Secukinumab and Dead Sea Climatotherapy Impact Resolved Psoriasis Skin Differently Potentially Affecting Disease Memory.

Secukinumab and Dead Sea treatment result in clear skin for many psoriasis patients, through distinct mechanisms. However, recurrence in the same areas after treatments suggests the existence of a molecular scar. We aimed to compare the molecular and genetic differences in psoriasis patients who achieved complete response from secukinumab and Dead Sea climatotherapy treatments. We performed quantitative immunohistochemical and transcriptomic analysis, in addition to digital spatial profiling of skin punch biopsies. Histologically, both treatments resulted in a normalization of the lesional skin to a level resembling nonlesional skin. Interestingly, the transcriptome was not normalized by either treatments. We revealed 479 differentially expressed genes between secukinumab and Dead Sea climatotherapy at the end of treatment, with a psoriasis panel identifying SERPINB4, SERPINB13, IL36G, IL36RN, and AKR1B10 as upregulated in Dead Sea climatotherapy compared with secukinumab. Using digital spatial profiling, pan-RAS was observed to be differentially expressed in the microenvironment surrounding CD103+ cells, and IDO1 was differentially expressed in the dermis when comparing the two treatments. The differences observed between secukinumab and Dead Sea climatotherapy suggest the presence of a molecular scar, which may stem from mechanistically different pathways and potentially contribute to disease recurrence. This may be important for determining treatment response duration and disease memory.

Climatotherapy at the Dead Sea for psoriasis is a highly effective anti-inflammatory treatment in the short term: An immunohistochemical study.

Climatotherapy is a well-described treatment of psoriasis. Dead Sea climatotherapy (DSC) in Israel consists of intensive sun and Dead Sea bathing and is very effective in improving clinical and patient-reported outcomes. However, the effect of DSC has not been widely studied. We aimed to investigate the effect of DSC on psoriasis skin using quantitative immunohistochemistry techniques and analysis of blood samples. Skin punch biopsies from 18 psoriasis patients from a previous cohort study were used. Biopsies were obtained from non-lesional skin and from a psoriasis target lesion at baseline. A biopsy was acquired from the target lesion after DSC. Among patients who achieved complete visual clearance, a biopsy was also obtained at relapse. Blood samples were obtained at the same time points. We performed haematoxylin and eosin staining and quantitative immunohistochemical analysis of CD3, CD4, CD8, CD11c, CD103, CD163, CD207, forkhead box P3, Ki67 and myeloperoxidase. We performed blood tests of cholesterol, c-reactive protein, glucose, haemoglobin A1c and triglycerides. All skin biomarkers except for CD207 were decreased after DSC. At relapse, none of the biomarkers were significantly different from the baseline lesional measurements. Total CD207 staining correlated with psoriasis area and severity index at baseline while CD163 staining correlated with psoriasis area and severity index at EOT. No changes were observed in selected blood tests during the study. Consistent with clinical results, DSC is highly effective in the short term almost normalising all investigated biomarkers. However, at relapse, biomarkers were upregulated to the baseline level.

The effects of viewing a winter forest landscape with the ground and trees covered in snow on the psychological relaxation of young Finnish adults: A pilot study.

Forest bathing is an outdoor activity, and it might be a promising preventive treatment for social problems involving stress. A vast number of studies confirm the positive effects of this activity on people's health. Nevertheless, little is known about the influence of winter forest bathing when conducted in an environment with snow cover on the ground and trees. Thus, a crossover experiment was designed in this study, with the participation of twenty-two healthy university students from Finland. During the experiment, a short exposition by a forest environment or landscape with buildings (as a control) was applied. Participants self-reported their psychological relaxation before and after the exposition, and the results were analyzed and compared. The mood, emotions, restorativeness, and subjective vitality were recorded as indices reflecting the psychological relaxation effect. The negative mood indices decreased significantly after exposition by the snow-covered environment, but the positive 'vigor' indices did not increase or decrease significantly. The level of negative emotions increased after the exposition with the control environment. Likewise, positive emotions decreased after the interaction with the control. Restorativeness was significantly increased after the exposition by the experimental forest but decreased after the viewing of the control buildings. The size of the effect in terms of restorativeness was the highest in this experiment. The subjective vitality was lowered as affected by the control, but it did not increase or decrease after the exposition with the experimental forest. There is probably an effect from the slight interruption in the process from the influence of the forest greens on participants because their vigor and vitality did not increase after the exposition with this environment in the study. However, snow might influence the participants as a calming and emotion-lowering component of the environment, but this idea needs to be further explored with the involvement of participants from other countries who would be viewing forest environments with snow cover and whose psychological relaxation could be measured.

Dead Sea climatotherapy versus topical steroid treatment for atopic dermatitis children: long-term follow-up study.

The aim of this study was to compare long-term results of 4 weeks Dead Sea climatotherapy at the Deutsches Medizinisches Zentrum, Israel to those obtained by classical topical treatment for moderate-to-severe atopic dermatitis. Seventy-two children from the Czech Republic were divided into three groups of 24 and treated during three periods (March 2014, October 2014 and March 2015) with gradually increasing sun exposure during 28 consecutive days. Forty-four children were treated with steroid creams at the Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic. The primary outcome was the change in the SCORing Atopic Dermatitis (SCORAD) index, recorded after 1 month of treatment (immediately after DSC) and 3, 6, 9, 12, and 18 months later in Prague. The mean SCORAD improvement was 87.5 ± 13.4% after 4 weeks at the Dead Sea and 86.1 ± 11.3% after 1 month of treatment with steroid creams in the Czech Republic. All 44 patients treated in Prague participated in this 18-month follow-up study, whereas only 47 patients (65.3%) after DSC treatment. Good clinical results were maintained in both groups and mean SCORAD values were stable and low, around 5.

Multidisciplinary Biopsychosocial Program for Chronic Musculoskeletal Pain at the Dead Sea.

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation for patients presenting with rheumatic diseases has been shown to produce better results in a warm climate. Dead Sea Climatotherapy (DSC) has been successfully used for decades to treat many patients with rheumatic diseases. OBJECTIVES: To evaluate the short-term improvement of Norwegian patients who presented with chronic pain following a multidisciplinary biopsychosocial approach to treatment combined with DSC. Both objective and subjective clinical parameters were evaluated. METHODS: This retrospective study included a statistical analysis of 938 patients presenting with rheumatoid arthritis and ankylosing spondylitis (n=105), osteoarthritis (n=342), fibromyalgia (n=374), and other orthopedic conditions (n=117). Clinical assessments were conducted before and after a 3 week treatment program at the Dead Sea. RESULTS: Six parameters improved significantly in the rheumatoid arthritis and ankylosing spondylitis group as well as in the osteoarthritis group. Five parameters in the fibromyalgia group improved, while two improved in the orthopedic conditions group. Overall, major significant changes occurred in the pain self-assessment, joint motility, and daily activities scores. CONCLUSIONS: A 3-week multidisciplinary biopsychosocial program combined with DSC induced positive changes in the clinical parameters of Norwegian patients presenting with chronic musculoskeletal pain.

The Effect of Pulmonary Rehabilitation in Mountain Environment on Exercise Capacity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Bronchitis.

BACKGROUND We aimed to test the effectiveness of the pulmonary rehabilitation in a mountain environment on the pulmonary function, physical performance, dyspnea, affective factors, and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB), as well as to determine predictors of clinical improvement. MATERIAL AND METHODS 128 consecutive patients (90 diagnosed with COPD and 38 diagnosed with CB) underwent comprehensive pulmonary rehabilitation for a duration of 3 weeks in one of 3 mountain health resorts in the High Tatras. The examination included spirometry (FEV1 and FEV1/FVC), 6-minute walk test (6MWT), Borg scale of dyspnea, and assessment of depression (Zung score), anxiety (Beck score), and QoL using the SF-36 scales. RESULTS After the study intervention, all patients in both monitored groups demonstrated significant improvements in objective measurements in which large treatment effect was achieved (for FEV1 η²=0.218, for 6MWT η²=0.771). Similarly, in subjective measurements a large effect was achieved (for the Beck score: η²=0.599, for the Zung score: η²=0.536). QoL improved after the intervention in all the monitored SF-36 scales in both groups (P<0.001 for all). In patients with COPD, the improvement of exercise capacity was positively correlated with baseline 6MWT and FEV1, and negatively with the Beck anxiety score and the Borg dyspnea score, whereas, only improvement in the mental summary component of QoL was negatively correlated with baseline 6MWT and FEV1 (P<0.05 for all). CONCLUSIONS Rehabilitation in a mountain environment has proven to be effective in both the reported diagnoses of COPD and CB. Improvements in both functional and subjective indicators were observed. These findings support the use of this treatment modality.

Temporal Stability of the Healthy Human Skin Microbiome Following Dead Sea Climatotherapy.

Dead Sea climatotherapy (DSC) is a therapeutic modality for a variety of chronic skin conditions, yet there has been scarce research on the relationship between the cutaneous microbiota and disease states in response to DSC. We characterized the skin bacterial and fungal microbiome of healthy volunteers who underwent DSC. Bacterial community diversity remained similar before and after treatment, while fungal diversity was significantly reduced as a result of the treatment. Individuals showed greater inter-individual than temporal bacterial community variance, yet the opposite was true for fungal community composition. We further identified Malassezia as the genus driving temporal mycobiome variations. The results indicate that the microbiome remains stable throughout DSC, while the mycobiome undergoes dramatic community changes. The results of this study will serve as an important baseline for future investigations of microbiome and mycobiome temporal phenomena in diseased states.

Efectos de un programa intensivo de talasoterapia y terapia acuática en pacientes con ictus. Estudio piloto / Effects of an intensive thalassotherapy and aquatic therapy program in stroke patients. A pilot study

Introducción. El ictus es la principal causa de discapacidad adquirida. Su planificación y gestión (sanitaria y social) varía y, aunque la prevención resulta crucial, no es menos importante disponer de mejores tratamientos y estrategias para reducir la discapacidad. Objetivo. Analizar la eficacia de un programa intensivo de talasoterapia y terapia acuática en pacientes con ictus, valorando parámetros clínicos y escalas funcionales validadas. Pacientes y métodos. Se realizó un estudio prospectivo cuasi experimental con 26 pacientes con discapacidad leve-moderada postictus. Los pacientes fueron evaluados con las siguientes escalas: equilibrio de Berg, equilibrio dinámico/Timed Up & Go, marcha de 10 metros, seis minutos de marcha y escala visual analógica del dolor, antes y después de realizar tres semanas de tratamiento. Resultados. Finalizado el tratamiento programado, se obtuvieron diferencias significativas para todas las variables estudiadas. Conclusión. Un programa intensivo de talasoterapia y terapia acuática contribuye a mejorar el equilibrio, la marcha y la percepción del dolor en estos pacientes (AU)

Introduction. Stroke remains the leading cause of acquired disability. Health and social planning and management may vary and although prevention is crucial, having better treatments and strategies to reduce disability is needed. Aim. To determine the effect of an intensive program of thalassotherapy and aquatic therapy in stroke patients, valuing clinical parameters and functional validated scales. Patients and methods. A quasi-experimental prospective study consisting of a specific program assessed pre- and post- 3 weeks treatment to 26 stroke patients with a mild- moderate disability. The outcomes measured were: Berg Balance scale, Timed Up & Go test, 10-meter walking test, 6-minute walking test and pain Visual Analogue Scale. Results. After intervention, participants had a significant improvement in all outcomes measured. Conclusions. Our results suggest that an intensive program of thalassotherapy and aquatic therapy could be useful during stroke rehabilitation to improve balance, gait and pain (AU)

[The role of climatic therapy in the combined spa and health resort-based treatment of the patients presenting with nonspecific respiratory diseases]. / Rol' klimatoterapii v kompleksnom sanatorno-kurortnom lechenii patsientov s nespetsificheskimi zabolevaniyami organov dykhaniya.

This article deals with the issues related to the role of climatic therapy in the combined spa and health resort-based treatment of the patients presenting with pathology of the respiratory system. The characteristics of climatic health resorts, the effects of various weather factors on the patients with nonspecific diseases of the respiratory organs, and the methods of climatic therapy are discussed with special reference to the physical factors influencing acclimatization and re-acclimatization as well as the prevention of meteopathic reactions. Much attention is given to the indications and contraindications for the referral of the patients with the above health problems to the local spa and health resorts facilities.

[The application of climatic therapy in the health resorts of the Black Sea coast of the Caucasus: the current state-of-the-art and the prospects for the further development]. / Klimatoterapiya na kurortakh Chernomorskogo poberezh'ya Kavkaza: sovremennoe sostoyanie i perspektivy razvitiya.

UNLABELLED: The present review summarizes the data published in the domestic and foreign literature concerning the history of climatic therapy, the current concepts of the mechanisms of action of the climatic and weather factors on the human body, the modern therapeutic modalities and technologies for health promotion. We consider not only the achievements but also the problems arising from insufficient knowledge of the impacts of current climate and extreme weather conditions on the state of human health and some disputable issues of the new methods and technologies of climatic therapy. IN CONCLUSION: the promising areas of further research and developments pertaining to climatic therapy as practiced under conditions of the Black Sea coast resorts.

[The immediate and long-term results of sylvinite speleoclimatotherapy in the children presenting with pollinosis].

The present open randomized comparative study had the objective to compare the effectiveness of two strategies for the treatment of early spring pollinosis in 23 children at the age varying from 2 to 17 years in the phase of exacerbation. The patients of the study group underwent 10 sessions of sylvinite speleoclimatotherapy 60 min in duration each in addition to conventional pharmacotherapy. The children included in the control group were treated by traditional medicamental therapy alone. The estimation of clinical symptoms on day 10 after the onset of the treatment with the use of a scoring system has demonstrated a marked decrease in the severity of allergic rhinitis (p = 0.003), conjunctivitis (p = 0.01), and the total number of signs and symptoms of the disease (p = 0.002) in the children managed with the use of sylvinite speleoclimatotherapy. Positive dynamics in the patients of the control group was less pronounced (p < 0.05). The aeropollinological data are presented giving evidence of the absence of a high pollen concentration in the air of the speleoclimatic chamber and its high content in the atmospheric air at the height of thepollen season of early spring allergens. The clinical manifestations of the allergic conditions were shown to depend on the concentration in the atmospheric air of the causative allergens from their principle plant sources (r = 0.66, p = 0.039 in the control patients in comparison with r = 0.42, p = 0.22 in the children treated by sylvinite speleoclimatotherapy. It is concluded that the results of the present study confirm the clinical effectiveness of sylvinite speleoclimatotherapy used in the acute phase of pollinosis. The combination of this modality with traditional medicamental therapy accelerates elimination of clinical symptoms of allergic rhinitis and conjunctivitis; moreover, it reduces the frequency of recurrent respiratory disorders.

[50 years of the methodology of weather forecasting for medicine].

The materials reported in the present article illustrate the possibility of weather forecasting for the medical purposes in the historical aspect. The main characteristics of the relevant organizational and methodological approaches to meteoprophylaxis based of the standard medical forecasts are presented. The emphasis is laid on the priority of the domestic medical school in the development of the principles of diagnostics and treatment of meteosensitivity and meteotropic complications in the patients presenting with various diseases with special reference to their age-related characteristics.

Does climate therapy at moderate altitudes improve pulmonary function in asthma patients? A systematic review.

PURPOSE: Allergic bronchial asthma is one of the most common chronic diseases worldwide. For many years, the climate at moderate altitude has been used as an alternative therapy for patients suffering from bronchial asthma. The aim of such therapy is to reduce the medication dose and to improve the quality of life for each patient. The aim of our current work was to assess published data evaluating the effects of climate therapy at moderate altitude on the health status of patients with bronchial asthma. The health status is represented through surrogate parameters for the pulmonary function (forced expiratory volume in one second (FEV1)), bronchial hyperresponsiveness (PC20), and inflammation (total number of eosinophils, eosinophilic cationic protein, and exhaled nitric oxide). METHODS: Our systematic review included randomized controlled trials (RCTs) and single-armed studies with adults and children participating. Included in our review were climate therapies occurring at moderate altitudes between 1,500 and 2,500 m and evaluation of patient FEV1 or PC20 values. RESULTS: A literature research in MEDLINE and EMBASE identified three RCTs, two clinically controlled trials, and 15 single-armed studies. Analysis revealed a lack of evidence regarding the moderate altitude therapy arising from small sample sizes, deficits in documentation, and heterogeneous results. Most of the studies, however, showed a tendency for improvement of the analyzed parameters. CONCLUSIONS: The currently available data do not allow for valid and generalizable recommendations with respect to moderate altitude therapy for patients with allergic bronchial asthma. There is a need for additional, qualitatively strong research including larger sample sizes and randomized, controlled trial design.

[Particular features of erythropoiesis in high altitude and possibilities of applying of hypoxic hypoxia methodology for the patients with hemopoietic suppression].

Conditions of hypoxic hypoxia at 3200 m height exert significant positive changes in hemopoiesis, normalizing erythropoiesis and coagulation system. Hypoxic climate therapy can be regarded as an additional efficient method to the pathogenetic treatment for patient with unpainful aplastic anemia and idiopathic thrombocytopenic purpura. It should be emphasized that patients must be out of immunosuppressive therapy when getting high altitude stationary.

Effect of the Dead Sea climatotherapy for psoriasis on quality of life.

BACKGROUND: It is well known that quality of life is an integral part in the outcome evaluation process of psoriasis treatment. Very few studies, however, examined the effect of climatotherapy at the Dead Sea on quality of life of such chronically ill patients. OBJECTIVES: To determine the effect of the Dead Sea climatotherapy on the quality of life of patients with psoriasis vulgaris and psoriatic arthritis. METHODS: A total of 119 patients participated in an observational prospective study carried out at the Deutsches Medizinisches Zentrum clinic, a medical skin care center specializing in climatotherapy. The patients completed questionnaires (Skindex-29) to quantify their quality of life at different time points: the day of arrival, the day of departure, and 3 and 6 months after the end of treatment. RESULTS: Marked improvement in the quality of life scores was measured between the time of arrival to time of departure and to 3 months after the end of treatment. CONCLUSIONS: Dead Sea climatotherapy has a significant positive influence on the quality of life of patients with psoriasis vulgaris and psoriatic arthritis.

[Optimization of the treatment of the patients presenting with chronic venous insufficiency in the lower extremities with the use of the modern methods of thalassotherapy].

The introduction of thalassotherapy (seaweed wraps cold) into the standard drug therapy and elastic compression techniques increases the effectiveness of conservative treatment of the patients presenting with chronic venous insufficiency due to the influence of biologically active components of brown algae that help to improve microcirculation, lymphatic drainage function, and peripheral hemodynamics. These effects lead to a decrease in the severity of hypoxia, enhancement of tissue trophism, promotion of inflammatory processes, reduction of the clinical manifestations of the disease, and improvement of the patients' quality of life.

Climatotherapy at the Dead Sea: an effective treatment modality for atopic dermatitis with significant positive impact on quality of life.

BACKGROUND: Atopic dermatitis (AD) has an appreciable effect on quality of life. Improving the quality of life of AD patients is a priority. OBJECTIVE: This study aimed to evaluate the impact of Dead Sea climatotherapy (DSC) as a treatment of AD and its influence on the quality of life of these patients. METHODS: Forty-nine adult patients with AD treated during the years 2009-2010 at the Deutsches Medizinisches Zentrum Medical Center participated in this prospective study. Climatotherapy was administered in accordance with a computer-designed protocol and included gradually increased sun exposure after a sea bath. Severity of AD was evaluated using the Scoring Atopic Dermatitis (SCORAD) index. Patient quality of life was evaluated using Skindex-29. Statistical analysis was performed using a paired t test and Wilcoxon and Mann-Whitney U tests. RESULTS: After treatment, the mean SCORAD value improved by 39 points (P < 0.001). The overall Skindex-29 score improved by a mean value of 33 points (P < 0.001). The pretreatment SCORAD, duration of AD, and maximal daily sun exposure predicted the posttreatment SCORAD values. Pretreatment Skindex-29 and patient age predicted the posttreatment Skindex-29 in a multiple linear regression model. CONCLUSIONS: Dead Sea climatotherapy provides an effective treatment modality for AD by improving the patient's skin condition and quality of life.

[Optimization of the-spa-and-resort treatment of the patients with metabolic syndrome].

The present study included 271 patients presenting with metabolic syndrome. It was designed to compare the efficacy of traditional and optimized therapeutic modalities for the management of this condition. The modified treatment program included climatotherapy, dietary therapy, physical exercises, hydro-balneotherapy, hypoxic hyperkapnotherapy, and education. The study demonstrated that the proposed therapeutic program increased the efficiency of the spa-and-resort treatment.

[The influence of different types of bathes for general health on the efficiency of combined spa and resort treatment of coronary heart disease].

The spa and resort treatment of coronary heart disease was given to 106 patients (34 men and 72 women) aged from 45 to 69 years presenting with angina of effort It consisted of basic therapy in combination with a rational diet, remedial physical exercises, thalassotherapy, underwater shower massage, low-mineralized Chvizhense water. The patients were allocated to three groups depending on the type of prescribed baths for general health, viz. radon baths (group 1), iodine-bromine baths (group 2), and hydrogen sulfide baths (group 3). The evaluation of the efficacy of different therapeutic modalities has demonstrated that the differential application of combined treatment with the inclusion of mineral waters of the Sochi health resort and underwater shower massage shower massage produces beneficial effect on the patients presenting with coronary heart disease.

[Thalassotherapy: long-term developments].

The currently available medical technologies for the rehabilitative and balneological treatment of osteoarthrosis enable specialists to significantly suppress the activity of inflammatory and destructive process, reduce severity of pain syndrome, improve functional abilities of the patients, prevent the further development of the disease, and increase the overall efficiency of health resort-based therapy by 18-20%.