B Acad Nat Med Paris
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B Acad Nat Med Paris · Mar 2016
Review[SPA therapy for pain of patients with chronic low back pain, knee osteo-arthritis and fibromyalgia].
The data of 33 randomized controlled trials suggest that chronic pain of patients with chronic low back pain, knee osteo-arthritis, fibromyalgia is significantly improved by balneotherapy and significantly better improved than by control treatments. For chronic low back pain (10 RCT, 1192 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 19.66 (95 % CI: 16.6 ; 22.8) and the effect size was 1.1 (95 %CI: 0.82 ; 1.38) favouring balneotherapy. For knee osteo-arthritis pain (17 RCT, 1428 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 13.24 (95 % CI: 5.52 ; 20.96) and the effect size was 0.72 (95 %CI: 0.51 ; 0.93) favouring balneotherapy. ⋯ Balneotherapy is a safe treatment as only 1 % of the patients receiving balneotherapy had to interrupt the treatment. However several methodological biases were observed in many trials, mainly a lack of statistical power due to a limited enrolment of patients, an insufficient duration of follow-up, an inhomogeneity of treatments. The clinical benefit has to be confirmed by stronger data of evidence but these data are sufficient to perform a more complete scientific analysis (meta-analysis) ; but further clinical investigations with a better methodological quality remain necessary.
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B Acad Nat Med Paris · Mar 2016
Review[Plasmodium falciparum resistance to artemisinin-based combination therapies (ACTs): Fears of widespread drug resistance].
Malaria treatment with ACTs (Artemisinin-based Combination Therapies), combining a chemical derivative of artemisinin, and a partner drug has, for more than 15 years, produced a notable decrease in the mortality in tropical and subtropical areas. However, since 2008, a serious threat has emerged in western Cambodia, where the clinical efficacy of artemisinins has significantly declined, with a delayed parasite clearance rate and high recrudescence rates in the following weeks. ⋯ ACTs remain effective as long as the partner drug retains its activity but more and more clinical failures related to parasite resistance to both resistant parasites in sub-Saharan Africa, the continent most affected by malaria, as was the case in the past with other antimalarial treatments. It is therefore essential to better understand, from phenotypic and genotypic points of view, the mechanisms of resistance developed by the parasite Plasmodium falciparum face artemisinin and its derivatives in order to offer new therapeutic tools.