1. DR.WAGDY ELTAIAR

2. OZONE THERAPY By Dr.Med.WAGDY EL Taiar Ozone Therapy Expert Member of international Ozone association Manager for Almahmoud medical center

3. DR.WAGDY ELTAIAR What is Ozone? Oxygen with 3 atoms O3 Created by O2 + Ultraviolet Rays O2 + High Voltage (lightning) O2 + Sea Waves

4. DR.WAGDY ELTAIAR What is Ozone? *Upper atmosphere… Ozone Layer *Lower atmosphere … Reduce Hydrocarbons

5. DR.WAGDY ELTAIAR History of Medical Ozone C. Lender 1870 (ozone purify the blood) In Holland 1893 Water treatment with ozone (now more than 3000 in the world) War I 1914-1918 ozone used to treat wounds, foot gangrene and effect of poisonous chlorine gas

6. DR.WAGDY ELTAIAR History of Medical Ozone Dr.Otto Warburg awarded Noble Prize in Medicine in 1931 and in 1944 for his discovery of the basic cause of cancer in damaged cell respiration. In 1983 first International Medical Ozone Association conference was held in Washington

7. DR.WAGDY ELTAIAR Approval of use of Ozone in Medicine After 130 years of usage it is approved in 22 countries: Germany, France, Italy, Russia, Romania, Poland, Bulgaria, Hungary, Czech Republic, Japan, Singapore, Cuba, Mexico, Britain and 25US states. In December 1999 approved in Egypt as an Adjuvant Therapy

8. DR.WAGDY ELTAIAR Mode of Action of Ozone Inactivation of bacteria, viruses, fungi and protozoa: –Disrupts the integrity of bacterial cell envelope through oxidation of the phospholipids and lipoproteins. –Damages viral capsid and upsets reproductive cycle by disrupting virus-to-cell contact with peroxidation. – Inhibits cell growth at certain stages in fungi

9. DR.WAGDY ELTAIAR Mode of Action of Ozone Enhancement of Circulation: –Reduce clumping of red cells and restore its flexibility and oxygen carrying ability. –Arterial oxygen partial pressure increases and viscosity decreases leading to better tissue oxygenation – Oxidizes plaque in arteries allowing removal of the breakdown products.

10. DR.WAGDY ELTAIAR Mode of Action of Ozone Stimulation of oxygen metabolism: –Increases red blood cell glycolysis rate  stimulation of 2,3-diphosphoglycerate (2,3- DPG)  increase of oxygen released to tissues. –Activates Krebs cycle by enhancing oxidative carboxylation of pyruvate  stimulating production of ATP.

11. DR.WAGDY ELTAIAR Mode of Action of Ozone Stimulation of the production of the enzymes which act as a free radical scavengers and cell wall protectors:Glutathione Peroxidase, Catalase, and Superoxide Dismutase Production of Prostacycline  vasodilatation.

12. DR.WAGDY ELTAIAR Mode of Action of Ozone Dissolution of malignant tumors: –Ozone inhibits tumor metabolism, oxidizes the outer lipid layer of malignant cells and destroys them through cell lysis Ozone increases the ability of phagocytes to kill tumor cells (by stimulation of conversion of arginine to citrulline, nitrite and nitrate by phagocytes)

13. DR.WAGDY ELTAIAR Mode of Action of Ozone Activation of the immune system: stimulates production of – Interferon –Tumor necrosis factor (TNF) –Interleukin 2

14. Reactive Oxygen Species (ROS) Medical ozone  Peroxides (at physiological pH < 8) easily penetrates cell membrane. e.g.: Hydrogen peroxide (H 2 O 2 ). e.g.: Lipid peroxides.  in plasma “lipoproteins”  in cell membrane [Polyunsaturated fatty acids] Hydroperoxides DR.WAGDY ELTAIAR

15. Erythrocytes:  ATP  2,3 DPG facilitates transfer of O 2 to tissues  clumping - enhances blood flow. Mononuclear cells (monocytes - lymphocytes). Physiological release of cytokines. O 3 modulates immune system. Neutrophils. Platelets.Endothelial cells. Activates body’s own antioxidant and radical scavengers. O 3 Action: Activates cellular metabolism: DR.WAGDY ELTAIAR

16. Conditions treated by Ozone As ozone works on the cellular level so it can be used in many conditions and in different specialties

17. DR.WAGDY ELTAIAR Conditions treated by Ozone Viral diseases e.g. Hepatitis, AIDS, Herpes Zoster Bacterial diseases e.g. infected wounds, diabetic foot, infected burns, chronic sinusitis Degenerative diseases and Disturbances of the immune system e.g. Rheumatic diseases and Rheumatoid disorders

18. DR.WAGDY ELTAIAR Conditions treated by Ozone Exhaustion, nervous tension, pain in general Vascular diseases e.g. atherosclerosis, disturbances in peripheral blood circulation Malignancy in combination with chemotherapy and/or radiotherapy Obesity and hyper-chlesterolaemia And many other conditions (around 190 disease or medical problem)

19. DR.WAGDY ELTAIAR

20. OZONE does Not Rule Out Classic Medicine

21. DR.WAGDY ELTAIAR But OZONE Has Remarkable Results # In Combination with Classic Medicine # If Classic Medicine Can Not be used due to Ineffectiveness Or Side-effects

22. DR.WAGDY ELTAIAR Ozone side effects In comparison to many other therapeutic modalities it has far less side effects

23. DR.WAGDY ELTAIAR CONTRA-INDICATIONS Thyrotoxicosis Favism

24. DR.WAGDY ELTAIAR CONTRA-APPLICATIONS Inhalational Direct Intravenous

25. DR.WAGDY ELTAIAR OZONE THERAPY in BACK PAIN

26. DR.WAGDY ELTAIAR Conditions Treated Myalgia Muscle Spasm Disc Prolapse Fatigue and overexertion of Back muscles

27. DR.WAGDY ELTAIAR Methods of Treatment Chemical Acupuncture in Pravertebral Muscle Intra-Discal injection Epidural injection Ozone Sauna

28. DR.WAGDY ELTAIAR

30. Chemical Acupuncture The iliac crests are palpated and transiliac line is determined to identify the L4 spinous process. The inter-spinous spaces are identified by selecting the space corresponding to the herniated disc. Roughly 2 cm are calculated bilaterally to the spinous process.

31. DR.WAGDY ELTAIAR Chemical Acupuncture Once the needle is inserted through the fasciae, material is aspirated while holding the needle still and a 20  /ml of an oxygen- ozone mixture is injected very slowly up to a maximum of 10 ml per infiltration. Aspiration is repeated during infiltration (Tabaracci, 2001)

32. DR.WAGDY ELTAIAR How does Ozone Injected Intra- muscularly Work? It infiltrates the muscle and in 24 hours some ozone moves towards the vertebral canal (as seen radiologically). Ozone dissolves into the interstitial water of the muscle and will generate H2O2, that will inhibit amyelinic fibers (C-nociceptors) and activates the anti-nociceptive system.

33. DR.WAGDY ELTAIAR How does Ozone Injected Intra- muscularly Work? As occurs during acupuncture (Ceccherelli et al, 1995), the introduction of the needle, re-enforced by the pressure of O2-O3 induces strong inhibition of nociceptors, and prolonged due to H2O2

34. DR.WAGDY ELTAIAR How does Ozone Injected Intra- muscularly Work? It is known that an algic stimulation of the skin and muscles can reduce pain through the mechanism of diffuse noxious inhibitory control (DNIC), that is why: the needle+H2O2+oxygen pressure can be translated into chemical acupuncture (Bocci, 1998)

35. DR.WAGDY ELTAIAR Comparative Studies on Back Pain due to Disc Prolapse Paravertebral injection of O2-O3 –75% satisfactory response Epidural injection with dexamethazone –55% satisfactory response Paraverteral injection of bupivacaine 0.25% –70% satisfactory response (Gionovich et al. 2001)

36. DR.WAGDY ELTAIAR Intra-Discal Injection Direct intradiscal injection of 3-10 ml of O2-O3 with conc. Of 20  g/ml. Several thousands of patients have been treated with a success rate of 54-86% (Alexandre et al. 1998,Jucopilla et al. 2000, Bonetti 2001 et al.,Fabris 2001 et al., Leonardi et al. 2001, Petralia et al. 2001)

37. DR.WAGDY ELTAIAR How Intra-Discal Injection Works? Ozone dissolves in the interstitial water and reacts immediately generating a cascade of ROS, among which H2O2 and possibly hydroxyl radical OH, which is most reactive. The hydroxyl radical reacts with carbohydrates and amino-acids composing proteoglycans and collagen type I and type II, major components of the degenerate nucleus pulposus leading to its breakdown (McCord 1974,Curran et al. 1984,Hawkins et al. 1996,Bocci et al. 2001,Leanardi et al. 2001)

38. DR.WAGDY ELTAIAR How Intra-Discal Injection Works? Consequently re-absorption of hydrolytic products and water may lead to progressive shrinkage and disappearance of of the herniated material

39. DR.WAGDY ELTAIAR there is an MD Research on this topic been carried on, in Neurology Department in the Faculty of Medicine, Ain Shams University with promising results

40. DR.WAGDY ELTAIAR Mechanisms Release of endorphins blocks transmission of the noxious signal to the thalamus and cortex Hypo-stimulation (elevation of the activation threshold) linked to the oxidative degeneration of C-nociceptors. H2O2 may act like capsaicin.

41. DR.WAGDY ELTAIAR Mechanisms Activation of the descending nociceptive system. Simultaneous psychogenic stimulation of the central analgesic system induced by the gas injection (elicitation of a placebo effect).

42. DR.WAGDY ELTAIAR Mechanisms The localized oxygenation and analgesia permit muscle relaxation and vasodilatation, and thus a reactivation of muscle metabolism, by favoring oxidation of lactate, neutralization of acidosis. Increased synthesis of ATP,Calcium reuptake and reabsorption of oedema.

43. DR.WAGDY ELTAIAR Conclusion Results are remarkable Safe and less invasive Used widely in Italy with wonderful results in thousands of patients BUT –Some of the mechanisms are postulations –Not enough combined researches with rheumatology or orthopedic doctors

44. DR.WAGDY ELTAIAR Conclusion The field is open for intensive researches to make use and settle down the benefit of OZONE in BACK PAIN, a safe, easy, effective, non-invasive, simple method.

45. DR.WAGDY ELTAIAR Thank You