Medical-legal considerations in the medical spa environment

A better understanding of the medical-legal considerations of the medical spa environment plays a role in promoting a successful medical spa. The medical spa setting is ideal for the performance of procedures that are incision-less, provide minimal discomfort, create little to no skin wound, and are performed in less than one hour. The procedures that fit this model include those that promote antiaging, those that lead to rhytid treatment, and hair removal.     

Cross-Border Dissemination of Methicillin-Resistant Staphylococcus aureus, Euregio Meuse-Rhin Region

Because the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs among the 3 countries forming the Euregio Meuse-Rhin (EMR) region (Belgium, Germany, and the Netherlands), cross-border healthcare requires information about the spread of MRSA in the EMR. We investigated the emergence, dissemination, and diversity of MRSA clones in the EMR by using several typing methods. MRSA associated with clonal complexes 5, 8, 30, and 45 was disseminated throughout the EMR. Dutch isolates, mainly associated with sequence types (ST) ST5-MRSA-II, ST5-MRSA-IV, ST8-MRSA-IV, and ST45-MSRA-IV had a more diverse genetic background than the isolates from Belgium and Germany, associated with ST45-MRSA-IV and ST5-MRSA-II, respectively. MRSA associated with pigs (ST398-MRSA-IV/V) was found in the Dutch area of the EMR. Five percent of the MRSA isolates harbored Panton-Valentine leukocidin and were classified as community-associated MRSA associated with ST1, 8, 30, 80, and 89.     

Cancer Mortality Survey in a Spa Area (Misasa, Japan) with a High Radon Background

The 1952–88 cancer mortality records for inhabitants of the Misasa spa area, Japan, which has a high radon background, and a neighboring control area without any radon spa were analyzed (average outdoor Rn concentration: 26 mBq-liter⁻¹ in Misasa vs. 11 mBq-liter⁻¹ in the control area). Standardized mortality ratios (SMRs) for cancers of all sites were significantly lower among the inhabitants of both Misasa (male 0.538; female 0.463) and the control area (male 0.850; female 0.770), than in the whole Japanese population. Poisson regression analysis showed that the relative risks among the inhabitants of Misasa were significantly lower than in the control area for deaths from cancers of all sites (0.67) and stomach cancer (0.59). The relative risk of lung cancer death was also lower (0.55 times) in Misasa than in the control area, although the difference was not statistically significant. These results suggest that the linear no-threshold hypothesis for radiation risk may not be valid for exposure to low doses of radon.     

Alternative treatment of psoriasis with balneotherapy using Leopoldine spa water

BACKGROUND: Leopoldine spa water is a hypotonic water rich in sulphate that has been used occasionally for balneological treatments in psoriatics. We evaluated the anti-inflammatory effects of this salso-sulphate water on the skin of subjects with psoriasis. PATIENTS AND METHODS: We selected 10 volunteer subjects (23-58 years old), who presented symmetrical, bilateral psoriasis involving at least 40% of the body surface. All the subjects were subjected to the following treatment schedule: (i) immersion of both arms in water twice a day [the right arm was immersed in Leopoldine spa water at its natural source temperature (27.2 degrees C) for 30 min, and the left arm was immersed in double-distilled water for 30 min at a constant temperature of 27 degrees C]; (ii) both arms were exposed to the sun for 60 min after each immersion; and (iii) vaseline containing moisturizing creams were applied liberally. The treatment was continued for 4 weeks and was well tolerated by all subjects. Response to treatment was assessed by means of the modified Psoriasis Area and Severity Index (PASI). Six of the 10 subjects volunteered to undergo a cutaneous biopsy of lesional skin both before and 4 weeks after treatment to allow for assessment of modifications of the cutaneous infiltrate in the areas treated. RESULTS: At the end of 4 weeks the average pretreatment PASI score of the left arms was 5.72 (range 4-9.6) while the right arms had a mean PASI of 5.56 (range of 3.2-9). At the end of the study the average PASI score was 0.78 for the arms treated with Leopoldine spa water and 2.83 for the arms treated with double-distilled water. The mean PASI improvement score for the Leopoldine spa water treated arms was 85.9% while the double-distilled water treated arms showed a PASI improvement score of 50.5%. An immunohistological study showed significant differences between the cutaneous samples taken 4 weeks after treatment and those taken before treatment with Leopoldine spa water. There were significant decreases in the numbers of epidermal CD4+ and CD8+ T lymphocytes and CD1a+ Langerhans cells (microscopic field at x 22 objective), as well as a decrease in the epidermal keratinocyte expression of intercellular adhesion molecule-1 and interleukin-8 and the dermal expression of CD4+ and CD8+ T lymphocytes. CONCLUSIONS: These data show the potential anti-inflammatory effects of Leopoldine mineral waters on human skin affected by psoriasis.     

MRSA eradication in dermatologic outpatients - theory and practice

Background: The dissemination of methicillin resistant staphylococcus aureus (MRSA) is an increasing challenge in medical care. Apart from hospital acquired MRSA, there has also been an increase in community acquired and livestock associated MRSA. While the risks of MRSA (e. g. wound infections) and consequences (e. g. rejection of patients) are well known, there are little data on the effectiveness of eradication procedures. Patients and methods: 32 patients with proven MRSA colonization were monitored during eradication for the following aspects: (1) localization of MRSA (swabs from hairline, anterior nares, throat, axillae, groins, perineum, and wounds, if present), (2) presence of eradication‐impairing factors, (3) length of time needed for eradication, (4) cost of eradication, (5) molecular fingerprint and risk assessment (spa‐types). Results: We describe the successful eradication of MRSA in all 32 patients. Most positive nasal swabs were obtained from the anterior nares and the throat and only rarely from the hairline or axillae. The greater the number of positive swabs, the more time was needed for eradication. In most patients (37.5%), eradication with topical antiseptics was successful. The average time for eradication was 12.97 (± 7.6) days. Twelve patients required systemic antibiotic therapy. Treatment costs associated with the use of systemic antibiotics were significantly higher. The most frequent spa types were t032 and t003. Conclusions: We report successful MRSA eradication in outpatients. Systemic antibiotics are unnecessary in the majority of patients. A combined anti‐MRSA strategy for inpatients and outpatients is recommended.     

Long-term benefit of radon spa therapy in the rehabilitation of rheumatoid arthritis: a randomised,double-blinded trial

This study investigates the effects of radon (plus CO₂) baths on RA in contrast to artificial CO₂ baths in RA rehabilitation using a double-blinded trial enrolling 134 randomised patients of an in-patient rehabilitative programme (further 73 consecutive non-randomised patients are not reported here). The outcomes were limitations in occupational context/daily living (main outcome), pain, medication and further quantities. These were measured before the start, after the end of treatment and quarterly in the year thereafter. Repeated-measures analysis of covariance (RM-ANCOVA) of the intent-to-treat population was performed with group main effects (GME) and group × course interactions (G × C) reported. Hierarchically ordered hypotheses ensured the adherence of the nominal significance level. The superiority of the radon treatment was found regarding the main outcome (RM-ANCOVA until 12 months: p _GME = 0.15, p _GxC = 0.033). Consumption of steroids (p _GME = 0.064, p _{G × C} = 0.025) and NSAIDs (p _GME = 0.035, p _{G × C} = 0.008) were significantly reduced. The results suggest beneficial long-term effects of radon baths as adjunct to a multimodal rehabilitative treatment of RA.     

High frequency of multidrug‐resistant Staphylococcus aureus with SCCmec type III and Spa types t037 and t631 isolated from burn patients in southwest of Iran

Methicilin resistance Staphylococcus aureus (MRSA) infections are the major challenges in hospitals, especially in the burn units. The use of molecular typing methods is essential for tracking the spread of S. aureus infection and epidemiological investigations. The aim of this study was to find the profile of the spa types and also the prevalence of each SCCmec type of S. aureus strains in a central burn hospital in southwest of Iran. A total of 81 non‐duplicate S. aureus were isolated from burn patients between April 2011 and February 2012. The susceptibility of the isolates against 13 different antibiotics was tested by disk agar diffusion (DAD) method. MRSA strains were identified by amplification of mecA gene. Multiplex‐polymerase chain reaction (PCR) technique was used to determine the SCCmec types of MRSA strains and all the S. aureus isolates were typed by spa typing method. Detection of mecA gene showed that 70 (86.4%) of the isolates were MRSA. The highest rate of resistance was observed for penicillin (97.5%) and erythromycin (77.8%). None of the isolates were resistant to vancomycin. Sixty‐seven of the 70 MRSA isolates harbored only SCCmec type III and three untypeable isolates. Five different spa types were detected. The most common spa types were t037 (42.5%) and t631 (34.5%) and were only found in MRSA isolates. Only SCCmec type III was found in burn patients which emphasizes the HA‐MRSA origin of these strains. Only five different spa types identified in this study are in accordance with one SCCmec type which indicates that a limited number of bacterial colons are circulated in the burn unit in this hospital.     

Clinical and economic analysis of spa therapy in Parkinson's disease.

The effectiveness of spa therapy in the management of patients with Parkinson's disease (PD) has never been evaluated. This is assessed in this pilot study. A prospective, randomized, cross-over, controlled study was conducted in 31 PD patients who underwent a 20-week spa period, including spa therapy for 3 weeks, and a 20-week non-spa period. Effectiveness was assessed using quality of life scales (PDQ-39 and SF-36), motor scale (UPDRS) and psychological questionnaire (GHQ-28), at baseline and at 4 (T4) and at 20 weeks (T20). Direct medical costs (radiological and laboratory tests, physician fees, drug therapy, and ancillary care) were recorded over each 20-week period. At T4, spa therapy improved significantly several dimensions of PDQ-39 and SF-36, part IV of the UPDRS, and GHQ-28. At T20, no difference in any parameter was found. The mean direct medical cost over 20 weeks (euro;1,328 +/- 167; pound 776 +/- 97 per patient) in the spa period was slightly but significantly reduced in comparison with that of the non-spa period (euro;1380 +/- 523; pound 807 +/- 306 per patient). This cost-effectiveness analysis suggests that spa therapy is more effective and less expensive than conventional treatment alone and could be beneficial in the management of PD.