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Techirghiol November 11, 2012

Authors: Daniela Profir, Viorica Marin, Olga Surdu, Sibel Demirgian, Elena Valentina Ionescu Balneal and Rehabilitation Sanatorium, Techirghiol, Romania

Ovidius University, Constanta, Romania

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Techirghiol Lake is a salty lake situated in southeast of Romania, famous for therapeutic effects due to its natural deposits of sapropelic mud. In Balneal and Rehabilitation Sanatorium from Techirghiol are treated patients with a wide range of diseases, using mud and salted water from the lake. There are two different ways of mud application cold mud ointment and heated mud packing or bath.

Most of inpatients are admitted in the sanatorium by means of public health insurance system, only a small number come by direct payment.

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Patients are using mud as cold mud ointment and than swim in the lake, method known from ancient times as Egyptian method.

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Here are some examples of how we are using sapropelic mud as heated mud wrapping and warm mud bath.

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Material and method

The study was conducted between May 2011 and April 2012 and 6281 patients were enrolled in this statistical analysis. The patients were admitted for a period of 12 days up to 30 days and received complex rehabilitation treatment: hydro-kinetic-therapy in the salted water of the pool, alternative with warm mud baths or hot mud wrapping, massage, electrotherapy, kinetotherapy. All patients underwent an initial clinical examination and then the physician filled up a questionnaire, which includes some personal data, information about the disease requiring admission (predominant symptom, main symptom location, physical activity at home, person who recommended balneal cure), if the patient has in the medical history any balneal treatment and what were the results, and finally the group of affections to which fit the existing symptoms. Data from the questionnaires were statistically processed and plotted. The used questionnaire was conceived by a group of physicians from the sanatorium.

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Balneal treatment center: Balneal and Rehabilitation Sanatorium Techirghiol

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Type of therapeutic factors

climate water mud

Type of cures external

internal During cure: 11, 14, 18, 21 days Name Age .. Surname ............................................................................................................... Sex: M/F... Address-No. tel. ... Profession (City, villag .......................................... In activity .. Retired Weight, .. Height . BMI = m (kg) / (h2) (m) B.P . H.B. .......... Smoking: No \ Yes (No cigarettes /day) .. Diabetes Type .. Other comorbidities Physical activity performed with coordination \ without coordination, daily, for 2-3 days, weekly, monthly, no physical activity. Specify the level of stress experienced; On a scale from 0-10. Clinical Data: Physician who recommended the cure: General Doctor . Specialist Doctor .. Non-medical person (friend, relative, etc.)... The symptom or the health condition that made him to follow the balneal cure - Pain - cervical, dorsal, lumbar, scapulo-humeral joint, sciatica, shoulder, elbow, fist, hand, hip, knee, ankle, foot, polyarthralgias - Functional deficit - upper limb, lower limb, upper limb + lower limb, both inferior members, the four members -Walk - individual - without support or with support - unipodal (cane, crutch, tripod), bipodal (cane, crutches, frame); wheelchairs; immobilized - Other Balneal treatment before: first cure, a cure prior days, . months ahead, more than two cures longer than 10 days; every months. Benefits of previous cures: reducing physical pain, reduce drug use, improve life quality, no lasting effect

Groups of pathology (diagnosis)

1. Musculoskeletal conditions: osteoarthritis, particular diseases (tendonitis, fibromyalgia), rheumatoid arthritis, ankilosing spondylitis (other spodyloarthropathy), the traumatic status, other orthopedic sequelae 2. O.R.L. 3. Diseases of the respiratory tract 4. Dermatological conditions 5. Cardiovascular / venous conditions 6. Digestive conditions 7. Endocrine and metabolic disorders 8. Renal and urinary disorders 9. Genital disorders 10. Neurological disorders 11. Psychiatric disorders 12. Pediatric diseases (under 16)

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Total F 692 456 212 137 2217 1220 19 15 M 236 75 997 4

Symptom cervical pain dorsal pain lumbar pain all column pain dorso-lumbar pain brachialgia sciatalgia shoulder pain elbow pain wrist pain hand pain hip pain knee pain ankle pain foot pain polyarthralgia TOTAL

63 40 23 50 32 18 341 188 153 289 150 139 22 13 9 20 17 3 59 43 16 480 295 185 1015 675 340 90 52 38 84 41 43 371 248 123 6029 3622 2407

The great majority of patients presented as main symptom lumbar pain (mostly degenerative or slipped disc hernia without neurological signs), followed by knee pain (osteoarthritis) and cervical pain (spondylosis or slipped disc hernia).

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From the chart above it can be seen that the most frequent affected region is vertebral column (with all segments), followed by knee and hip.

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Gender distribution of main symptom

Comparing distribution of main symptom in men and women, one can see that incidence of almost all the symptoms is increased in women , with the greatest difference for wrist and hand pain, except for foot pain, that is predominant in men.

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Vertebral pain
cervical pain dorsal pain lumbar pain all segments dorso-lumbar pain

F
66,08% 64,45% 55% 80,95% 75,47%

M
33,92% 35,55% 45% 19,05% 24,53%

Lumbar pain has a similar incidence in men and women, the other types are predominant in women.

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Reason for admission pain functional deficit others not known

Number of patients 6029 212 10 27

The most frequent reason for admission is by far pain of different causes (96%) and only a small number of patients addressed for a functional deficit.

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Gender distribution of reason for admission

Reason for admission pain functional deficit others F 57,69% 1,16% 0,11% M 38,34% 2,21% 0,00%

There is an increased incidence in women of pain as reason for admission, meanwhile in case of functional deficit men are predominant.

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Functional deficit of homolateral limbs (hemiplegia) is predominant and has an increased incidence in men.

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By far, the most frequent pathology in admitted patients is locomotor pathology (more than 90%), followed by neurologic pathology, that includes sciatalgia and brachyalgia, as results of slipped disc hernia.

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Osteoarthritis with different locations has the greatest incidence, followed by others, in which the most prevalent was lumbar slipped disc hernia without neurologic signs.

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In this group of age (young people) spinal pain is responsible for more than 50% of presentations, maybe because of lack of physical activity as a result of vibrant life of active people nowadays. On the second and third place, but far beyond spinal pain, there is functional deficit of homolateral limbs and of lower limbs, due mostly to trauma.

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As one can see, there is an increased incidence of lumbar pain as a result of early discopathy, followed by dorsal pain, mainly produced by changes of spine axis (scoliosis, kyphosis).

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In this age group spinal pain is also predominant as admission reason, but followed by sciatalgia, mainly caused by slipped disc hernia, as a result of sedentariness and vicious diet.

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In this group of age incidence of lumbar pain is increasing, but on the second place comes cervical pain, probably because of high frequency of spondylogenic changes.

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In this group of age spinal pain is predominant because of marked degenerative changes of vertebrae, followed by sciatalgia, but on the third place is knee pain, mainly due to osteoarthritis, but also to traumatic causes. As one can see, the incidence of polyarthralgia begins to increase slowly.

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Comparing the two charts, we can see similar incidences for pain with same location.

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In this group of age spinal pain is again on the first place, followed by knee pain and hip pain, mostly because acceleration of cartilage degradation with age.

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Although on the first place remains spinal pain, in this group of age one can see a major change of situation. The following symptoms which determined presentation in sanatorium are hand pain, wrist pain and polyarthralgia, all due mainly to arthritic changes that characterizes third age.

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In this chart one can see similar incidences for pain with same location as in groups of age 40-49 and 50-59 years old, with a slight increase of frequency for dorsal pain, that can be explained by increasing osteoporosis after this age.

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After balneal treatment most of the patients have confirmed a decrease of pain, in some cases associated with improvement of life quality.

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From the point of view of affected region, more than 50% from the
patients admitted in sanatorium suffer from spinal pain, considering all three regions of column. On the second place there is knee pain, mostly caused by osteoarthritis. Hip pain comes on the third place, most cases having degenerative determination.

Incidence of main symptom is increased in women in all cases, except

foot pain which is slightly increased in men.

Among spinal pain, lumbar region is most affected, followed by

cervical pathology, than dorsal symptomatology. Gender distribution of spinal pain shows that there is a predominance in women, no matter the region affected, with almost similar incidence for lumbar spine in men and women.

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More than 96% from patients describe as reason for admission pain, a far
smaller percentage has functional deficits.

From all reasons for admission, pain is predominant in women, meanwhile

functional deficits has a greater incidence in men.

Among functional deficits there is an increased incidence of damage of

homolateral limbs (hemiplegia), followed by functional deficit of lower limb, mostly caused by radiculitis from slipped disc hernia or as orthopedic sequelae.

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Predominant pathology in sanatorium is locomotor pathology (92%),

followed by neurologic pathology (7%).

From the group of osteo-articular pathology the greatest incidence is

attributed to osteoarthritis, followed by early stage of slipped disc hernia.

In all analyzed age groups, spinal pain is predominant. The second

place varies as age increases, from functional deficits in young people (especially after traumas) to degenerative diseases after fifth decade (knee and hip arthritis, polyarthralgia).

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Balneal treatment with salted water and sapropelic mud results in

alleviation of pain in most of the patients, also for an important part of patients contribute to improvement of life quality.

Actual statistic analysis shows a great addressability of patients from

all over the country, most of them with chronic degenerative rheumatism. As the frequency of this pathology is increasing continuously and drug treatment has many side effects, patients are looking for less harmful alternative treatment.

We hope that in the future more patients will address to this modern
balneal center, due to beneficial effects of sapropelic mud, demonstrated by studies performed by the research center within sanatorium.

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Thank you for your attention!