evidence-based-balneotherapy-inhungary

1、Evidence-based balneotherapy in Hungary,Katalin Szendi M.D., Ph.D.Department of Public Health Medicine, Universitiy of Pécs, Pécs, Hungary,Introduction,Balneotherapy:Ancient, traditional treatmentEurope, oth

2、er parts of the worldMusculoskeletalGynaecologicalDermatological conditions (psoriasis)Peripheral vascular diseases, etc.Used empirically for centuries18th century – chemical analyses – inorganic salts onlyRece

3、nt decades – studies, clinical trials,Introduction,Balneotherapy defined as the use of:Natural mineral watersNatural peloids and mudNatural sources of different gases (CO2, H2S, Rn222)Implemented as/by:Head-out imm

4、ersion in mineral waterMud- or peloid-packs to body regionsExposure to gases during bathing and by inhalationDrinking mineral water,Introduction,Hungary:Rich in thermal-mineral waters> 1300 thermal wells270 qual

5、ified medicinal water, 275 qualified mineral waterGeothermal conditions – geothermal gradientPannonian basin – crust 10 km thinner50 °C / km (world average – 26 ° C / km)Thermal water underground – 70-80

6、%,,,,Mechanism of action of balneotherapy,Physical:CardiovascularPulmonalRenalEndocrineNeuromuscularHematologicWater depthPostureBuoyancyTemperature,Chemical:Absorption through the skin (limited data)Other:

7、AntioxidantImmunologic,Evidence-based balneology research in Hungary,Evidence-based balneology research in Hungary,Started in the 19th centuryThe Hungarian Balneological Society was founded in 1891,Musculoskeletal cond

8、itionsKnee osteoarthritis,Musculoskeletal conditionsHand osteoarthritis,Musculoskeletal conditionsChronic low back pain,Musculoskeletal conditionsUnderwater traction therapy on neck and lumbar pain,Gynaecological con

9、ditions(Harkány medicinal water),Chronic pelvic inflammatory diseasePost-operative rehabilitationInfertilityJuvenile bleeding disordersMenopause complaintsPelvipathia vegetativaEndometriosisCarbonyl sulphid

10、e and hydrogen sulphideAntioxidants, antibacterial, antimycoticMuscle relaxant, vasodilator, anti-inflammatory, beta-endorphin,Gynaecological conditionsChronic inflammatory pelvic disease,Dermatological conditionsPso

11、riasis,Dermatological conditionsUV-protective property of organic matter in natural thermal water samples (Varga et al. 2015),Organic fractions of five thermal (spa) water samplesPhoto-biological effectsOrganic isolat

12、es applied in the Ames test combined with UV-irradiationStudy the UV sensitivity of Salmonella typhimurium TA strainsFour samples (with TA100 his+ revertants) showed measurable survival of following exposure to a norm

13、ally lethal UV doseMetabolic activation with a mammalian microsomal fraction (S9) elevated the effect,The importance of organic substances in balneotherapy,Which ingredients are responsible for the therapeutic effects?

14、Chemical features – mechanism of action mostly unknownHealing effect is attributed to inorganic ingredientsLimited evidence – e.g. H2S, CO2, RnRecently, several organic compounds detected (GC, HPLC, MS)Role in ther

15、apy? – e.g. oestrogens in Hévíz, in mud from Dead seaBiological activity?,Gas chromatograms,Hajdúszoboszló,Kakasszék,Dombóvár-Gunaras,Sárvár,Conclusions,Different mineral con

16、tentDifferent temperatureSame resultsDouble-blind studies:Better results with medicinal water than tap waterOther study design:Better results with medicinal water compared to other controlsIn several cases improv

17、ement in the control groups (tap water/physiotherapy)Balneotherapy ensures more significant and long-term improvement,Conclusions,Hungarian thermal mineral waters:Degenerative musculoskeletal disorders – reduce painD

18、egenerative joint and spinal diseasesOsteoarthritis of hand and kneeChronic low back painirrespectively of mineral content and concentrationDermatologic and gynaecologic disorders – sulphur and salt bathCardiac an

19、d vascular rehabilitation – carbon dioxide bath, dry carbonic snow, and mofettaEndocrine system – radon bath and radon caveStudy of a large number of patients is required,Hévíz,Gellért Spa, Budapest,Rud