Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis.

BACKGROUND: Chronic plaque psoriasis is an immune-mediated, chronic, inflammatory skin disease, which can impair quality of life and social interaction. Disease severity can be classified by the psoriasis area and severity index (PASI) score ranging from 0 to 72 points. Indoor artificial salt bath with or without artificial ultraviolet B (UVB) light is used to treat psoriasis, simulating sea bathing and sunlight exposure; however, the evidence base needs clear evaluation. OBJECTIVES: To assess the effects of indoor (artificial) salt water baths followed by exposure to artificial UVB for treating chronic plaque psoriasis in adults. SEARCH METHODS: We searched the following databases up to June 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trial registers, and checked the reference lists of included studies, recent reviews, and relevant papers for further references to relevant trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) of salt bath indoors followed by exposure to artificial UVB in adults who have been diagnosed with chronic plaque type psoriasis. We included studies reporting between-participant data and within-participant data. We evaluated two different comparisons: 1) salt bath + UVB versus other treatment without UVB; eligible comparators were exposure to psoralen bath, psoralen bath + artificial ultraviolet A UVA) light, topical treatment, systemic treatment, or placebo, and 2) salt bath + UVB versus other treatment + UVB or UVB only; eligible comparators were exposure to bath containing other compositions or concentrations + UVB or UVB only. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. The primary efficacy outcome was PASI-75, to detect people with a 75% or more reduction in PASI score from baseline. The primary adverse outcome was treatment-related adverse events requiring withdrawal. For the dichotomous variables PASI-75 and treatment-related adverse events requiring withdrawal, we estimated the proportion of events among the assessed participants. The secondary outcomes were health-related quality of life using the Dermatology Life Quality Index, (DLQI) pruritus severity measured using a visual analogue scale, time to relapse, and secondary malignancies. MAIN RESULTS: We included eight RCTs: six reported between-participant data (2035 participants; 1908 analysed), and two reported within-participant data (70 participants, 68 analysed; 140 limbs; 136 analysed). One study reported data for the comparison salt bath with UVB versus other treatment without UVB; and eight studies reported data for salt bath with UVB versus other treatment with UVB or UVB only. Of these eight studies, only five reported any of our pre-specified outcomes and assessed the comparison of salt bath with UVB versus UVB only. The one included trial that assessed salt bath plus UVB versus other treatment without UVB (psoralen bath + UVA) did not report any of our primary outcomes. The mean age of the participants ranged from 41 to 50 years of age in 75% of the studies. None of the included studies reported on the predefined secondary outcomes of this review. We judged seven of the eight studies as at high risk of bias in at least one domain, most commonly performance bias. Total trial duration ranged between at least two months and up to 13 months. In five studies, the median participant PASI score at baseline ranged from 15 to 18 and was balanced between treatment arms. Three studies did not report PASI score. Most studies were conducted in Germany; all were set in Europe. Half of the studies were multi-centred (set in spa centres or outpatient clinics); half were set in a single centre in either an unspecified settings, a psoriasis daycare centre, or a spa centre. Commercial spa or salt companies sponsored three of eight studies, health insurance companies funded another, the association of dermatologists funded another, and three did not report on funding. When comparing salt bath plus UVB versus UVB only, two between-participant studies found that salt bath plus UVB may improve psoriasis when measured using PASI 75 (achieving a 75% or more reduction in PASI score from baseline) (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.24 to 2.35; 278 participants; low-certainty evidence). Assessment was conducted at the end of treatment, which was equivalent to six to eight weeks after start of treatment. The two trials which contributed data for the primary efficacy outcome were conducted by the same group, and did not blind outcome assessors. The German Spas Association funded one of the trials and the funding source was not stated for the other trial. Two other between-participant studies found salt bath plus UVB may make little to no difference to outcome treatment-related adverse events requiring withdrawal compared with UVB only (RR 0.96, 95% CI 0.35 to 2.64; 404 participants; low-certainty evidence). One of the studies reported adverse events, but did not specify the type of events; the other study reported skin irritation. One within-participant study found similar results, with one participant reporting severe itch immediately after Dead Sea salt soak in the salt bath and UVB group and two instances of inadequate response to phototherapy and conversion to psoralen bath + UVA reported in the UVB only group (low-certainty evidence). AUTHORS' CONCLUSIONS: Salt bath with artificial ultraviolet B (UVB) light may improve psoriasis in people with chronic plaque psoriasis compared with UVB light treatment alone, and there may be no difference in the occurrence of treatment-related adverse events requiring withdrawal. Both results are based on data from a limited number of studies, which provided low-certainty evidence, so we cannot draw any clear conclusions. The reporting of our pre-specified outcomes was either non-existent or limited, with a maximum of two studies reporting a given outcome. The same group conducted the two trials which contributed data for the primary efficacy outcome, and the German Spas Association funded one of these trials. We recommend further RCTs that assess PASI-75, with detailed reporting of the outcome and time point, as well as treatment-related adverse events. Risk of bias was an issue; future studies should ensure blinding of outcome assessors and full reporting.

Crenotherapy modulates the expression of proinflammatory cytokines and immunoregulatory peptides in nasal secretions of children with chronic rhinosinusitis.

BACKGROUND: The effect of crenotherapy on major mucosal markers of inflammation, TNF alpha, human beta-defensins 2 (hBD-2), and calprotectin, are largely unexplored in pediatric chronic rhinosinusitis (CRS). The aim of this study was to investigate the effects of crenotherapy with sulfate-sodium-chloride water on mucosal markers of inflammation in children with CRS. METHODS: Children with CRS received 15-day crenotherapy consisting of sulfate-sodium-chloride thermal water inhalations by nasal aerosol (15 minutes/day). Concentrations of nasal mucosal markers of inflammation (TNF alpha, hBD-2, and calprotectin) were measured before and after crenotherapy. Presence of specific symptoms (nasal obstruction, nasal discharge, facial pain, sense of smell, and cough), value of symptoms score sino-nasal 5 (SN5), quality of life (QoL) score (1 [worse] to 10 [optimal]) were also assessed. RESULTS: After crenotherapy a significant reduction was observed in TNF alpha (from 0.14 ± 0.02 to 0.08 ± 0.01; p < 0.001), calprotectin (from 2.9 ± 1.0 to 1.9 ± 0.5; p < 9.001), and hBD-2 (from 2.0 ± 0.1 to 0.9 ± 0.6; p < 0.001) concentrations. A significant (p < 0.05) reduction in number of subjects presenting symptoms of nasal obstruction (100% versus 40%), nasal discharge (33% versus 13%), facial pain (30% versus 10%), and sense of smell (60% versus 20%) was observed. A significant improvement of SN5 (from 3.07 ± 0.76 to 2.08 ± 0.42; p < 0.001) was observed after the crenotherapy. QoL also improved after crenotherapy (from 4.2 ± 1.1 to 6.6 ± 1.0; p < 0.001). CONCLUSION: Crenotherapy induced a down-regulation of nasal mucosal inflammatory mediators in children with CRS.

Effect of beverages on bovine dental enamel subjected to erosive challenge with hydrochloric acid

This study evaluated by an in vitro model the effect of beverages on dental enamel previously subjected to erosive challenge with hydrochloric acid. The factor under study was the type of beverage, in five levels: Sprite® Zero Low-calorie Soda Lime (positive control), Parmalat® ultra high temperature (UHT) milk, Ades® Original soymilk, Leão® Ice Tea Zero ready-to-drink low-calorie peach-flavored black teaand Prata® natural mineral water (negative control). Seventy-five bovine enamel specimens were distributed among the five types of beverages (n=15), according to a randomized complete block design. For the formation of erosive wear lesions, the specimens were immersed in 10 mL aqueous solution of hydrochloric acid 0.01 M for 2 min. Subsequently, the specimens were immersed in 20 mL of the beverages for 1 min, twice daily for 2 days at room temperature. In between, the specimens were kept in 20 mL of artificial saliva at 37ºC. The response variable was the quantitative enamel microhardness. ANOVA and Tukey's test showed highly significant differences (p<0.00001) in the enamel exposed to hydrochloric acid and beverages. The soft drink caused a significantly higher decrease in microhardness compared with the other beverages. The black tea caused a significantly higher reduction in microhardness than the mineral water, UHT milk and soymilk, but lower than the soft drink. Among the analyzed beverages, the soft drink and the black tea caused the most deleterious effects on dental enamel microhardness.

Este estudo avaliou através de um modelo in vitro o efeito de bebidas no esmalte dental previamente submetido a desafio erosivo com ácido clorídrico. O fator em estudo foi o tipo de bebida, em cinco níveis: Sprite Zero (Coca-Cola® Brasil) controle positivo, leite integral Ultra High Temperature (Parmalat®), extrato de soja integral (Ades® Original), chá preto com baixo teor calórico sabor pêssego (Leão Ice Tea Zero Coca-Cola® Brasil) e água mineral Prata® (controle negativo). Setenta e cinco espécimes de esmalte bovino foram distribuídos entre os cinco tipos de bebidas (n = 15), de acordo com delineamento em blocos completos e casualizados. Para a formação das lesões de desgaste erosivo, os espécimes foram imersos durante 2 min em 10 mL de solução aquosa de ácido clorídrico 0,01 M. Subsequentemente foram imersos em 20 mL das bebidas por 1 min, duas vezes ao dia durante 2 dias, em temperatura ambiente. Nos intervalos entre as imersões os espécimes permaneceram em saliva artificial a 37ºC. A variável de resposta quantitativa foi microdureza superficial do esmalte. ANOVA e teste de Tukey demonstraram diferenças altamente significativas (p <0,00001) no esmalte exposto ao ácido clorídrico e às bebidas. O refrigerante provocou diminuição da microdureza superficial significativamente maior do que as demais bebidas. O chá preto provocou diminuição da microdureza significativamente maior que a água mineral, o leite UHT e o extrato de soja, porém menor que o refrigerante.Entre as bebidas analisadas, refrigerante e chá preto demonstraram efeitos mais deletérios sobre a microdureza do esmalte dental.

Screening of estrogen-like activity of mineral water stored in PET bottles.

Bottled mineral water consumption is steadily rising in the World. Italy is the largest natural mineral water consumer in Western Europe, about 200L per capita per annum. Recently, research has concentrated upon emerging toxicological problems such as the presence in drinking water of substances which interfere with the function of the endocrine system; defined as endocrine disruptors (EDs). The aim of this study was to assess the risk of exposure of the population to chemicals with estrogen-like activity through mineral water consumption by monitoring the presence of estrogenic compounds in mineral water bottled in polyethylene terephthalate (PET). A solid phase extraction (SPE) with C18 cartridges was carried out. The estrogenic activity of the extracts was assayed using a yeast assay expressing the human estrogen receptor alpha (hERalpha). This preliminary study shows that more than 90% of the water samples did not exhibit any appreciable estrogenic activity. The highest estrogenic activity detected in water extracts was equivalent to the activity induced by 23.1ng/L of the natural hormone 17beta-estradiol. Some mineral water samples showed toxicity on yeast cells.

[The iron carbonate waters of the Maritime Territory]. / Uglekislye zhelezistye vody Primorskogo kraia.

Balneological and experimental examinations were made of physiological properties of carbonate iron mineral waters of the Primorskiy Territory. The waters were found perspective as a source of ecologically healthy water, to prevent diseases, to raise nonspecific resistance of the body.

Estimativa de risco devido à ingestäo de isótopos de urânio em fontes de águas minerais / Risk due assessment to the intake of uranium isotopes in mineral spring waters

Complementar dados de investigaçäo anterior sobre o risco de induçäo de câncer devido à ingestäo de 226Ra, 228Ra e 222Rn em fontes de águas minerais de uma regiäo de altos nçiveis de radioatividade natural, do Brasil. Desta forma, foi realizada a estimativa de induçäo de câncer devido à ingestäo de 238U e 234U nessas mesmas águas. O coeficiente de risco para os isótopos naturais de urânio foi considerado como sendo o mesmo daquele utilizado para a induçäo de sarcoma ósseo pelo 226Ra e que a quantidade depositada no osso corresponde a 25 vezes a ingestäo diária de 226Ra e a 11 vezes a ingestäo diária dos isótopos de urânio de meia-vida longa. Amostras de água das fontes utilizadas pela populaçäo de Agua da Prata, Estado de Säo Paulo, foram coletadas, num período de um ano, de forma a abranger todas as estaçöes. Foram encontradas concentraçöes variando de 2,0 a 28,4 mBq/L e de 4,7 a 143m Bq/L para 238U e 234U, respectivamente. Baseando-se nessas concentraçöes foi estimado o risco devido à ingestäo dos isótopos de urânio: um total de 0,3 casos de câncer por 106 indivíduos expostos. Este dado indica que a ingestäo crônica de urânio nas concentraçöes observadas nas fontes analisadas resultará em um acréscimo no número de casos de câncer fatais de 0,1 por cento. Se as incertezas na estimativa dos efeitos carcinogênicos forem levadas em consideraçäo, pode-se concluir que praticamente nenhum caso de câncer ocorrerá devido á ingestäo de urânio presente nas águas minerais analisadas

[Assessment of risk due to the intake of uranium isotopes in mineral spring waters]. / Estimativa de risco devido à ingestão de isótopos de urânio em fontes de águas minerais.

OBJECTIVE: To complement the data of a previous research concerning the evaluation of the lifetime risk of radiation-induced cancer due to the ingestion of 226Ra, 228Ra and 222Rn in mineral spring waters from a natural highly radioactive region of Brazil. The study was performed to evaluate the lifetime risk of radiation-induced cancer due to the ingestion of 238U and 234U in the same spring waters. METHOD: It is assumed that the risk coefficient for natural U isotopes is the same as for the 226Ra-induced bone sarcomas and that the equilibrium for skeletal content is 25 times the daily ingestion of 226Ra, but 11 times the daily ingestion of long-lived uranium isotopes. Waters samples were collected seasonally over a period of one year at all the spring sites used by the local population of Aguas da Prata, S. Paulo State (Brazil). RESULTS: Concentrations ranging from 2.0 to 28.4 mBq/L and from 4.7 to 143 mBq/L were observed for 238U and 234U, respectively. Based upon the measured concentrations the lifetime risk due to the ingestion of uranium isotopes was estimated. A total of 0.3 uranium-induced cancers per 10(6) exposed persons was predicted, suggesting that chronic ingestion of uranium at the levels observed at these springs will result in an incremental increase of fatal cancers of 0.1%. CONCLUSIONS: By taking into account the uncertainties in evaluating the carcinogenic effects, it can be concluded that virtually no cancer would be expected from the ingestion of uranium in the mineral spring waters analyzed.

Lesiones agudas gástricas inducidas por aguas bebibles, en ratas / Acute gastric lesions induced by drinking water, in rats

En ratas Wistar, se estudió el efecto inductor de lesiones agudas gástricas ocasinadas por las siguientes aguas y bebidas, previa medición de su pH: 1) Solución fisiológica. 2) Agua corriente. 3) Agua de pozo. 4) Agua de pozo más Puritabs. 5) Solución fisiológica más 2 gotas de cloro. 6) solución fisiológica mas 4 gotas de cloro. 7) Solución fisiológica más 8 gotas de cloro. 8) Agua hervida y reposada. 9) Agua de tanque de departamento. 10) Agua de tanque de inodoro. 11) Agua de hielo derretido. 12) Agua de río Paraná (zona norte Rosario. 13) Agua de río Paraná (zona sur) Rosario. 14 Agua de lluvia Rosario. 15) Agua de lluvia, zona rural. 16) Agua mineral efervescente. 17) Agua mineral no efervescente. 18) Soda. 19) Agua eletrolíctica Sprite. 20) Coca Cola. Se concluyó: 1) Que existió una marcada variabilidad en el pH de las soluciones fisiológicas y del agua corriente. 2) Que las aguas de lluvia y del río Paraná fueron tenuemente ácidas; en contraste, las bebidas gaseosas electrolíticas y la Coca Cola fueron altamente ácidas (pH 2,5), 3) Que solamente la solución fisiológica a pH 6,68, la solución fisiológica más 2 gotas de cloro y el agua mineral no efervescente fueron las únicas aguas bebibles que no provocaron lesiones agudas gástricas en ratas

[Histomorphometric profile of bone fluorosis induced by prolonged ingestion of Vichy Saint-Yorre water. Comparison with bone fluorine levels]. / Profil histomorphométrique de la fluorose osseuse induite par l'ingestion prolongée d'eau de Vichy Saint-Yorre. Comparaison avec le taux de fluor osseux.

Nine transiliac bone biopsies from 7 patients with skeletal fluorosis due to prolonged ingestion of often high quantities of Vichy Saint-Yorre water were analyzed. Four of these patients also suffered from a chronic renal failure. A histomorphometric study was possible in 8 out of the 9 biopsies. The measurement of bone fluoride content, and a microradiographic examination, were performed on all bone samples. The radiologically evident osteosclerosis observed in each patient was confirmed by the significant increase of trabecular bone volume. Furthermore, the osteoid surfaces were very extended but the thickness of osteoid seams was normal in 6 out of 8 cases. Two biopsies demonstrated a morphological evidence of osteomalacia with abnormally thick osteoid seams. Calcification rate, measured in one of these 2 cases after tetracycline double labeling, was extremely low (less than 0.20 micron/d). The bone fluoride content was significantly high in each specimen (greater than 0.40 bone ash%) and correlated with relative osteoid volume (r' = 0.91) and thickness index of osteoid seams (r' = 0.83). Histologically, bone tissue showed modifications classically reported in the various types of skeletal fluorosis (formation defects, mottled bone with mottled periosteocytic lacunae). In conclusion, the prolonged administration of Vichy Saint-Yorre water containing 8.5 mg of fluoride ion per liter, provokes a skeletal fluorosis. This intoxication appeared very quickly if the patient suffered from an even mild renal failure. Once again, it is shown that a disturbed renal function predisposes to an excessive retention of fluoride.

[Risk of bone disease as a result of fluoride intake in chronic renal insufficiency]. / Risque osseux de l'apport fluoré chez l'insuffisant rénal chronique.

Four cases of osteosclerosis were observed in patients with renal failure. All subjects presented with moderate reduction in renal function which had been stabilized for several years. Osteosclerosis appeared progressively but was clinically symptomatic in only one patient. Fluoride intoxication was ascertained on the basis of X-ray examination and bone biopsy. In addition, the source of fluoride intoxication was easily recognized as the drinking water (2 to 3 1/day), "Vichy Saint Yorre" commercial mineral water (fluoride concentration 9 mg/l) in 3 cases, and tap water in the fourth case. These observations emphasize the risk of high chronic fluoride intake in patients with renal failure, even with mild reduction of glomerular filtration rate.

[Action of the mineral content level of desalinized conditioned water of the bicarbonate class on the gonadal function in male white rats]. / Deistvie urovnia mineralizatsii opresnennykh konditsionirovannykh vod gidrokarbonatnogo klassa na funktsional'noe sostoianie gonad samtsov belykh krys.

As known, the salt content in the potable water has a gonadotropic effect, the level of which being in agreement with the traditional norm. However, within the normal limits one can distinguish better or worse functional manifestations. It has been shown that statistical treatment of the data, using the Student t-test, is of low efficiency because it neglects the ratio between groups. Of greater efficiency is the statistical treatment based on the domineering order. Proceeding from the theoretical speculations and experimental results, potable water with the mineral content of 250 mg/l should be regarded as optimal.