Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study.

BACKGROUND: Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people. The treatment of osteoarthritis includes non-pharmacological, pharmacological, and surgical therapies. Silver level evidence has been found concerning balneotherapy in osteoarthritis. AIM OF THE STUDY: The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain, knee function, and quality of life in patients with knee osteoarthritis, compared to the control group. STUDY DESIGN: randomized, controlled, single-blind, follow-up study. SETTING: Spa Hévíz and St. Andrew Hospital for Rheumatic Diseases POPULATION: This study included 77 outpatients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria. METHODS: Patients were randomized into two groups. In group I (n = 38), subjects bathed in Lake Hévíz and in group II (N.=39), patients were treated in a pool full of tap water. Water temperature was 34 °C for both groups. Participants underwent 30-minute therapy sessions, five times a week for three weeks. Outcome measures were pain visual analogue scale scores, active flexion degree, knee circumference, stair-climb time, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and EuroQoL Group 5-Dimension Self-Report Questionnaire score (EQ-5D). Study parameters were recorded at baseline, immediately after treatment, and after 15 weeks. RESULTS: Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores (P<0.01), active flexion degree (P<0.01), physical function components of WOMAC (P<0.05), and EQ-5D scores (P<0.05) even after 15 weeks. CONCLUSIONS: Balneotherapy improved pain, function as well as the quality of life in patients with knee osteoarthritis. CLINICAL REHABILITATION IMPACT: Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis.

Clinical characteristics of the smooth tubercle bacilli 'Mycobacterium canettii' infection suggest the existence of an environmental reservoir.

Over a 3-year follow-up, 30 out of the 318 unique Mycobacterium tuberculosis complex isolates recovered in the Republic of Djibouti had a smooth-type morphology and were Niacine-negative, the characteristics of 'Mycobacterium canettii' strains. Unlike M. tuberculosis, 'M. canettii' grew on nutrient-poor media at 30°C, and possessed characteristic lipids. They were isolated from respiratory and extra-respiratory sites from patients with typical forms of tuberculosis. Most cases resolved with antibiotic therapy but in two human immunodeficiency virus-positive patients 'M. canettii' infection led to septicaemia and death. No cases of human-to-human transmission were observed. The proportion of tuberculosis cases caused by 'M. canettii' was higher among French patients than among Djiboutian patients. Patients with 'M. canettii' were significantly younger than those with tuberculosis caused by other M. tuberculosis complex strains. Smooth tubercle bacilli could be misidentified as non-tuberculous mycobacteria and appear to be limited to the Horn of Africa. Their characteristics are consistent with the existence of non-human sources of infection.

[Comparison of annual risk for tuberculosis infection (1994-2001) in school children in Djibouti: methodological limitations and epidemiological value in a hyperendemic context]. / Comparaison du risque annuel d'infection tuberculeuse (1994-2001) auprès d'enfants scolarisés à Djibouti: limites méthodologiques et intérêt épidémiologique dans un contexte hyperendémique.

The purpose of this report was to describe a tuberculin survey conducted in 2001 to assess the trend in the annual risk for tuberculosis infection in Djibouti and compare resulting data with those obtained in a previous survey conducted in 1994. In 2001 cluster sampling allowed selection of 5599 school children between the ages of 6 and 10 years including 31.2% (1747/5599) without BCG vaccination scar. In this sample the annual risk of infection (ARI) estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (18 mm) determined according to the "mirror" method were 4.67%, 3.64%, 3.19% and 2.66% respectively. The distribution of positive tuberculin skin reaction size was significantly different from the normal law. In 1994 a total of 5257 children were selected using the same method. The distribution of positive reactions was not significantly different from the gaussian distribution and 28.6% (1505/5257) did not have a BCG scar. The ARI estimated using cutoff points of 6 mm, 10 mm, and 14 mm corrected by a factor of 1/0.82 and a mode value (17 mm) determined according to the "mirror" method were 2.68%, 2.52%, 2.75% and 3.32 respectively. Tuberculin skin reaction size among positive skin test reactors was correlated with the presence of a BCG scar, and its mean was significantly higher among children with BCG scar. The proportion of positive skin test reactors was also higher in the BCG scar group regardless of the cutoff point selected. Comparison of prevalence rates and ARI values did not allow any clear conclusion to be drawn, mainly because of a drastic difference in the positive reaction distribution profiles between the two studies. The distribution of the skin test reaction's size 1994 study could be modelized by a gaussian distribution while it could not in 2001. A partial explanation for the positive reaction distribution observed in the 2001 study might be the existence of cross-reactions with environmental mycobacteria.

Decentralisation of directly observed treatment in a large African city: evaluation of the experience of Djibouti.

SETTING: Decentralisation of directly observed treatment (DOT) for tuberculosis patients in three public centres in Djibouti city from April 2000. OBJECTIVES: To evaluate decentralisation based on the success rate by site of treatment and according to certain critical variables. METHODS: Comparative evaluation of the success rate of smear-positive patients followed in all treatment centres from 1 May 2000 to 31 March 2001. RESULTS: The success rate was 58% for the main centre, Centre Paul Faure, and 81% for all the peripheral centres together (P < 10.6). It was 80% for the three new centres and 85% for the established centres (P > 0.05). Age under 20 years, female sex and treatment centre were factors linked to success. After stratification, sex was shown to be the confounding variable. Multivariate analysis shows that non-Djibouti nationality is related to treatment success (P = 0.02). In the groups of established and new centres, there is an inverse linear relationship between success rate and workload, with greater capacity in the established centres. CONCLUSIONS: Urban decentralisation of DOT increases the chances of treatment success among smear-positive patients. Another centre for supervised treatment needs to be created in one of the public health centres in Djibouti city.

[Tuberculosis and HIV infection: experience of the national tuberculosis prevention program in Djibouti: 1990-1996]. / Tuberculose et infection VIH l'experience du programme national de lutte antituberculeuse de Djibouti: 1990-1996.

Based on analysis of data collected from the national tuberculosis prevention program in Djibouti between 1990 and 1996, the authors analyzed the relationship between HIV infection and tuberculosis. The study cohort comprised a total of 22,000 patients including 14,000 with documented HIV infection. Although HIV infection probably worsened the situation, it was neither the only nor the main factor involved in the resurgence of tuberculosis. Demographic growth, higher population density, and increasing poverty as well as the quality of the national tuberculosis prevention program must be taken into account. The incidence of smear-negative tuberculosis was not significantly higher in HIV-infected patients (incidence of smear positive cases, > 92%). Extrapulmonary tuberculosis especially of pleural involvement was more common (15% versus 9.4%). Treatment was effective in HIV-infected patients. If directly observed (DOT) therapy was used, there was no risk of emergence of multidrug-resistant tuberculosis strains. Drug side-effects associated with the protocols used in Djibouti were not greater in HIV-infected patients. Most additional mortality observed in HIV-infected tuberculosis patients (10.5% versus 2%) was due to progression of HIV infection.

Developmental changes within the core of artifact concepts.

Three experiments addressed the relative importance of original function and current function in artifact categorization. Subjects were asked to judge whether an artifact that was made for one purpose (e.g. making tea) and was currently being used for another purpose (e.g. watering flowers) was a teapot or a watering can. Experiment 1 replicated the finding by Hall (1995) (unpublished manuscript) that adults rely on the original function of an artifact over a current function in their kind judgments. Experiments 2 and 3 revealed that whereas the kind judgments of 6-year-olds, like those of adults, patterned with the original function, those of 4-year-olds did not. Four-year-olds were influenced by the order in which the functions were mentioned in the story. Further, in their justifications 6-year-olds and adults referred to the origin of the objects, whereas 4-year-olds virtually never did. We conclude that 6-year-olds have begun to organize their understanding of artifacts around the notion of original function, and that 4-year-olds have not. The data are discussed as they bear on children's understanding of the design stance (Dennett, D. C. (1987).

The predictive value of the development of the acetabular teardrop figure in developmental dysplasia of the hip.

We reviewed the radiographs of 72 hips, 47 with developmental dysplasia of the hip (DDH), and 25 normal hips, to determine the timing of the normal appearance of the acetabular teardrop figure and the value of teardrop development after reduction of the hip in predicting outcome. In normal hips, all children had a teardrop figure by age 18 months. In the 47 hips with DDH, no teardrop figure appeared until the hip was reduced. The DDH hips were divided into two groups based on the success of the initial reduction. By using statistical analysis, we found that the appearance of the acetabular teardrop within 6 months after reduction of the hip is strongly associated with a favorable long-term outcome. We believe that the appearance of the teardrop is the earliest radiographic sign that a stable, concentric reduction of the hip has been achieved.

Combination trochanteric arrest and intertrochanteric osteotomy for Perthes' disease.

A significant complication associated with femoral varus osteotomy (FVO) is trochanteric overgrowth and concomitant abductor weakness. We identified 28 patients who underwent unilateral FVO for Perthes' disease, had a healed femoral head on their latest radiograph, and had at least 2.1 years of follow-up. The patients were divided into two groups; group 1: patients who did not receive prophylactic trochanteric arrest (TA) at the time of FVO; group 2: patients who did receive TA. Clinical parameters were quantified using objective measurements and a scoring system for reported symptoms. At postoperative follow-up, group 2 had greater articulotrochanteric distance (ATD), better range of motion, less abductor weakness, less pain, and superior activity levels. These differences were statistically significant. This study demonstrates that when properly performed with respect to indications and timing, the combination of TA and FVO provides an effective means of managing Perthes' disease when "head at risk" signs are present. The authors include a detailed discussion of surgical technique.