehiscence and re-operations rates were significantly lower in G1 compared with G2 (p = 0.001). Postoperative foreskin retractability was better in G1, with a significantly higher incidence of secondary phimosis in G2 (p = 0.001). The median treatment costs were significantly lower in G1 compared with G2 (p = 0.001).

Conclusion

Postoperative dressing using oxygen-enriched oil-based gel was highly effective, promoting a faster wound healing in patients who underwent distal hypospadias repair. It reported a lower incidence of foreskin dehiscence and better foreskin retractability compared with the control group. It was cost-effective and clinically safe without allergy or intolerance to the product.

Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol

Background: The advent of pediatric endoscopic pilonidal sinus treatment (PEPSiT) has dramatically changed the surgical management of pilonidal sinus disease (PSD) in children and adolescents. This study aimed to report the outcome of our new structurated protocol, including PEPSiT, laser epilation, and oxygen-enriched oil-based gel dressing, for treatment of PSD in pediatric patients and describe tips and tricks of the technique. Methods: We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period. All patients received laser epilation (LE) before and after surgery. Post-operative dressing was performed using silver sulfadiazine spray and in the last 18 months oxygen-enriched oil-based gel. We divided the patients in two groups according to the protocol adopted: G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients and G2 (laser + silver sulfadiazine spray dressing) included 55 patients. The two groups were compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction. Results: No difference emerged between the two groups regarding the average operative time, the average post-operative pain score, the average analgesic requirement, the average hospitalization and the average time to full daily activities (p = 0.33). No intra- or post-operative complications including wound infection occurred in both groups. The patients required an average number of 7 LE sessions (range 4-10) to achieve complete hair removal. The overall success rate was significantly higher in G1 (n = 71, 98.6%) compared with G2 (n = 50, 90.9%) [p = 0.001]. The recurrence rate was also significantly lower in G1 (n = 1, 1.4%) compared with G2 (n = 5, 9%) [p = 0.001]. Furthermore, G1 reported a faster wound healing (average 21 days) compared with G2 (average 29 days) [p = 0.001] and a higher patient satisfaction score (average 4.9) compared with G2 (average 4.2) [p = 0.001]. Conclusions: Based upon our experience, PEPSiT may be considered the standard of care for surgical treatment of PSD in children and adolescents. Our new structurated protocol consisting of pre-operative LE, PEPSiT, and post-operative wound management with oxygen-enriched oil-based gel dressing and LE, allowed to achieve an excellent outcome, with a success rate > 98%.

Ozone therapy a new vista in dentistry: integrated review

Application of ozone in oral care comes as new and alternative treatment modality in dentistry. The impact of biological and digital information leads to use of ozone application by various means for numerous treatment options in oral cavity. Ozone is a form of oxygen, which has an effective role in management of oral diseases. This review mainly emphasizes on utility of ozone in oral health care management. Its therapeutic potential and its clinical application in oral pathologies, periodontology, endodontics, oral surgery, prosthodontics, orthodontics, restorative dentistry, wound healing, tooth mineralization as treatment choice are reviewed.