Manejo da sede: perspectiva do paciente cirúrgico queimado / Thirst management: perspective of burnt surgical patient

Objetivo: explorar a percepção de um paciente cirúrgico queimado em relação à sede e seu manejo no período pré-operatório e pós-operatório imediato. Relato de caso: trata-se de um estudo com abordagem qualitativa, exploratória, do tipo estudo de caso. Os critérios de inclusão foram: paciente estar internado no centro de tratamento de queimados, ser submetido a procedimento cirúrgico ou balneoterapia, ter experenciado a sede no período pré-operatório ou pós-operatório e ter recebido o manejo da sede. Para a coleta de dados utilizou-se entrevista semiestruturada, gravada e transcrita. Paciente do sexo feminino, de 32 anos, admitida com queimaduras de segundo grau em extensão de tórax, membros superiores e pescoço por tentativa de autoextermínio com álcool. Passou por seis procedimentos e esteve internada por 15 dias até o momento da coleta. Experienciou o desconforto sede durante o jejum pré-operatório e pós-operatório, considerado intenso e muito estressante durante sua internação. Conclusão: a partir da identificação do desconforto sede, utilizou-se como estratégia o picolé de gelo, que fez diferença em seu tratamento. O modelo de manejo da sede é pioneiro no cuidado ao paciente queimado e apresenta benefícios para minorar a sede.

Objective: explore thirst perception of a burnt surgical patient and its management in the preoperative and immediate postoperative period. Case report: study with a qualitative and exploratory approach, named as case study. Inclusion criteria were: inpatient at burnt treatment unit, undergone surgical procedure or balneotherapy, experienced thirst in the preoperative or postoperative period and received thirst management. For data collection, semi-structured interviews were performed, recorded and transcribed. Female patient, 32 years old, admitted with second degree burns in extension of thorax, upper limbs and neck due to attempted self-extermination with alcohol. Underwent six procedures and was hospitalized for 15 days until the data collection. Experienced thirst discomfort during preoperative and postoperative fasting, which was considered intense and very stressful during his hospitalization. Conclusion: since the identification of thirst discomfort, the ice popsicle was used as a strategy, which made difference in her treatment. The thirst management model is pioneer in care of burnt patients and has benefits to alleviate thirst.

Análise comparada do termalismo social nos sistemas de saúde europeus: contribuições para o SUS / Comparative analysis of social thermalism in European health systems: contributions to SUS

O termalismo social refere-se ao acesso aos tratamentos termais como direito de cidadania. A pesquisa buscou comparar a inserção do termalismo social nos sistemas de saúde da Espanha, França, Itália e Portugal, por meio dos componentes dos sistemas (acesso/cobertura, financiamento, força de trabalho, insumos e técnicas, organização, regulação, rede de serviços e prestação de serviços) com vistas a contribuir com o termalismo no Sistema Único de Saúde. (SUS). Foi utilizado o método de revisão integrativa da literatura. A base de dados da pesquisa foi fundamentada em artigos científicos disponíveis em bases de dados eletrônicas que abordam o termalismo nos países selecionados na pesquisa. Foi realizada busca reversa com base nas referências dos artigos selecionados, além de artigos publicados em revistas eletrônicas não indexadas relacionadas ao termalismo nos últimos 20 anos. Totalizaram-se 22 documentos incluídos no estudo. Os dados foram analisados através da Análise de conteúdo de Bardin. Os resultados e discussões são apresentados em oito categorias: caracterização histórica do termalismo social nos sistemas de saúde analisados; grau de cobertura/acesso, financiamento; força de trabalho, insumos e técnicas; organização e regulação; rede e prestação de serviços. Os modelos de seguro e seguridade social cobrem parte do tratamento termal dos países europeus selecionados, financiados a partir de co-pagamento e reembolso. Com relação à força de trabalho, diversas são as profissões relacionadas ao termalismo, notadamente médicos especialistas. No que concerne aos insumos e técnicas dos tratamentos termais, observa-se a grande aproximação com os países selecionados. Contudo, o número de dias do ciclo de tratamento termal cobertos nos sistemas analisados variaram entre os países. Ainda quanto aos insumos, observou-se que os balneários dos países europeus são classificados de acordo com as características físico-químicas das águas minerais. Os serviços de termalismo social são regulados principalmente pelo Ministério da Saúde de cada país, excetuando-se o programa de termalismo espanhol, pois ali é definido como um dos serviços complementares dos benefícios do serviço de Seguridade Social. Por fim, a prestação de serviços de termalismo social nos países analisados é preponderantemente realizada em estabelecimentos termais credenciados. Estes serviços estão, portanto, localizados no nível de atenção especializada e são referenciados pelos profissionais médicos da atenção primária à saúde. Considera-se que no Brasil faz-se necessário ampliar o financiamento do termalismo social, capacitar a força de trabalho, elaborar protocolos de tratamentos com tratamentos de, no mínimo, 9 dias, classificar os balneários brasileiros de acordo com as indicações a partir das qualidades de suas águas, e criar centros especializados em termalismo em nível secundário. Observa-se ainda a necessidade de legislações especificas para fomentar e regular os estabelecimentos termais e o termalismo social.

Recuento histórico de la virtud curativa de las aguas minero-medicinales de San Miguel de los Baños / Historical review of the curative virtue of mineral-medicinal waters of San Miguel de los Baños

RESUMEN San Miguel de los Baños surgió y se desarrolló gracias a sus aguas mineromedicinales. Con el objetivo de determinar el origen, estudio y caracterización de estas se realiza revisión bibliográfica, mediante la consulta de bibliografías y documentos históricos recopilados; la información se buscó sin restricción de fecha de publicación, por descriptores, en bases de datos de la Biblioteca Virtual de Salud y por Google, en pos de hallar publicaciones, artículos y archivos que contuvieran en las palabras clave, determinándose que en los momentos fundacionales y durante el funcionamiento del balneario se realizaron estudios de caracterización, uso y terapéutica de las aguas provenientes de los manantiales: "El Tigre" y "La Salud"; desde 1962 no se brinda atención médica, desde 1984 a la fecha solo constan estudios geo- mineros, físico-químicos y bacteriológicos. La población local hace uso de estas aguas sin indicación, dosis y registro. No se han publicado estudios basados en la evidencia necesarios para la prescripción actual (AU).

Summary San Miguel de los Baños was founded and developed thanks to its mineral- medicinal waters. A bibliographic review was carried out with the objective of determining the origin, study and characterization of these waters consulting bibliography and historical documents, searching information without publishing date restriction, using descriptors in databases of the Virtual Health Library and Google for publications, articles and files having the used key words. The authors arrived to the conclusion that in the times of foundation and during the years of the spa functioning, there were carried out studies on characterization, use and therapeutic of the waters running from the springs "El Tigre" and "La Salud"; medical care is not provided since 1962; only geo-mining, physic-chemical and bacteriological studies were carried out from 1984 up to the date. Local population uses the waters without prescription, doses or recording. No evidence-based studies were published for their current prescription (AU).

IL-10 Cytokine as Potential Biomarkers in Women with Fibromyalgia Who Underwent to a Short Balneotherapy Treatment

Abstract Fibromyalgia (FM) is a nonarticular rheumatic syndrome that leads to diffuse myalgia, sleep disturbances and morning stiffness. Balneotherapy has been shown an effective strategy to improve the health conditions of patients; however, the treatment follow-up is based on patient report due to the lack of biomarkers. Thus, this study evaluated the application of cytokines and phosphoglycerate mutase I (PGAM-I) to monitoring FM patient underwent to balneotherapy treatment. Eleven healthy and eleven women with FM were submitted to daily sessions of balneotherapy during 10 days. Clinical and quality of life parameters were assessed through a FIQ questionnaire. Blood levels of TNF-(, interleukins (IL-1, IL-2 and IL-10) and PGAM-I expression in patients' saliva were also evaluated. Patients with FM showed significant improvements in their clinical status after treatment. Also, FM patients has IL-10 levels lower than healthy women and the balneotherapy increased the expression of this cytokine in both groups, concomitantly to pain relief. Although inflammatory cytokines (IL-1, IL-2 and TNF-() were more expressed in FM patients than healthy patients their levels did not reduce after treatment. A slight increase of PGAM-I expression was observed. In conclusion, IL-10 levels could be a useful biomarker to balneotherapy follow-up of FM patients. However, these findings must be analyzed in a larger number of patients in order to validate IL-10 as an effective biomarker.

Effectiveness of short-term physical agents treatment on macroscopic morphology in patients with plaque psoriasis / Efectividad del tratamiento a corto plazo de los agentes físicos en la morfología macroscópica de las placas de psoriasis

Psoriasis is a chronic inflammatory disease that presents skin rashes which can arise through plaques. The aim of this work was to compare the effectiveness of short-term physical agents treatment on macroscopic morphology (area and erythema) in patients with plaque psoriasis. This prospective randomized experimental study included fourteen subjects, medically diagnosed with psoriasis, with more than one plaque in the skin and voluntarily without topical treatment. All subjects completed the study that consisted of 12 treatment sessions divided in control (C), artificial balneotherapy (AB), phototherapy (PT) or balneophototherapy (BPT) groups. After session 12, there was a significant reduction of the plaque area by all treatments when compared to C group and BPT was the most effective one. However, only AB and PT presented a reduction of erythema. Regarding severity, 9 patients changed to a lower category on the PASI test, and 5 of them maintained a mild psoriasis, but lowered their score. Finally, 13 of 14 subjects improved their quality of life. The physical agents used reduced the severity of psoriasis and improved quality of life of patients after 12 sessions of treatment during a onemonth period. The BPT was the more effective in controlling psoriasis by diminishing its area and PT by attenuating the erythema.

La Psoriasis es una enfermedad inflamatoria crónica que presenta irritación cutánea que puede derivar a placas. El objetivo de este trabajo fue comparar la efectividad del tratamiento a corto plazo con agentes físicos en la morfología macroscópica (área y eritema) en pacientes con placas de psoriasis. Estudio experimental, prospectivo, randomizado. Catorce sujetos participaron con diagnóstico médico de psoriasis, con más de una placa en la piel y sin tener tratamiento tópico de forma voluntaria. Todos los sujetos completaron el estudio, el cual consistió de 12 sesiones de tratamiento dividido en grupo control (C), BA, FT y BFA. Posterior a la sesión 12, se observó una reducción significativa en toda el área de las placas que recibieron tratamiento al compararlas al grupo C y el grupo BFA fue el más efectivo. Sin embargo, solo los grupos BA y FT presentaron una reducción del eritema. Respecto a la severidad, 9 pacientes cambiaron de la baja categoría en el test de PASI y 5 de ellos se mantuvieron en el nivel medio, pero disminuyeron su puntaje. Finalmente, 13 de 14 sujetos mejoraron su calidad de vida. Los agentes físicos usados redujeron la severidad de la psoriasis y mejoraron la calidad de vida de los pacientes después de 12 sesiones de tratamiento durante el período de un mes. La BFA fue la más efectiva en controlar la psoriasis por la disminución en el área y la FT por la atenuación del eritema.

Toxicidad a dosis repetidas (28 días) por vía oral del agua termomineral de San Antonio de Putina, Puno / Repeated dose 28-day oral toxicity study of hot springs water from San Antonio de Putina, Puno

Objetivo. Determinar la toxicidad a dosis repetidas durante 28 días, de la ingestión por vía oral del agua termal de San Antonio de Putina-SAP-(Puno), en un modelo murino. Materiales y métodos. Diseño experimental, se utilizaron diez ratas de experimentación de cepa Holtzman, los que fueron divididos en dos grupos de cinco cada uno: un grupo de estudio, al que se le administró en forma repetida, agua termal traída de SAP, en una dosis de 1000 mg/kg en un volumen de 2 mL/100g, y un grupo control con agua potable esterilizada en el mismo volumen. Se realizaron observaciones clínicas diarias, determinación semanal del peso corporal, y después de 28 días se procedió con el estudio histopatológico de órganos (corazón, riñón, hígado y pulmón) y la determinación de parámetros hematológicos y bioquímicos; previo sacrificio de los animales de experimentación. Resultados. No se produjeron muertes (DL50> 1000 mg/kg) ni alteraciones permanentes de signos clínicos. Se observó aumento de peso, sin diferencias estadísticas entre los grupos. Los resultados hematológicos y bioquímicos reflejaron ligeras variaciones no significativas entre grupos, pero dentro del rango de la normalidad. No se observaron alteraciones histopatológicas. Conclusiones. No se encontraron signos de toxicidad aguda ante la administración de agua termomineral de San Antonio de Putina (Puno) en dosis repetidas por un periodo de 28 días.

Objective. To determine 28-day oral acute toxicity at repeated doses of hot springs water from San Antonio de Putina ­SAP- (Puno) in rats. Materials and methods. Experimental design, ten Holtzman rats were used, which were divided into two groups of five each: a study group that was exposed to repeated administration of SAP hot spring water in a dose of 1000 mg / kg in a volume of 2 mL/100g; and a control group, which sterilized water was given in the same volume. Daily clinical observations were made, weekly determination of body weight; and after 28 days; previous sacrifice of animals, the histopathological study of organs (heart, kidney, liver and lung) and determination of hematological and biochemical parameters were made. Results. No deaths (LD50> 1000 mg/kg) or permanent alterations of clinical signs were observed. Weight gain without statistical differences between the groups was observed. The hematological and biochemical results showed slight nonsignificant variations between groups, but in normality levels. No histopathological alterations were observed. Conclusions. No signs of acute toxicity were found after 28-days repeated administration of hot spring water from San Antonio de Putina (Puno).

Exercícios físicos aquáticos e equilíbrio em idosos: uma revisão sistemática / Aquatic physical exercises and balance in the elderly: a systematic review / Ejercicios físicos acuáticos y el equilibrio en los ancianos: una revisión sistemática

O objetivo foi verificar os efeitos de exercícios aquáticos no equilíbrio de idosos. Os artigos foram identificados por busca sistemática no Pubmed, SciELO e Lilacs, descritores "elderly", "exercise" e "water"; "elderly", "water" e "balance"; "elderly", "water" e "gait"; "elderly", "water" e "balance". A fase inicial totalizou 545 artigos e, afinal, ficaram 9 artigos para análise na revisão sistemática. Conclui-se que o exercício aquático é capaz de promover melhoras e manutenção no equilíbrio de idosos.

The objective was to verify the effects of aquatic exercises on the balance of the elderly. The articles were identified by systematic search in Pubmed, SciELO and Lilacs, descriptors "elderly", "exercise" and "water"; "Elderly", "water" and "balance"; "Elderly", "water" and "gait"; "Elderly", "water" and "balance". The initial phase totaled 545 articles and the final one was 9 articles for analysis in the systematic review. It is concluded that aquatic exercise is capable of promoting improvements and maintenance in the balance of the elderly.

El objetivo fue verificar los efectos de los ejercicios acuáticos sobre el equilibrio de los ancianos. Los artículos fueron identificados por búsqueda sistemática en Pubmed, SciELO y Lilacs, descriptores "ancianos", "ejercicio" y "agua"; "Ancianos", "agua" y "equilibrio"; "Ancianos", "agua" y "marcha"; "Ancianos", "agua" y "equilibrio". La fase inicial totalizó 545 artículos y la última fue de 9 artículos para su análisis en la revisión sistemática. Se concluye que el ejercicio acuático es capaz de promover mejoras y mantenimiento en el equilibrio de los ancianos.

A Survey on the Awareness of Balneotherapy in Dermatologic Outpatients and Dermatologists / 대한피부과학회지

BACKGROUND: Balneotherapy, although not a well-established treatment, has been used for dermatologic diseases from ancient to modern times. However, there is little knowledge regarding the current awareness of balneotherapy in dermatologic patients and dermatologists. OBJECTIVE: To understand the current situation of balneotherapy, we first evaluated the utilization and awareness of balneotherapy among dermatology outpatients and dermatologists. METHODS: A written questionnaires were completed by 183 outpatients who visited the Department of Dermatology at a University Hospital. Online questionnaires were completed by 37 dermatologists. RESULTS: Only a small percentage of the outpatients used thermal springs/spas for therapeutic purposes. On the contrary, 93% of them used it for leisure and rest. Most outpatients thought the cleanliness of water is the most important factor in thermal springs/spas. Both outpatients (81%) and dermatologists (81%) regarded balneotherapy as a medically unestablished folk remedy. Though regarded as a folk remedy, almost all outpatients (98%) thought that balneotherapy helps improve general health problems, such as fatigue and skin diseases, or conditions related to blood circulation, pain, and joint/muscle. Participants thought that dermatology and rehabilitation medicine can be connected to balneotherapy. Although they thought that balneotherapy can improve general health, most dermatologists (70%) mentioned that it is difficult to judge the efficacy of balneotherapy owing to the lack of sufficient evidence. CONCLUSION: Although not yet considered as a confirmative therapeutic modality owing to the lack of medical verification, there is positive recognition and outlook for the effect of balneotherapy in Korea. To offer precise information to patients, more attention from dermatologists would be needed to confirm its actual efficacy.

Efecto terapéutico de las aguas mineromedicinales en el tratamiento de la gingivoestomatitis herpética aguda / Therapeutic effect of medicinal mineral needles in the treatment of acute herpetic gingivostomatitis

Introducción: el empleo de las aguas con fines curativos, se remonta a épocas tempranas en la evolución del hombre. Objetivo: determinar el efecto terapéutico de aguas mineromedicinales en el tratamiento de gingivoestomatitis herpética aguda. Métodos: estudio analítico cuasiexperimental, en el Policlínico Gilberto Marquetty, Candelaria, Artemisa, en el periodo de octubre de 2011 a octubre de 2012, con un universo de 110 niños de 1 a 14 años diagnosticados con gingivoestomatítis herpética aguda. Por muestreo aleatorio simple se dividieron en dos grupos, Grupo 1 (Control) 55 pacientes, se aplicó tratamiento convencional con antihistamínico y analgésicos, prescripto por el facultativo. Grupo 2 (Estudio): 55 pacientes, se aplicó tratamiento con aguas mineromedicinales. Las variables estudiadas fueron edad, sexo, zona de residencia, síntomas colaterales, zonas anatómicas afectadas y evolución. Se consideró favorable cuando curó o mejoró y desfavorable cuando siguió igual o empeoró. La información se obtuvo por examen físico evolutivo al tercer, quinto y décimo día de tratamiento, evaluando sintomatología y cuadro clínico. Para el análisis de la información se utilizó distribución de frecuencias absolutas y porcentaje. Resultados: evolución satisfactoria, en menos días de tratamiento y con ausencia de reacciones adversas en los pacientes tratados con aguas mineromedicinales; el 50,90 por ciento de niños al tercer día de tratamiento estaban curados y el 96,36 por ciento, al décimo día. Conclusiones: las aguas mineromedicinales del manantial El Templado de San Diego de los Baños tiene efectos terapéuticos favorables en el tratamiento de las gingivoestomatitis herpética aguda en niños; se logró una evolución clínica favorable en menor tiempo que en el tratamiento convencional(AU)

Introduction: The use of needles with therapeutic aims dates back to early ages in humankind evolution. Objective: To determine the therapeutic effect of medicinal mineral needles in the treatment of acute herpetic gingivostomatitis. Methods: Quasi-experimental analytical study, in Gilberto Marquetty Polyclinic of Candelaria, Artemisa Province, from October 2011 to October 2012, with a target group of 110 children at ages 1-14 years diagnosed with acute herpetic gingivostomatitis. By random sampling, they were divided into two groups: 1 (control group, 55 patients), to which conventional treatment with antihistaminic and analgesics, prescribed by the doctor; 2 (study group, 55 patients), to which treatment was applied with medicinal mineral needles. The variables studied were age, sex, dwelling area, side symptoms, affected anatomical areas and natural history. It was considered favorable when healed or ameliorated; and unfavorable when remained the same or worsened. The information was obtained by followed-up physical examination after three, four and five days of treatment, evaluating symptoms and clinical frame. For information analysis, distribution of absolute frequencies and percentages were used. Results: Satisfactory natural history, in less than ten days of treatment and without side effects in patients treated with medicinal mineral needles. 50.90 percent of children were healed after three days of treatment and 96.36 percent after ten days. Conclusions: medicinal mineral needles from El Templado springs of San Diego de los Baños have favorable therapeutic effects in the treatment of acute herpetic gingivostomatitis in less time than the conventional treatments(AU)

Balneotherapy is a potential risk factor for Pseudomonas aeruginosa colonization

ABSTRACT The practice of immersion in burn patient has been abandoned in many parts of the world but in Brazil it is still common. The aim of this study was to ascertain if balneotherapy is a risk factor for Pseudomonas aeruginosa colonization in thermally injured patients. Eighteen patients from a Burn Center were studied for 14 weeks for Pseudomonas aeruginosa. Samples were collected by swabbing the exudate of wounds, before and after giving bath to the patients and from balneotherapy table. Pulsed-field gel electrophoresis was used to determine bacterial genetic relatedness. Thirty-seven P. aeruginosa isolates were detected from 292 swabs collected from patients' burn surface area and from the balneotherapy table. Profile analysis of P. aeruginosa DNA fragmentation showed 10 clones among the 37 strains analyzed. Type A is the most prevalent clone, with 23 strains distributed into eight subtypes. These were present in the swabs collected, before and after the patients' bath, from the surface of the bath table, suggesting that there was cross-contamination between the patients in different ways. This work demonstrates that balneotherapy is a risk factor in the Burn Center studied, because the same clone was found among P. aeruginosa isolates collected at various points and times.

RESUMO A prática de balneotarapia em paciente queimado foi abandonada em muitas partes do mundo, mas no Brasil ainda é comum. O objetivo deste estudo foi verificar se a balneoterapia é um fator de risco para a colonização por Pseudomonas aeruginosa em pacientes queimados. Dezoito pacientes internados em um Centro de Queimadura (CQ) foram acompanhados por 14 semanas. Amostras foram coletadas do exsudato de feridas, antes e depois do banho dos pacientes e também da mesa onde a balneoterapia foi realizada. A relação genética entre as cepas de P. aeruginosa foi determinada pela electroforese em gel de campo pulsado. Trinta e sete cepas foram detectadas a partir de 292 swabs coletados de área de superfície das feridas dos pacientes e da mesa de balneoterapia. Análise de fragmentação do DNA das 37 P. aeruginosa mostrou a existência de 10 clones. O tipo A foi o clone mais prevalente, com 23 cepas distribuídas em oito subtipos. Estas estavam presentes nas lesões dos pacientes antes e após o banho e na mesa onde o banho foi realizado, sugerindo contaminação cruzada inter e intra-pacientes e pacientes e mesa de banho. Este trabalho mostra que a balneoterapia é um fator de risco para colonização por P. aeruginosa, no CQ estudado, pois um mesmo clone da bactéria foi encontrado nos isolados coletados em vários pontos e épocas diferentes.

Immunomodulatory Effects of Deokgu Thermomineral Water Balneotherapy on Oxazolone-Induced Atopic Dermatitis Murine Model

BACKGROUND: Although the therapeutic mechanism of balneotherapy for atopic dermatitis has not been clarified, many atopic patients who visit thermomineral springs have shown clinical improvements. OBJECTIVE: This study was aimed to evaluate the immunomodulatory effect of thermomineral water balneotherapy on the atopic dermatitis murine model. METHODS: The oxazolone-induced atopic dermatitis murine model was used to evaluate the therapeutic effect of balneotherapy with Deokgu thermomineral water compared with distilled water. Histologic evaluation and confocal microscopic imaging were performed to analyze the lesional expression of cluster-of-differentiation (CD)4 and forkhead box p3 (Foxp3). Lesional mRNA expression of interleukin (IL) 33, thymic stromal lymphopoietin (TSLP), and Foxp3 was evaluated by real-time reverse transcription polymerase chain reaction. RESULTS: Compared with the distilled water bath group, confocal microscopic evaluation of CD4 and Foxp3 merged images showed increased expression of regulatory T cells in the thermomineral balneotherapy group. The lesional mRNA level of IL-33 showed a reduced trend in the thermomineral balneotherapy group, whereas the level of mRNA of Foxp3 was increased. TSLP showed a decreased trend in both distilled water and thermomineral water bath groups. There was a trend of reduced expression in lesional IL-33 mRNA but increased cell count of CD4+ Foxp3+ regulatory T cells in thermomineral balneotherapy compared with distilled water bath. CONCLUSION: Therefore, thermomineral balneotherapy can be an effective and safe adjuvant therapeutic option for atopic dermatitis.

Efficacy of Balneotherapy as an Adjuvant Treatment for Atopic Dermatitis at Yuseong Spa, Korea / 대한피부과학회지

BACKGROUND: Long-term use of various topical and systemic therapies for atopic dermatitis is associated with cutaneous and systemic adverse effects. Balneotherapy as an adjuvant treatment for atopic dermatitis has been extensively studied, and is considered effective and safe, in many countries. However, there is limited evidence from Korea, with only one previous report on the subject. OBJECTIVE: The aim of this study was to investigate the therapeutic efficacy and safety of balneotherapy in the treatment of atopic dermatitis in a Korean population. METHODS: Thirty atopic dermatitis patients were included in this randomized clinical trial evaluating the therapeutic efficacy of balneotherapy at Yuseong Spa, for four weeks. The patients were assigned to two groups: the control group (allowed treatment only) and balneotherapy group (additionally treated with balneotherapy). Assessment was made at baseline, and after 1, 2, and 4 weeks of treatment. RESULTS: At week 4, compared with the control group, the balneotherapy group showed significantly greater improvement in the eczema area and severity index score, physician's global assessment, patient's self global assessment, and in the measured value of transepidermal water loss. The visual analog scale for pruritus in the balneotherapy group decreased, whereas it increased in the control group. None of the patients experienced any adverse events. CONCLUSION: Our study suggests that balneotherapy may be beneficial, is safe, and may increase the quality of life for patients with atopic dermatitis.

Immunomodulatory Effects of Balneotherapy with Hae-Un-Dae Thermal Water on Imiquimod-Induced Psoriasis-Like Murine Model

BACKGROUND: Balneotherapy, although not a well-established dermatological treatment, is thought to have therapeutic properties for psoriasis and is used as an alternative treatment modality throughout the world. OBJECTIVE: To evaluate the mechanism underlying the therapeutic immunologic effects of thermomineral water. METHODS: A murine model of imiquimod-induced psoriasis-like skin inflammation was used for evaluating the therapeutic effects of balneotherapy with Hae-Un-Dae hot spring mineral water. The clinical improvements were evaluated by a dermatologist. Lesional cytokines, including interleukin (IL)-17A, IL-23, and IL-22, were quantitatively measured by real-time reverse transcriptase polymerase chain reaction. Serum levels of interferon-gamma, IL-4, IL-5, and IL-17A were measured by enzyme-linked immunosorbent assay. T cell proportions in the spleen were evaluated by flow cytometry, and histopathological evaluation of the skin was also performed. RESULTS: The mineral water balneotherapy group showed faster improvement in skin erythema and scales than the distilled water bathing group. A substantial reduction was observed in the lesional mRNA levels of IL-17A and IL-23 in the mineral water group. Serum levels of IL-4 and IL-5 were significantly decreased in the mineral water group but not in the distilled water group. Normalized T cell proportions were observed after bathing. CONCLUSION: Balneotherapy showed immunomodulatory effects in a psoriasis-like murine model. Balneotherapy suppressed lesional IL-23 and IL-17A, which are important cytokines in the pathogenesis of psoriasis. These results suggest that balneotherapy can be used as an effective and safe treatment for psoriasis.

Passive body heating improves sleep patterns in female patients with fibromyalgia

OBJECTIVE: To assess the effect of passive body heating on the sleep patterns of patients with fibromyalgia. METHODS: Six menopausal women diagnosed with fibromyalgia according to the criteria determined by the American College of Rheumatology were included. All women underwent passive immersion in a warm bath at a temperature of 36 ±1 °C for 15 sessions of 30 minutes each over a period of three weeks. Their sleep patterns were assessed by polysomnography at the following time-points: pre-intervention (baseline), the first day of the intervention (acute), the last day of the intervention (chronic), and three weeks after the end of the intervention (follow-up). Core body temperature was evaluated by a thermistor pill during the baseline, acute, chronic, and follow-up periods. The impact of this treatment on fibromyalgia was assessed via a specific questionnaire termed the Fibromyalgia Impact Questionnaire. RESULTS: Sleep latency, rapid eye movement sleep latency and slow wave sleep were significantly reduced in the chronic and acute conditions compared with baseline. Sleep efficiency was significantly increased during the chronic condition, and the awakening index was reduced at the chronic and follow-up time points relative to the baseline values. No significant differences were observed in total sleep time, time in sleep stages 1 or 2 or rapid eye movement sleep percentage. The core body temperature and Fibromyalgia Impact Questionnaire responses did not significantly change over the course of the study. CONCLUSION: Passive body heating had a positive effect on the sleep patterns of women with fibromyalgia.

Therapeutic Effects and Immunomodulation of Suanbo Mineral Water Therapy in a Murine Model of Atopic Dermatitis

BACKGROUND: Balneotherapy is widely used as an alternative treatment modality for AD. Although the clinical benefit of some mineral waters has been established, their mechanisms of action in alleviating AD are only partly understood. OBJECTIVE: The clinical modification and immunomodulatory or anti-inflammatory effects of mineral water from the Suanbo hot springs on the differentiation and cytokine production of Th1, Th2, and regulatory T cells (Treg) were investigated using spleen, skin tissue, and serum from NC/Nga mice. METHODS: The therapeutic effects of bathing in mineral water in a Dermatophagoides farinae body extract ointment (Dfb ointment)-induced AD mouse model were assessed by measuring the modified Scoring atopic dermatitis (SCORAD) index scores, transepidermal water loss (TEWL), histological and immunohistochemical changes of the skin lesion, serum levels of interferon (IFN)-gamma, interleukin (IL)-4, IL-5 and immunoglobulin E, mRNA expression of IFN-gamma, IL-4 and IL-5 of dorsal skin, and helper T cell differentiation in the spleen. RESULTS: Bathing in mineral water significantly reduced the modified SCORAD index scores, TEWL, epidermal hyperplasia, and inflammatory cell infiltration. IL-4 production and Th2 cell differentiation showed a decreasing tendency with mineral water bathing, but the Th1 cells did not. On the contrary, differentiation to Treg cells was promoted with mineral water bathing. CONCLUSION: Balneotherapy not only has anti-inflammatory activity, but also shows positive effects on cutaneous barrier homeostasis. These results suggest that the favorable effects of balneotherapy may be mediated by modifying the Th2 response, and possibly in part by inducing Treg cell differentiation.

Effect of Spa Spring Water on Cytokine Expression in Human Keratinocyte HaCaT Cells and on Differentiation of CD4+ T Cells

BACKGROUND: Skin acts as the first line of defense against any foreign materials outside of our body. In inflammatory skin disease, the pathogenesis is due to an immune reaction in the keratinocytes, immune cells and soluble mediators. Balneotherapy is widely used for the treatment of inflammatory skin disease, but the mechanisms are only partly understood by immune regulation. Balneotherapy in dermatologic disease can affect the secretion of pro-inflammatory cytokines, IL-1alpha and tumor necrosis factor from keratinocytes, and possibly affect the T cell differentiation. OBJECTIVE: In this study, we evaluated the effect of spa spring water from Yong-gung oncheon on the cells, and investigated the skin immune reaction. METHODS: We investigated the immunomodulatory or anti-inflammatory effect of thermal spring water on the expression of pro-inflammatory cytokines in the HaCaT cells under Toll-like receptor (TLR) stimulation, as well as the effect on the differentiation of CD4+ T cells under spring water. RESULTS: The treatment of spa spring water from Yong-gung oncheon decreased the expression of proinflammatory cytokines under TLR stimulation to the HaCaT cells and antigen presenting cells. In addition, spa spring water attenuated the differentiation process of subsets of CD4+ T cells, i.e., Th1, Th2 and Th17 cells. All these immune parameters can be used to evaluate the efficacy of spa spring water in Korea, in terms of the immune modulatory effect. CONCLUSION: Spa spring water treatment suppressed the inflammatory cytokines production and also modulated the differentiation of CD4+ T cells into Th1, Th2, and Th17 cells, but not the Tregs cells.

Clinical study of treating knee osteoarthritis (Bi syndrome of knee) by massage combined Chinese materia medica footbath fumigation and washing / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of treating knee osteoarthritis (KOA, Bi syndrome of knee) by massage combined Chinese materia medica (CMM) footbath fumigation and washing, and to observe the changes of the Lysholm knee score (LKSS).</p><p><b>METHODS</b>Totally 61 patients with grade I to III KOA were randomly assigned to two groups, the treatment group and the control group. Patients in the treatment group were treated with massage combined CMM footbath fumigation and washing, while those in the control group were treated with oral administration of meloxicam. They were treated for 20 days (times). The LKSS was assessed before treatment, 10 days of treatment, by the end of the treatment, and 1 month after treatment.</p><p><b>RESULTS</b>(1) The therapeutic efficacy in the treatment group was superior to that in the control group (P < 0.05). Thirteen cases were clinically controlled, with 11 markedly effective, 6 effective, and 1 ineffective in the treatment group, while 5 cases were clinically controlled, with 11 markedly effective, 10 effective, and 4 ineffective in the control group. (2) The LKSS: The post-treatment LKSS was higher than that before treatment in the two groups. The LKSS at 10 days (times) of treatment was lower in the treatment group than in the control group, but with no statistical difference (P > 0.05). The LKSS by the end of the treatment was higher in the treatment group than in the control group (P < 0.05). (3) The case number of patients in need of receiving the treatment again within 1-month follow-up and the difference between the LKSS at follow-ups and that by the end of the treatment were lower in the treatment group than in the control group (P < 0.01).</p><p><b>CONCLUSION</b>Massage combined CMM footbath fumigation and washing had better clinical efficacy on patients suffering from KOA.</p>

Germanidade e banhos medicinais nos primórdios dos balneários no Rio Grande do Sul / Germanism and medicinal bathing in the early days of health resorts in Rio Grande do Sul

Nos primórdios dos balneários no Rio Grande do Sul, encontravam-se alguns imigrantes alemães, não apenas entre os banhistas, mas também entre os empresários do incipiente ramo do curismo-turismo. Era um grupo pequeno de imigrantes de origem urbana que, em geral, já conhecia as vantagens curativas ou revigorantes dos banhos em balneários europeus. Entre eles destacavam-se os médicos, importantes emissores de um discurso científico em prol dos balneários. As práticas terapêuticas de banhos de mar chegaram ao Brasil meridional pela imigração européia da segunda metade do século XIX, embora sua difusão só tenha ocorrido na primeira metade do século seguinte, quando se desenvolveram as primeiras praias balneárias no Rio Grande do Sul.

Estudo comparativo entre tratamento convencional e tratamento com heparina tópica para a analgesia de queimaduras / Comparative study of conventional and topical heparin treatments for burns analgesia

OBJETIVOS: Este estudo prospectivo, randomizado, aberto e controlado por comparador ativo teve o objetivo de avaliar a eficácia analgésica e tolerabilidade da heparina não-fracionada administrada topicamente no tratamento de queimaduras. MÉTODOS: Cinquenta e oito pacientes do sexo masculino ou feminino foram randomizados para tratamento convencional (C) ou tratamento com heparina tópica (HT). Foram incluídos pacientes com: idade entre 18 e 55 anos, queimaduras de 2º e 3º graus por fogo ou escaldo em 10 por cento a 30 por cento da superfície corpórea (SC), sem história de diáteses hemorrágicas ou hipersensibilidade à heparina e com área queimada em 3º grau menor de 10 por cento da SC. O grupo C realizou periodicamente balneoterapia terapêutica para desbridamento das lesões seguida de curativos com sulfadiazina de prata. O grupo HT realizou o primeiro desbridamento e teve suas áreas queimadas deixadas expostas para receber três vezes ao dia heparina não fracionada em spray na dose de 4200 UI para cada 1 por cento de SC queimada. A eficácia analgésica foi avaliada nos 38 pacientes que completaram o estudo pela demanda de medicamentos analgésicos e pela Escala Analógico Visual de Dor (EAV). A tolerabilidade foi avaliada nos 58 pacientes randomizados pela incidência comparativa de reações adversas nos dois grupos. RESULTADOS: O grupo HT solicitou menos analgésicos (11,83 ± 9,38 por paciente no grupo HT contra 33,35 ± 20,63 no grupo C, p<0,01), referiu menos dor pela EAV, apresentou menos febre e mais sangramento que o grupo C. Não houve diferença na incidência de infecção local, septicemia e nos exames de segurança. CONCLUSÃO: O esquema HT apresentou eficácia analgésica superior ao esquema C sem problemas importantes de tolerabilidade.

OBJECTIVE: This was a prospective, randomized, open-label study controlled by active comparator. The aim was to assess analgesic efficacy and overall tolerability of a burn treatment based on topic administration of unfractionated heparin. METHODS: Fifty eight male or female patients were randomized for conventional treatment (group C) or topical heparin treatment (group TH). Ages of patients enrolled ranged from 18 to 55 years. They had 2nd and 3rd degree burns on 10 percent to 30 percent of the body surface (BS) caused by fire or scald, no hemorrhagic diseases, no hypersensitivity to heparin and less than 10 percent of the BS burned to 3rd degree. The group C had frequent debridement under anesthesia or analgesia and received silver sulfadiazine dressings. The group TH had the first debridement and their wounds left open to receive 4200 IU of unfractionated heparin topically for each 1 percent of burned BS, three times daily. Efficacy was evaluated from files of the 38 patients who completed the study according to demand of analgesic medications and response to the pain Visual Analog Scale (VAS). Tolerability was evaluated from the files of all 58 randomized patients by the comparative incidence of adverse reactions. RESULTS: The group TH demanded less analgesic medications (11.83 ± 9.38 per patient against 33.35 ± 20.63 for the C group, p<0.01), reported less pain in the VAS, had less fever and more bleeding than group C. There was no difference in the incidence of local infection, septicemia and safety exams. CONCLUSION: The group TH presented less pain without important tolerability problems.