Ocena efektywności klinicznej lecznictwa uzdrowiskowego : przegląd literatury

Założenia: Leczenie uzdrowiskowe budzi wiele kontrowersji oraz skrajnych opinii odnośnie skuteczności i bezpieczeństwa tej formy terapii, a co za tym idzie finansowania leczenia w uzdrowisku ze środków publicznych. Cele: Celem pracy jest ocena efektywności klinicznej leczenia uzdrowiskowego przeprowadzona na podstawie analizy wyników doniesień naukowych odnalezionych w ramach przeglądu literatury. Metodyka: Poszukiwano wiarygodnych opracowań wtórnych dostępnych w bazach informacji medycznej: The Cochrane Library, bazie MEDLINE, EMBASE oraz Centre for Reviews and Dissemination (CRD). Włączano wszystkie prace spełniające kryteria włączenia (przeglądy systematyczne oraz niezależne raporty oceny technologii medycznej - raporty HTA), które zostały opublikowane do dnia 27 maja 2011 roku. Dodatkowo przeszukano artykuły opublikowane w polskich czasopismach: "Acta Balneologica", "Rehabilitacja Medyczna" oraz "Fizjoterapia Polska" (do analizy włączano zarówno pierwotne badania kliniczne, jak również opracowania wtórne). Wyniki: W wyniku przeszukania elektronicznych baz informacji medycznej odnaleziono 872 pozycje bibliograficzne, z których do dalszej analizy włączono 41 doniesień naukowych. Spośród 41 doniesień naukowych, wstępnie zakwalifikowanych do analizy, na etapie weryfikacji prac na podstawie pełnych tekstów do analizy włączono 8 prac. Dodatkowo do analizy włączono 11 doniesień naukowych opublikowanych w czasopiśmie "Acta Balneologica" oraz 3 prace opublikowane w "Fizjoterapii Polskiej". Na podstawie wyników odnalezionych doniesień naukowych ocenia się, że lecznictwo uzdrowiskowe istotnie zmniejsza nasilenie bólu oraz poprawia jakość życia pacjentów z chorobą zwyrodnieniową stawów, fibromialgią, przewlekłym bólem odcinka lędźwiowo-krzyżowego kręgosłupa, łuszczycowym zapaleniem stawów, zesztywniającym zapaleniem stawów kręgosłupa oraz reumatoidalnym zapaleniem stawów. Nie raportowano żadnych poważnych działań niepożądanych związanych z leczeniem w uzdrowisku. Wnioski: Leczenie uzdrowiskowe jest skuteczne w zmniejszaniu nasilenia objawów niektórych chorób układu mięśniowo-szkieletowego. Niezbędne są dalsze, dobrze zaprojektowane, kliniczne badania z grupą kontrolną, oceniające skuteczność leczenia uzdrowiskowego.Objective: Spa treatment arouses a lot of controversy and conflicting opinions. The aim of this study was to evaluate the clinical efficacy and safety profile of spa treatment. Assessment was based on a review of available publications. Methods: The Cochrane Library, MEDLINE, EMBASE and the Centre for Reviews and Dissemination (CRD) databases were searched for health technology assessment (HTA) reports and systematic reviews. All publications which met the predesigned inclusion criteria were included. The data search was concluded on 27st May 2011. Additionally Acta Balneologica, Rehabilitacja Medyczna and Fizjoterapia Polska were searched for both clinical trials and reviews. Results: During the search 872 publications were identified of which 41 articles were selected for further analysis, out of which 8 systematic reviews met the inclusion criteria upon the basis of full text analysis. Additionally 11 reports which had been published in Acta Balneologica and 3 in Fizjoterapia Polska were included in the study. Based on the performed review of the available studies, spa treatment appears to be an effective method in the treatment of patients suffering from osteoarthritis, fibromyalgia, chronic low back pain, psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis. Spa treatment is associated with no serious side effects. Conclusions: Spa treatment is effective in the relief of symptoms of rheumatic diseases and musculoskeletal disorders. However, existing research is not sufficiently strong to draw firm conclusions. Well-designed controlled clinical trials are needed for the assessment of the effects of spa treatment

Medical rehabilitation in Poland during the COVID-19 pandemic : regulatory and organizational issues.

The medical rehabilitation system in Poland includes various rehabilitation services, financed by various institutions, including the NFZ, ZUS, KRUS, PFRON and local governments. The aim of the study is to identify the most important problems and limitations of this system, especially in the context of the COVID-19 pandemic. The most important issues to be solved and proposed reforms of the medical rehabilitation system in Poland presented in recent years were identified. The impact of the COVID-19 pandemic on this system, providing rehabilitation services and problems related to the im­plementation of further legal regulations in the first months of the pandemic were discussed. One of the most important recommended changes is the implementation of the comprehensive care model and the activities aimed at coordinating various elements and levels of rehabilitation.COVID-19coronavirusmedical rehabilitationNational Health Fundpandemicspa treatmen

Rehabilitacja medyczna osób starszych. Zasadność, potrzeby i możliwości

Medical rehabilitation of elderly people. Validity, needs and potentialRehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. WHO, in “World Report on Disability”, defines rehabilitation as a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments. Lack of rehabilitation services creates a barrier to full inclusion and participation in all aspects of life. The aim of this article was to present the nature of medical rehabilitation, in particular medical rehabilitation of elderly people. The basic definitions of medical rehabilitation and physiotherapy were also presented. The medical rehabilitation system in Poland, its organization and funding system was shown based on publications and statistical data of the Central Statistical Office (GUS) as well the access to medical rehabilitation services and selected medical procedures was assessed based on available data from National Health Fund (NFZ) and Ministry of Health (MZ)

Novel splice site mutation in the PROS1 gene in a Polish patient with venous thromboembolism : c.602-2delA, splice acceptor site of exon 7

We identified a novel splice site mutation of the PROS1 gene in a Polish family with protein S (PS) deficiency and explored the molecular pathogenesis of this previously undescribed variant. A novel mutation was detected in a 26-year-old woman with a history of venous thromboembolism (VTE) provoked by oral contraceptives. Her family history of VTE was positive. The sequence analysis of the PROS1 gene was performed in the proband and the proband’s family. The proband and their asymptomatic father had lower free PS levels (45% and 50%, respectively) and PS activity (48% and 44%, respectively). Total PS levels were normal (65.6% and 62.4%, respectively). The sequence analysis of the PROS1 gene revealed the presence of heterozygous deletion at the nucleotide position c.602-2 in intron 6, just upstream of exon 7, detected in the proband and her father. This variant alters the splice acceptor site of exon 7, and, according to the in silico prediction, it is highly likely to cause in-frame exon 7 skipping. We also presented follow-up data of two other Polish patients with PS deficiency associated with splice site mutations in PROS1 gene

Cytotoxic and antioxidant activity of hypericum perforatum L. extracts against human melanoma cells from different stages of cancer progression, cultured under normoxia and hypoxia

Oxidative stress and the hypoxic microenvironment play a key role in the progression of human melanoma, one of the most aggressive skin cancers. The aim of our study was to evaluate the effect of Hypericum perforatum extracts of different origins (both commercially available (HpEx2) and laboratory-prepared from wild grown (HpEx12) and in vitro cultured (HpEx13) plants) and hyperforin salt on WM115 primary and WM266-4 lymph node metastatic human melanoma cells cultured under normoxic and hypoxic conditions. The polyphenol content, radical scavenging activity, and hyperforin concentration were determined in the extracts, while cell viability, apoptosis, ROS production, and expression of NRF2 and HO-1, important oxidative stress-related factors, were analyzed after 24 h of cell stimulation with HpExs and hyperforin salt. We found that cytotoxic, pro-apoptotic and antioxidant effects depend on the extract composition, the stage of melanoma progression, and the oxygen level. Hyperforin salt showed lower activity than H. perforatum extracts. Our study for the first time showed that the anticancer activity of H. perforatum extracts differs in normoxia and hypoxia. Importantly, the composition of extracts of various origins, including in vitro cultured, resulting in their unique properties, may be important in the selection of plants for therapeutic application

Phytosulfokine stimulates cell divisions in sugar beet (Beta vulgaris L.) mesophyll protoplast cultures

The aim of this work was to improve plating efficiency of sugar beet mesophyll protoplast cultures. Preliminary experiments showed that cultures of good quality, viable protoplasts were obtained in rich media based on the Kao and Michayluk formulation and with the calcium alginate as an embedding matrix. Nevertheless, in these cultures cell divisions were either not observed or very seldom confirming earlier reported recalcitrance of sugar beet protoplasts. The recalcitrant status of these cultures was reversed upon application of exogenous phytosulfokine (PSK)—a peptidyl plant growth factor. The highest effectiveness of PSK was observed at 100 nM concentration. Plating efficiencies obtained in the presence of PSK reached approximately 20% of the total cultured cells. The stimulatory effect of phytosulfokine was observed for all tested breeding stocks of sugar beet. Our data indicate that PSK is a powerful agent able to overcome recalcitrance of plant protoplast cultures