The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review.

BACKGROUND: Hydrotherapy is frequently indicated for the rehabilitation of patients with rheumatoid arthritis (RA); nevertheless, there has been inadequate appraisal of its effectiveness. The potential benefits of hydrotherapy for patients with RA are to improve and/or maintain functional ability and quality of life. OBJECTIVES: The aim of this systematic review was to evaluate the effectiveness of hydrotherapy in the management of patients with RA. METHOD: AMED, CINAHL, EMBASE, MEDLINE, PubMed, Science Direct and Web of Science were searched between 1988 and May 2011. Keywords used were rheumatoid arthritis, hydrotherapy, aquatic physiotherapy, aqua therapy and water therapy. Searches were supplemented with hand searches of references of selected articles. Randomized controlled trials were assessed for their methodological quality using the Physiotherapy Evidence Database (PEDro) scale. This scale ranks the methodological quality of a study scoring 7 out of 10 as 'high quality', 5-6 as 'moderate quality' and less than 4 as 'poor quality'. RESULTS: Initially, 197 studies were identified. Six studies met the inclusion criteria for further analysis. The average methodological quality for all studies was 6.8 using the PEDro scale. Most of the studies reported favourable outcomes for a hydrotherapy intervention compared with no treatment or other interventions for patients with RA. Improvement was particularly noted in reducing pain, joint tenderness, mood and tension symptoms, and increasing grip strength and patient satisfaction with hydrotherapy treatment in the short term. CONCLUSIONS: There is some evidence to suggest that hydrotherapy has a positive role in reducing pain and improving the health status of patients with RA compared with no or other interventions in the short term. However, the long-term benefit is unknown. Further studies are needed.

Effect of Norplant implants on the pituitary-adrenal axis function and reserve capacity.

The present work investigated the effects of Norplant implants on the pituitary-adrenal function among 15 users of Norplant implants prior to and 6 months after insertion of the implants. Serum cortisol levels and their diurnal variations, ACTH and 24-h urinary 17-ketosteroids, ketogenic steroids, 17-hydroxy steroids, and creatinine, were measured. Also, a dynamic test (the 5-h Synacthen depot = ACTH stimulation test) was done before and 6 months after implants insertion. The 9 a.m. cortisol levels were blunted (within the normal ranges) while the 6 p.m. values were unaltered. The 24-h urinary ketogenic, hydroxy, and ketosteroids were also unchanged after Norplant implants use. The ACTH stimulation test showed a decreased adrenal response which was also within normal ranges. These data should raise the question related to suprarenal response to acute or prolonged stresses, such as surgical operations or shock in women using Norplant implants.

PIP: To ensure that Norplant contraceptive implants are not associated with a risk of pituitary-adrenal suppression, a series of laboratory tests were conducted in 15 women both before and 6 months after Norplant insertion. Comparisons of hormonal profiles before and after Norplant insertion revealed a significant drop in morning serum cortisol levels (404.33 +or- 84.07 nmol/l vs. 353.67 +or- 56.65 nmol/l, p 0.05), but no significant change in evening readings. The observed changes in morning cortisol values were still within the normal range. Serum ACTH values and 24-hour urinary 17-hydroxy steroids, 17-ketogenic steroids, and 17-ketosteroids were not different after insertion compared to baseline. Before Norplant insertion, injection of synthetic ACTH resulted in a 259.59 +or- 169.53% increase in the mean level of serum cortisol 5 hours later; 6 months after Norplant insertion, the percent rise above baseline was 165.85 +or- 91.64%. The significantly lower adrenal response among Norplant users (although still within normal limits) is presumably due to a local inhibition of the adrenal itself and not of the hypothalamic-pituitary axis. Although these findings suggest a minimal suppressive effect of prolonged microdose release of levonorgestrel from Norplant implants, the suprarenal response to acute or prolonged stresses (e.g., surgical operations or shock) in Norplant users requires investigation.

Ocular histoplasmosis due to Histoplasma farciminosum in Egyptian donkeys.

In this study 19 donkeys suffering from face excoriations below the medial canthas and lesions in the lacrymal apparatus were subjected to clinical radiological and microbiological investigations. Also histopathological examination of biopsy materials from ocular lesions were made. Eleven out of 19 donkeys (57.9%) showed specific lesions in the lacrymal apparatus. Mycological examination revealed the isolation of Histoplasma cells from 10 out of 19 examined cases. The isolated Histoplasma culture, although not completely identical to H. farciminosum, was more related to this than to other Histoplasma species. Histopathological examination revealed the presence of marked tissue infiltration by lymphocytes, monocytes and macrophages. Also the fungal organism appeared as double-contoured yeast cells lying within macrophages and giant cells.

Urinary hormonal profile during the first cycle of low-dose oral contraceptive pills in women.

Ovarian function was studied in ten normal fertile women before and during the first cycle on a low-dose micropill containing 30 mcg ethinyl estradiol and 150 mcg L-norgestrel. In a control cycle and the first treatment cycle, steroid metabolites estrone-3-glucuronide (E1-3G) and pregnanediol-3 alpha-glucuronide (Pd-3G) were measured in daily early morning urine (EMU) samples. Also, luteinizing hormone (LH) was estimated during the expected periovulatory period. During the first cycle of micropill intake, ovarian function was suppressed in all cases. This is evidenced by significantly lower E1-3G and Pd-3G and absent midcycle LH peak compared to control cycles. The pattern of steroid metabolites was almost flat with no peaks. It is concluded that there is no need to cover the first cycle of micropill intake with other contraceptive methods.

Effect of the administration of vitamin B6 at two levels of intake on xanthurenic acid excretion among oral contraceptive pill users.

PIP: Researchers compared data on 30 25-35 year old women who took the combined oral contraceptive (OC) Ovlar (0.05 mg ethinyl estradiol and 0.5 mg dinorgestrel) for 2-5 years with data on 10 women who did not take OCs to determine the longterm effect of Ovlar on vitamin B6 metabolism and urinary Xanthurenic acid (XA). Cases received either 50 mg or 100 mg of vitamin B6 tablets every day for 4 weeks. Mean XA excretion/24 hours stood much higher among OC users than among the controls (12.51 vs. 2.33; p.01), e.g., XA excretion among OC users ranged from 3.45 to 34.95 mcg/24 hours. Among the OC users, mean urinary XA excretion/24 hours was significantly higher before 50 mg vitamin B6 administration than it was after its administration (13.5 mcg vs. 2.71 mcg; p.01). Administration of 100 mg vitamin B6 had the same effect (11.52 mcg vs. 2.26 mcg; p.01). XA excretion was basically the same for the 2 OC user groups (50 mg and 100 mg administration of vitamin B6). Both doses of vitamin B6 brought about comparable XA excretion levels as the control group. The researchers concluded that 50 mg of vitamin B6 taken daily for 4 weeks is sufficient to correct vitamin B6 deficiency and changed metabolism among OC users. Research has demonstrated that OCs alter vitamin B6 tryptophan metabolism in 2 ways. They increase hepatic tryptophan oxygenase activity resulting in a surplus of tryptophan further in the pathway to niacin. This effect explains the higher production of several metabolites. OCs also reduce the proclivity for kynureninase, the pyridoxal phosphate of vitamin B6 dependent enzyme of tryptophan metabolism perhaps increasing the need for plasma pyridoxal phosphate.^ieng

Clinicopathological studies on neurectomy in equids.

Clinical and pathological changes following neurectomy were studied experimentally in 46 male and female equids. Sixty-three operations were performed using either the traditional or the Fackelman and Clodius methods of neurectomy. The effect of arteriovenous ligation was studied in 12 animals and 20 angiograms were performed post mortem to study the arterial pattern of the extremities of the operated limb. Neuroma formation (31 cases) and sloughing of the hoof (five cases) were the two main untoward sequelae. Neurectomy by the technique of Fackelman and Clodius proved superior to the traditional method. No essential changes were observed after ligation of the blood vessels, except in one case where collateral circulation was established.

Effect of heat on uterine contractions during normal labor.

The effect of local application of heat on the abdominal wall on uterine activity was evaluated in 15 full-term multiparous women early in the first stage of labor. Cardiotocographic monitoring showed that heat induces a significant increase in uterine activity without causing any abnormal fetal heart changes. The stimulated contractions return back to base line level following removal of heat. The application of heat on the abdominal wall of women in early labor appears to offer a new non-pharmacological modality for the stimulation of uterine activity.

Management of uterine bleeding by PGs or their synthesis inhibitors.

PIP: Based on the assumption that excess prostaglandins (PGS) of E type (vasodilators and inhibitors of platelet aggregation) may be involved in excessive bleeding due to IUDs, PG synthetase inhibitors were administered to evaluate this hypothesis's validity. In addition, the role of PGs and its inhibitors on dysfunctional uterine bleeding was also studied. In the IUD-induced bleeding study patients were divided into 2 subgroups. Subgroup 1 included patients with menorrhagia caused by IUDs; 50 women were treated with oral indomethacin and 25 subjects were given placebo on the same schedule. In Subgroup 2, fewer cases were selected, double-blindly, and 3 different PG inhibitors were tested in a cross-over manner. Menstrual blood loss (MBL) was measured. 2 subgroups were also used in the dysfunctional uterine bleeding study, the first of which received intravenous infusions of PGF2 alpha or 15-methyl F2 alpha for 6 hours and the second of which was treated with oral indomethacin (25 mg tds) for 5 days. MBL was measured and compared to the subject's period before treatment. Results from the IUD bleeding studies showed that regardless of the method of evaluation or the drug used, administration of nonsteroidal antiinflammatory drugs (NSAID) induced drastic reductions in MBL (subjective evaluation showed 92% success with indomethacin). Quantitative MBL measurement also verified the consistent and significant reduction in MBL under treatment. Oral NSAID in cases of dysfunctional bleeding was associated with marked decrease in MBL also. However, histologic changes were observed in endometrial vessels, notably thickening of subendothelial connective tissue and prominent endothelial cells. Intravenous infusions also reduced MBL but not as significantly as oral administration. And fibrin deposition was marked after intravenous treatment.^ieng

[Onchocerca raillieti n.sp. (Filarioidea) from a domestic donkey in Africa]. / Onchocerca raillieti n.sp. (Filarioidea) chez l'Ane domestique en Afrique

Onchocerca raillieti sp. n. (Filarioidea), from the domestic donkey (Equus asinus) in Africa, is described. The species is compared to O. bohmi (Supperer, 1953) n.comb, O. reticulata Diesing, 1841, O. cervicalis Railliet et Henry, 1910, O. flexuosa (Wedl, 1856) and O. armillata Railliet et Henry, 1909 and can be differentiated by numerous characters of which the most important are the anterior region of the female (which is straight and slender, 6 to 8 cm long, and bears longitudinal striae) and the 10 symmetrically arranged pairs of caudal papillae. O. raillieti seems to be a primitive species by several characters (caudal papillae, cervical papillae, oesophagus, vulva and cuticle.)