Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - New Medicine 1/2013, s. 3-8
*Aneta Dąbek, Janusz Domaniecki, Piotr Czyżewski, Małgorzata Bujar-Misztal
Evaluation of selected therapeutic methods in patients with primary Raynaud”s syndrome
Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
Head of Department: Małgorzata Łukowicz, MD, PhD, assoc. Prof.
Summary
Introduction. The only treatment method for individuals with primary Raynaud”s widely used in Poland, is drug therapy.
Aim. The aim of the study was to demonstrate experimentally that other non-pharmacological treatment for primary Raynaud”s sufferers are possible, and to determine their efficacy.
Material and methods. The paper describes and discusses the results of comprehensive assessment of 60 patients of the Department of Dermatology. The patients were randomly assigned to a control group and two experimental groups (relaxation therapy and physical therapy, 20 patients each). As it would be unethical to deny treatment to those patients assigned to the control group, that group received drug therapy alone, while the other two groups received drug therapy plus additional treatments (infrared sauna or relaxation training). All patients were assessed on three occasions: at baseline (before the experiment) (I), and after twelve (II) and twenty-four (III) weeks of treatment. The paper presents the results of assessment of changes in capillary circulation (by capillaroscopy), pain, sweating (VAS scale), frequency of Raynaud”s attacks (questionnaire), and level of anxiety (STAI questionnaire).
Results. The experimental groups (physical therapy and relaxation therapy) demonstrated significantly better results on capillaroscopic examination after 24 weeks of treatment compared to the control group (p = 0.015 and p = 0.030, respectively). After 24 weeks of treatment, the physical therapy group reported a lower level of pain than the control group at p = 0.032.
Conclusions. The results of the study show that the health-related problems of patients with primary Raynaud”s require an interdisciplinary approach.
INTRODUCTION
The Raynaud”s syndrome is a paroxysmal vasoconstriction of peripheral arterioles in hands, more rarely feet, ears, tongue or mamma. The contraction lasts 15 to 45 minutes. During the ischemic paroxysm an intensive paleness of the fingers is observed and the patient complains of sensory disorders, also called ‘numb” fingers. After the ischemic paroxysm, redness and finger swelling is visible and the patient experiences strong pulsing pain (1-3).
The Raynaud”s disease pathomechanism has not been thoroughly explored.
Excessive mental excitation (stress) and cold are considered as the main cause of primary Raynaud”s syndrome (4).
Studies (5) shown a strong connection between Raynaud”s disease and affection of nail plates and exacerbation of mycosis. Apart from typical mycotic changes, untreated Raynaud”s disease may lead to shallow nail ruptures, whitlow and ulcerations (2).
The only treatment method for individuals with primary Raynaud”s widely used in Poland, is drug therapy. Preferred are the preparations with prolonged action as they lower the risk of side effects such as headaches, skin redness, blood pressure drop and gastro-esophageal reflux. Pharmacotherapy often doesn”t bring expected result, requires huge expenses and is inconvenient for the patient – medications need to be administered 3 to 4 times daily (4, 6).
Researchers (7-9) proved the efficacy of analgesic laser therapy in patients with primary Raynaud”s syndrome.
Foreign literature widely describes the therapy of patients with primary Raynaud”s employing the biofeedback phenomenon (10).
Few authors (4, 10, 11) claim that relaxation and acupuncture should be primal part of primary Raynaud”s syndrome treatment, especially in patients, in whom the stress is the main trigger of ischemic attacks.
AIM
The aim of the study was to demonstrate experimentally that other non-pharmacological treatment for individuals with primary Raynaud”s is possible, to determine their efficacy and to evaluate patients” subjective sentiments towards experimental forms of therapy.
Following hypothesis was assumed:
1. IR sauna has therapeutic values in rehabilitation of patients with primary Raynaud”s syndrome.
2. Relaxation constitutes the efficient form of therapy in rehabilitation of patients with primary Raynaud”s syndrome.
In order to verify the above hypothesis, the following experimental question was asked:
1. Will the therapy proposed in experimental groups lead to significant improvement of the following factors:
– capillary circulation
– hand pain reduction
– hand sweating reduction
– decrease of Raynaud”s syndrome frequency
MATERIAL AND METHODS
The study included 98 patients with Raynaud”s disease aged between 18 and 50 years-old. Patients have been undergoing an ambulatory treatment in Dermatology Clinic of Warsaw Medical University. Qualification for the study was based on the completion of the following criteria:
Age over 18 years.
– History of clinical symptoms characteristic for the primary Raynaud”s phenomenon for at least two years.
– Characteristic capillaroscopic image (blood congestion, vasospasm, Raynaud”s loops).
– Absence of concomitant disease justifying the primary Raynaud”s phenomenon.
– Drug therapy with pentoxifylline prescribed by dermatologist.
– Absence of contraindications for the use of IR sauna.
Patients with Raynaud”s disease were qualified to three following groups: control and two experimental groups with physical and relaxation therapy. The therapy lasting 24 weeks was successfully finished by 60 individuals. Table 1 shows characteristics of the study group including group abundance, age and sex.
Table 1. Study group characteristics.
CharacteristicGroup
ControlExperimental
RelaxationPhysical therapy
n (number of patients)202020
Sex (F; M)20F19F; 1M20F
Age (years)33 ± 1325 ± 433 ± 10.5
The study was conducted with the permission of Senate Ethical Committee for Scientific Research of Józef Piłsudski University of Physical Education in Warsaw (SKE 001/18-1/2007).
Patients with Raynaud”s disease participated in evaluation three times: at the therapy baseline (I examination), after 12 weeks of therapy (II examination) and after 24 weeks of therapy (III examination). Following parameters were evaluated: microcirculation and hand sweating, pain, anxiety level. To asses the efficacy of applied therapeutic procedures, following methods were used.
Capillary circulation
Capillaroscopic examination was carried out in order to assess changes in both hands” microcirculation (12).
Due to a high cost of this method, capillaroscopy was conducted twice – before (I examination) and after the therapy (II examination). Comparative three degree scale was applied, in which “-1” indicated deterioration, “0” – absence of changes and “1” indicated improvement.
Hand pain evaluation
Evaluation of hand pain was established with the use of Visual Analogue Scale (VAS). The VAS scale is a horizontal line, 10 cm in length, with labels anchored at each end (the minimum and the maximum), on which the patient marks the point representing the intensity of perceived pain. The result is presented in millimeters (distance between the point and the left end of the stretch) (13). Patients indicated the usually perceived pain.
Hand sweating
Hand sweating evaluation was also conducted employing VAS scale. Patients indicated the usual hand sweating degree
Frequency of ischemic attacks
Assessment of the Raynaud”s syndrome recurrence was carried out based on one week”s period. The study participants answered the following question: “How often do you experience Raynaud”s symptoms?”
A. once a week
B. twice a week
C. three times a week
D. more frequently (how often?)
Statistical analysis
The study data were analyzed with the use of SPSS statistical package ver.14. Kolmogorov-Smirnov test was used to estimate probability distributions. Multi-factorial ANOVA was used to compare values of the parameters such as: hand pain, hand sweating, symptom”s frequency per week. The Kruskal–Wallis one-way analysis of variance was used to test the quality of capillary circulation medians among groups. The lowest range of significance level was set at p ≤ 0.05.
Control group
As it would be unethical to deny treatment to patients assigned to the control group, this group received pharmacotherapy alone, while the other two groups received pharmacotherapy and additional treatments (infrared sauna or relaxation training). All individuals taking part in the study were administered pentoxifylline, prescribed by a dermatologist, twice a day. Therapy among patients with Raynaud”s disease lasted for 24 weeks.
Experimental group – relaxation

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Piśmiennictwo
1. Choi WS, Choi CJ, Kim KS et al.: To compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud”s phenomenon in South Korea; Korean Raynaud study. Clinical Rheumatology 2009; 28(5): 553-559. 2. Rychlik-Golema W, Adamiec R, Bednarska-Chabowska D, Adamiec J: Fenomen Raynaud – wciąż aktualny problem kliniczny. Przegląd Lekarski 2002; 59(1) 49-54. 3. Aron JH, Fink GW, Swartz MF et al.: Cerebral oxygen desaturation after cardiopulmonary bypass in a patient with Raynaud”s phenomenon detected by near-infrared celebral oximetry. Anesth Analog 2007; 104: 1034-1036. 4. Cooke JP, Marshall JM: Mechanism of Raynaud”s disease. Vascular Medicine 2005; 10: 293-307. 5. Araviiskaya ER, Kutznetzov AV, Petrischev NN et al.: Analysis of microcir ulation and regional blood flow in the patients with onychomycosis and Raynaud disease. Dermatologia Kliniczna 2004; 6(2): 71-74. 6. Puszczewicz M: Objaw Raynauda – problem interdyscyplinarny. Forum Medycyny Rodzinnej 2008; 2(2): 121-126. 7. Al-Awami M, Schillinger M, Maca T: Low level laser therapy for treatment of primary and secondary Raynaud”s phenomenon. Vasa 2004; 1: 25-29. 8. Hirschl M, Katzenschlager R, Francesconi C, Kundi M: Low level laser therapy in primary Raynaud”s phenomenon – results of a placebo contolled, double blind intervention study. J Rheumatol 2004; 31(12): 2406-2412. 9. Kita J, Kuryliszyn-Moskal A, Dakowicz A: Biostymulacja laserowa terapii zaburzeń mikrokrążenia u pacjentów z objawem Raynauda. Post NMed 2012; 2: 95-98. 10. Middaugh JS, Haythornthwaite AJ, Thompson B et al.: The Raynaud”s Treatment Study: Biofeedback Protocols and Acquisition of Temperature Biofeedback Skills. Applied Psychophysiology and Biofeedback 2001; 26(4): 251-278. 11. Garcia-Carrasco M, Jimenez- -Hernandez M, Escarcega RO et al.: Treatment of Raynaud”s phenomenon. Autoimmun Rev 2008; 8(1): 62-68. 12. Michalska-Jakubus M, Chodorowska G, Krasowska D: Kapilaroskopia wału paznokciowego. Mikroskopowa ocean zmian morfologicznych mikrokrążenia w twardzinie układowej. Postępy Dermatologii i Alergologii 2010; 2: 106-118. 13. Cepuch G, Wordliczek J, Golec A: Wybrane skale do badania natężenia bólu u młodzieży-ocena ich przydatności. Polska Medycyna Paliatywna 2006; 5(3): 108-113. 14. Kihara T, Biro S, Imamura M et al.: Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. J AM Coll Cardiol 2002; 39: 754-759. 15. Masuda A, Nakazato M, Kihara T et al.: Repeted thermal therapy dismishes appetite loss and subjective complaints in midly depressed patients. Psychosomatica Medicine 2005; 67(4): 643-647. 16. Masuda A, Koga Y, Hattamaru M et al.: The effects of repeated thermal therapy for patient with chronic pain. Psychother Psychosom 2005; 74(5): 288-294. 17. Kulmatycki L, Miedzińska B: Podatność na relaksację a cechy osobowości. Postępy Rehabilitacji 1999; 3: 151-159. 18. Kostrzewa-Jabłonka M: Wpływ wysokiego poziomu napięcia na efekty leczenia w wyniku kompleksowej fizjoterapii chorych z dyskopatią szyjną i lędźwiową. Postępy Rehabilitacji 1999; 2: 81-88. 19. Brzeziński J: Metodologia badań psychologicznych. PWN, Warszawa 2007.
otrzymano: 2013-01-10
zaakceptowano do druku: 2013-02-25

Adres do korespondencji:
*Aneta Dąbek
Department of Rehabilitation The University of Physical Education
34 Marymoncka St., 00-968 Warsaw
tel.: +48 22 834-11-88
e-mail: anetadabek@o2.pl

New Medicine 1/2013
Strona internetowa czasopisma New Medicine