Efficacy of spa-therapy, mud-pack therapy, balneotherapy and mud-bath therapy in the management of knee osteoarthritis. A systematic review

Background: Osteoarthritis (OA) is the most common musculoskeletal disease in the world. OA is the result of an inflammatory and degenerative process affecting the entire joint. Osteoarthritis, especially involving the knee, has a relevant socio-economic impact in terms of drugs, hospital admissions, work absences and temporary or permanent invalidity. Therapy of knee osteoarthritis is based on pharmacological and non-pharmacological measures. Methods: We conducted a systematic review of the studies published between 2002 and 2017 on spa-therapy, mud-pack therapy, balneotherapy and mud-bath therapy in the treatment of knee osteoarthritis in order to investigate the evidence of the efficacy of such treatment on pain, functional limitation, drug use and quality of life. Overall, 35 studies were examined among which 12 were selected and included in the review if trial comparative. Each report was reviewed to identify the criteria used for study enrolment and for assignment to experimental vs control groups, sample size, type and characteristics of treatment, features of mineral water, control intervention, assessment point, endpoints, outcome measures, tests used for statistical analysis of the results. We have been able to illustrate the main results obtained in the individual studies and to elaborate these results in order to allow as much a unitary presentation as possible, and hence an overall judgment. Results: Because the studies we reviewed differed markedly from one another in terms of the methods used, we were unable to conduct a quantitative analysis (meta-analysis) of pooled data from the 12 studies. For the purposes of the present review, we re-evaluated the results of the different studies using the same statistical method, the Student’s t test, which is used to compare the means of two frequency distributions. Among all the studies, the most relevant indexes used to measure effectiveness of spa therapy were improved including VAS, Lequesne’s and WOMAC Score. Conclusions: The mud-pack therapy, balneotherapy, mud-bath therapy and spa therapy has proved to be effective in the treatment and in the secondary prevention of knee osteoarthritis, by reducing pain, non-steroidal antiinflammatory drug consumption, functional limitation and improving quality of life of affected patients. Is a noninvasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis

Epidemiology of nephrolithiasis

The main purpose of the study is to acquire useful information on nephrolithiasis in Italy, given the recent increase in its prevalence. The analysis was based on data from sample surveys of the Italian population carried out in 1983 and 1993-1994 as well as on data obtained from medical records of patients treated at the ASTIF in Fiuggi. An increase in the prevalence of the disease from 11.7 to 17.2 out of 1,000 inhabitants has been observed over the last 10 years; most patients are men and elderly, and the highest frequency is in southern and the lowest in northern Italy. The results of the study confirm the hereditary predisposition, since nephrolithiasis is very common among patients' parents (22.5%) and siblings (14.1%). The patients eat more meat than others and are often overweight or obese; the latter represent 18% of these patients and 11% of the general population

LE COPERTURE PER LA VACCINAZIONE ANTI-HPV RAGGIUNTE NELLA ASL ROMA B

Introduzione. Si stimano 500000 nuovi casi/anno, nel mondo, e 3500, in Italia, di carcinoma della cervice uterina. È il primo tumore riconosciuto dall’OMS come interamente riconducibile ad un agente infettivo, lo Human Papillomavirus; grazie allo sviluppo di vaccini anti-HPV ne è possibile la prevenzione primaria. Dal 2007/08 la vaccinazione è offerta attivamente e gratuitamente in tutte le regioni italiane alle ragazze nel 12° anno di vita. Nel Lazio la gratuità è garantita fino ai 18 anni. Scopo dello studio è valutare le coperture vaccinali raggiunte ad oggi per anti-HPV nelle ragazze delle coorti di nascita 1997-2001 residenti nell’area di appartenenza della ASLRomaB. Metodi. Sono stati analizzati i dati raccolti dalla anagrafe vaccinale della ASLRomaB, distinti per distretto, dal 16 giugno 2008 al 31 marzo 2015, relativi alle coorti di nascita oggetto di chiamata attiva e gratuita. La valutazione dei dati ha riguardato ciascuna dose prevista per il completamento del ciclo vaccinale. Risultati. Per la prima dose vaccinale si verifica un trend in lieve crescita dalle coorti 1997-98 alle coorti 1999-2000, si osserva invece un decremento di oltre il 5% per la coorte 2001 rispetto alla coorte 2000. L’andamento risulta simile ai dati rinvenuti nel Lazio, dove un calo si registra già dalla coorte 2000. Non tutte le ragazze completano il ciclo vaccinale determinando un decremento di circa il 3% per le coperture della terza dose (stabilizzatesi intorno al 71%) rispetto alla prima, in analogia a quanto registrato nel Lazio. Si riscontrano tra i risultati dei 4 distretti dell’ASLRomaB delle diversità i cui motivi sono in corso di valutazione. Si stanno analizzando i dati relativi alla coorte 2002. Conclusioni. Le osservazioni effettuate ed in corso, individuate le possibili cause dei risultati non soddisfacenti, sono finalizzate all’attuazione di strategie migliorative

Efficacy of spa-therapy in the management of knee osteoarthritis

Osteoarthritis (OA) is the most common musculoskeletal disease worldwide. OA, and especially knee osteoarthritis, is a condition of high socio-economic impact in terms of drug spending, hospital admissions, work absences and temporary or permanent invalidity. The aim of this research is to evaluate literature on the efficacy of SPA-therapy (mud-pack therapy and/or bath therapy) in the management of knee osteoarthritis. We conducted a systematic review of the literature on SPA-therapy in the treatment of knee. A total of 1044 patients were enrolled in the aforementioned studies, of which 582 belonged to experimental groups while 462 belonged to control groups. The main methods used for clinical assessment were: VAS, WOMAC, Lequesne’s Index, MCII, AIMS and SF-36. Statistical analysis was performed using common tests. In particular, due to the effect of spa-therapy in the patients participating in the research, the score of VAS, Lequesne's Index, and the three different WOMAC indices were respectively decreased compared to the initial value with a statistically significant difference.The research confirms that by spa therapy is possible to obtain good results for pain, articular function and quality of life with reduction of disabling consequences in affected patients

A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis

Mud-bath therapy plays a primary role in the treatment and prevention of osteoarthritis that has been recognised since antiquity. Numerous studies have demonstrated its clinical benefits and its effects on inflammatory mediators (interleukins), the immune system, cenesthesic factors (endorphins), and the diencephalic-pituitary-adrenal axis. This study was conducted to assess the efficacy of mud-bath therapy with mineral water from the Sillene Spring at Italy's Chianciano Spa in patients with osteoarthritis of the knee. Patients (n = 61) were divided into two groups. Group A underwent three cycles of mud-based spa therapy over a year's time, whereas group B did not. Clinical conditions, visual analogue scale pain ratings, and Lequesne indexes of the two groups were compared. We also compared these same parameters in the patients of the two groups that were following the therapy with drugs and in the patients of the group A before and after spa treatment. The percentage of patients with no symptoms or mild symptoms was higher in group A than in group B. Within group A, this percentage was higher after treatment than before spa therapy. Even in the comparison between the patients of the two groups that were following the therapy with drug, the results was that in group A the percentage of patients with no symptoms or mild symptoms was higher than in group B. Statistical analyses based on various tests revealed that almost all these differences were highly significant. No adverse effects were observed in any of the patients in group A. In conclusion, the mud-bath therapy performed at Chianciano Spa with Sillene Spring water remarkably improved the clinical conditions of patients with knee arthritis and significantly reduces the frequency and severity of symptoms and the disability they cause

Clinical researches on the efficacy of spa therapy in fibromyalgia. A systematic review

Background. Fibromyalgia is characterized by chronic widespread pain, tenderness at muscle and tendon insertions point when digital pressure is applied, sleep disorders, chronic fatigue, depressive episodes, anxiety, and other functional somatic syndromes. Objective. The aim of this study was to determine whether balneotherapy with mineral waters and mineral-water containing mud is effective in the management of fibromyalgia. Methods. We conducted a systematic review of the literature regarding spa therapy in the treatment of the fibromyalgia. We searched many databases for articles published between 2000 and 2012 and we selected 7 studies among 65 articles retrieved. A total of 142 patients received balneotherapy and 129 were controls. Conclusion. Study data confirms that spa therapy could improve the symptoms of fibromyalgia including pain, depression and minor symptoms

Correlation between collateral ventilation and interlobar lung fissures

Abstract BACKGROUND: New bronchoscopic techniques for end-stage emphysema treatment are nowadays available; the presence of interlobar collateral ventilation (CV) and interlobar lung fissures (ILF) is crucial for patient selection. OBJECTIVES: Assessment of these variables has been reported previously, but it has never been anatomically validated in vivo. This is the purpose of our study. METHODS: Twenty-one patients undergoing lung resection for lung cancer were prospectively enrolled in this study. At operation, CV was assessed by the Chartis catheter system. ILF completeness at high-resolution computed tomography (HRCT) was retrospectively reviewed. The ILF status at HRCT and at surgery was compared; furthermore, the relationship between CV and ILF status was assessed. RESULTS: At HRCT, ILF were incomplete in 18 cases; at catheter evaluation, CV was present in 11 cases; 15 patients had incomplete ILF at operation. HRCT specificity, sensitivity and accuracy were 33, 93 and 76% compared with ILF status at surgery. HRCT accuracy was 90% on the right and 63% on the left. We demonstrated a high grade of probability of CV presence and incomplete ILF at surgery (odds ratio = 10.0). CONCLUSIONS: There is a correlation between ILF status and CV. Both catheter evaluation of CV and HRCT assessment of ILF show some limitations. However, the cumulative information provided by these techniques allows to reliably assess the anatomical ILF status.BACKGROUND: New bronchoscopic techniques for end-stage emphysema treatment are nowadays available; the presence of interlobar collateral ventilation (CV) and interlobar lung fissures (ILF) is crucial for patient selection. OBJECTIVES: Assessment of these variables has been reported previously, but it has never been anatomically validated in vivo. This is the purpose of our study. METHODS: Twenty-one patients undergoing lung resection for lung cancer were prospectively enrolled in this study. At operation, CV was assessed by the Chartis catheter system. ILF completeness at high-resolution computed tomography (HRCT) was retrospectively reviewed. The ILF status at HRCT and at surgery was compared; furthermore, the relationship between CV and ILF status was assessed. RESULTS: At HRCT, ILF were incomplete in 18 cases; at catheter evaluation, CV was present in 11 cases; 15 patients had incomplete ILF at operation. HRCT specificity, sensitivity and accuracy were 33, 93 and 76% compared with