Hydrotherapy and Its Application in Oral Medicine

When it comes to natural medicine, the use of water or hydrotherapy is as old as humankind. Hydrotherapy is also known as water therapy, pool therapy, balneotherapy and aquatic therapy. Water as a treatment aid was used in various parts of Rome, Greece, Egypt, China and Japan in the ancient period. Water therapy means using water for medicinal purposes like hot tubs, cold water treatments, ice packs, steam vapours, saunas, mineral springs, hot springs, wet towel applications, water exercises, and water massages. Therefore, the use of water at different temperatures and in different forms provides various effects on several systems of the body. Great results of hydrotherapy were experienced by people in physical functioning, energy, sleep, cognitive function, ability to work and participation in daily life. Based on the available data and literature this review propounds that water therapy has an empirical evidence-based outcome on various systems of the body. KEY WORDS Natural Medicine, Hydrotherapy, Empirical Evidence-Based, Various Systems.

The hidden history of hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP) is a relatively new construct, first reported in the early 20th century, despite major aetiologic factors (farming, bird husbandry) being part of human activities for millennia. Initial confirmed HP reports include exposure to farming and forestry (1932) and bird exposure (1965), much more recently in time than is often assumed. Later changes in occupational and living practices have led to HP associated with isocyanates, machine coolants, indoor mould, hot tubs, and other exposures. Evolution in our pathological understanding of interstitial lung disease in general, wider computerised tomography (CT) utilisation, and advances in immunology and genomics have shaped our modern conceptualisation of HP. Examining historical accounts of HP and its causative factors not only considers when the first cases were recognised, but also explores why the disease emerged at specific times and places, and may provide further insights relevant to the mechanisms underlying HP and disease prevention.

Microbiological alterations in the conjunctiva of hot tub-soaking ophthalmologists (MACHO): a randomized double-blind clinical trial

Background: To determine if there is a difference in the quantity of microbial flora of the conjunctiva in individuals practicing head submersion (“dunk”) versus no head submersion (“no-dunk”) during hot tub use. Methods: In this double-blind randomized clinical trial, healthy volunteers aged ≥ 18 years were recruited. Participants were randomized to head submersion versus no head submersion during a 15-minute hot tub soak. Study personnel, masked to the dunk or no-dunk group assignment, obtained conjunctival cultures before and immediately after hot tub use. De-identified specimens were submitted to the clinical microbiology laboratory for culture and analysis. The main outcome measure was the difference in the quantity of organisms cultured from the conjunctiva before and after hot tub exposure, as determined using a defined ordinal scale. A two-tailed Student’s t-test was performed to compare the total microbial colony counts between the two arms. Simpson’s diversity was used to measure the changes in organism diversity between the arms. Results: Of 36 enrolled subjects, 19 were randomly assigned to the dunk and 17 were assigned to the no-dunk groups. Water samples obtained from all hot tubs were culture negative. Eleven of 19 eyes (58%) from the dunk group and eight of 17 eyes (47%) from the no-dunk group had negative conjunctival bacterial cultures before and after hot tub exposure. However, six of 19 eyes (32%) and four of 17 eyes (24%) of the dunk and no-dunk groups, respectively, were culture-positive after, but not before hot tub exposure. The quantity of organisms before and after hot tub exposure was not significantly different between the two arms (P = 0.12). However, the dunk group only showed a small increase in the quantity of organisms after as compared to before hot tub use (P = 0.03). None of the samples from subjects or hot tubs were culture-positive for Acanthamoeba. Conclusion: Head submersion in a public hot tubs during a 15-minute soak does not appear to change conjunctival flora, as determined by culture plate yield.

Impact of swimming pool water treatment system factors on the content of selected disinfection by-products

Recommendations regarding disinfection by-products (DBPs) in pool waters consider the content of trihalomethanes (THMs) and combined chlorine (CC) as indicators of DBPs based on which the health risk for swimmers and staff of pool facility can be determined. However, the content of DBPs in swimming pools depends on many factors. In this paper, the influence of selected factors (physicochemical parameters of water and technological parameters) on the content of THMs and CC in pool water was determined. During the 6-month period, 9 pools of various functions were analyzed. The water in pools was subjected to the same method of treatment. The content of THMs and CC was compared against the content of organic matter, free chlorine and nitrates, pH, temperature, redox potential and turbidity, technological, and operational parameters. The THM content did not exceed the limit value of 0.1 mg/L. The content of CC varied significantly, from 0.05 to 1.13 mg Cl2/L. It was found that a very large water volume per person, in comparison to a very small one, contributed to the low content of CC and THMs. The high load expressed as m3 of water per person or m2 of water per person and the specific function of hot tubs (HT1 and HT2) led to the average concentration of CC in these pools exceeding 0.3 mg Cl2/L. The THM concentrations in hot tubs (especially in HT1) were also among the largest (0.038–0.058 mg/L). In terms of the analyzed microbiological indicators, the quality of the tested pool water samples was not in doubt. It was found that the purpose of the pool, its volume, and number of swimmers should be the key parameters that determine the choice of methods of water treatment. The research on the pool water quality in the actual working conditions of swimming pool facilities is necessary due to the need to preserve the health safety of swimmers and staff.

Two children with extra-nodal Mycobacterium avium complex infection

Mycobacterium avium complex (MAC) is usually considered an opportunistic organism, which infects immunocompromised children or those with structural airway abnormalities. We present two cases of MAC infection affecting immune competent children, likely from hot tubs with primary involvement of pulmonary and urinary systems. These cases highlight the importance of asking about hot tub use in immune competent children with suspected or confirmed MAC infections.

A Snapshot of the Prevalence and Molecular Diversity of Legionella pneumophila in the Water Systems of Israeli Hotels

Exposure to Legionella spp. contaminated aerosols in hotel settings confers risk for travel-associated Legionnaire’s disease (TALD). In this study, we investigated the prevalence of Legionella contamination and its molecular diversity in hotels and resorts across Israel. The study was comprised of a convenience sample of water systems from 168 hotels and resorts countrywide, routinely inspected between March 2015 and February 2017. Isolation and quantitation of Legionella were performed in a water laboratory using the ISO 11731 method. The distribution of Legionella isolates was analyzed according to geography and source. The genetic diversity of a subset of isolates was analyzed by sequence-based typing (SBT) at the National Reference Laboratory for Legionella and compared to the national database. Out of 2830 samples tested, 470 (17%) obtained from 102 different premises (60% of hotels) were positive for Legionella spp. In 230 samples (49% of all positive, 8% of total samples), accounting for 37% of hotels, Legionella spp. counts exceeded the regulatory threshold of 1000 CFU/L. The most frequently contaminated water sources were cooling towers (38%), followed by faucets, hot tubs, water lines, and storage tanks (14–17% each). Furthermore, 32% and 17% of samples obtained from cooling towers and hot tubs, respectively, exceeded the regulatory thresholds. SBT was performed on 78 strains and revealed 27 different sequence types (STs), including two novel STs. The most prevalent STs found were ST1 (26%), ST87 (10%), ST93 (6%), and ST461 and ST1516 (5% each). Several L. pneumophila STs were found to be limited to certain geographical regions. This is the first study to investigate the prevalence and diversity of Legionella in hotels and resorts in Israel during non-outbreak environmental inspections. These findings will inform risk assessment, surveillance, and control measures of TALD.

Nontuberculous Mycobacterial Infection

Non-tuberculous mycobacteria (NTM), other than Mycobacterium tuberculosis (TB) may produce pulmonary infection. NTMI is typically an indolent infection except in immunocompromised and HIV infected patients. Imaging plays a crucial role in suggesting NTMI as a possible diagnosis in this patient population. Always consider classic or cavitary NTMI in patients with upper lobe cavitary disease similar to active cavitary TB. However, in such cases TB must always be excluded. In elderly white women, persistent right middle lobe/lingular atelectasis, bronchiectasis or consolidation should suggest the diagnosis of bronchiectactic NTMI. In patients with imaging findings of subacute hypersensitivity pneumonitis, the radiologist must review the history and consult with the clinician in order to identify the triggering allergen, including NTM which is associated with indoor hot tubs.