CLINICA BALNEARIA

Author: MD Rosa Martnez Lpez, Termas de Cuntis Leonardo Proyect:Thermal Baths for Active Ageing Montecatini Terme October, 22th 2011

Termas de Cuntis is one of the most traditional thermal resorts of Galicia. During the last decade it has became one of the largest complex dedicated to balneotherapy in Spain.

This wide space includes more than 40 individual treatment cabins: Air baths - hydromassage baths. Thermal pool. Jacuzzi, jets, showers, Vichy shower, para-muds. Massage, esthetic, electrotherapy, physiotherapy. Breathing room with inhalers and nebulizer, vapor stoves, vaporarium, bio sauna, foot baths and hand baths static, dynamic foot baths, thermarium circuit, etc) . The thermal-leisure area is called "Acquaform" includes two pools (one outdoor), areas of back and foot jets, massage tables, counter-current, swan necks, waterfalls, swimming areas... and "Vital Club" endowed with Finnish sauna, steam heaters, bio sauna, Jacuzzis, and walk-in ice.

The resort has two hotels: Hotel La Virgen(****): It is the most important building in the quiet spa town of Cuntis. (Original design of the famous architect Antonio Palacios).

Hotel Castro do Balneario (****): Galician traditional restored house which retains all of its unique elements and it is considered as a "charming hotel. In addition, the entire complex is surrounded by over 50,000 m of private parks.

Our mineral-medicinal waters

Temperature: Hyperthermal. We have several springs with temperatures ranging between 25 C and 63,1 C. Composition: Sulfurous alkaline water. Predominant ions: Carbonate, sodium, chloride, fluoride, silica and lithium.

CHEMICAL COMPOSITION Sulfur 8,9 mg/L

Carbonate 36,60 mg/L Sodium 109,10 mg/L Chloride 60,00 mg/L

Silica 48,90 mg/L

CHEMICAL PHYSICAL PORPERTIES

Conductivity: Temperature: Turbidity: pH: 427,05 S/cm a 20 C 25 C to 63,10 C 0,60 NTU 9,30

COMPLETE CHEMICAL COMPOSITION

Potassium (K) Magnesium (Mg) Lithium (Li) Sufates (SO4) Iron (Fe) Phosphates (PO4) Fluorides (F-) Strontium (Sr) Carbonates (CO3) Calcium (Ca) Boron (B)

4,00 mg/L 0,60 mg/L 0,11 mg/L 31,00 mg/L 0,00 mg/L 1,80 mg/L 7,80 mg/L 0,02 mg/L 12,00 mg/L 1,60 mg/L 0,67 mg/L

Actions
Respiratory system: - Improvement of the local circulation. - Improvement of the tropism of the mucous cells. - Improvement of the mucolytic action. - Improvement of cilia mucous cell movement. - Antiinflammatory action. Skin: - Antiinflammatory. - Antipruriginous effects. - Antibacterial and antifungal. - Keratoplastic action. At systemic level: - Desensitizes, it improves the allergy and anaphylactic responses. - Decrease colesterol total and the LDL-col in serum. - Increase hemogoblin in serum.

Indications
The diseases that are treated with our water are: Rheumatic chronic diseases: Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, Respiratory diseases : Asthma, bronchitis, emphysema, bronchiectasis , Otorhinolaryngology diseases: Chronic pharyngitis, chronic laryngitis, rhinitis, Dermatology diseases: Psoriasis, dermatitis, Rehabilitation: Recovery from sports injuries (Constusions, fibrilar rupture, sprain, overload, etc), Recovery from fractures, sequels from traumatisms and accidents, luxations Psychological syndromes: Psychosomatic disorders, anxious stages, depressive stages, physical and intellectual exhaustion, stress

Patients treated per year

2875

Women Men
6273

Patients diseases Women

DIABETES DYSLIPIDEMIA

OSTEOPOROSIS

WOMEN >75

WOMEN 55-75
HTA

ARTHROPATHY
0% 20% 40% 60% 80% 100%

Patients diseases Men

DIABETES DYSLIPIDEMIA

OSTEOPOROSIS

MEN >75 MEN 55-75

HTA

ARTHROPATHY

0%

20%

40%

60%

80%

100%

Scientific evidences of the sulfur water effects in the osteoarthritis treatment.

In relation with the treatment of the osteoarthritis with sulfur waters, some authors applies mud therapy and/or hydropinotherapy as well as/instead of the inmersion . The conclusions of our bibliographic review tries to unify the common effects of the substances present in all of these thermal techniques, mainly the sulfur which main forms are SO and HS The HS is proposed by the majority of experts as the main responsible for the antioxidative and antiinflammatory effects of the thermal waters.

Main mechanism underlying to the physiopathology of osteoarthritis

Synovitis Mechanical articular overload

IL, TNF-

IL

Chondrocyte

NO

Cell apoptosis

Synthesis and activation

MMP
Cartilaginous matrix destruction
Oxidative stress

Biochemical effects of sulfur water in osteoarthritis

Antioxidative effects Lipids oxidation biomarkers (MDA) Proteins oxidation biomarkers (protein carbonyles) Thiols (SH ) Changes in serum activity of SOD and CAT Antiinflammatory effects TFN- NO Effects on proteolytic enzymes Several types of MMP Other effects Adiponectin PGE, LTB, IL-1 demostrated in fibromyalgia patients

M/ml 12 11 10 9 8 7 6 Controls Before therapy On 5 day After therapy

Malondialdehyde concentration (xSD) in the controls and in the patients group before and after the sulfur baths therapy and on the day 5 during the therapy

U/gHb
3000 2500 2000 1500 1000 Controls Before therapy On 5 day After therapy

Superoxide dismutase activity (xSD) in the controls and in the patients group before and after the sulfur baths therapy and on the day 5 during the therapy

VAS 100 90 80 70 60 50 40 30 20 10 0 Before treatment Day 5 End treatment

Days

Pain intensity in the patients before and after the sulfur baths therapy and on the day 5 during the therapy

Clinical results
Low back pain
Improvement of pain (VAS score). Improvement of flexibility (SCHOBER index). Less analgesic consumption.

Improvement of Quality of life (Oswestry low back

pain disability index)

Clinical results
Gonarthrosis
Improvement of symptoms (VAS score) Improvement in functionality status (WOMAC index) Improvement of Quality of life (NHP index)

Clinical results
Hip osteoarthritis
Possible improvement of pain (VAS score).
Possible improvement of functionality status (WOMAC index). Future specific randomized control trials for

coxarthrosis are needed to guarantee the stadistic

results of the beneficts in pain and functionality

provided by sulfur waters therapies.

Acknowledgments
To the organization, Terme di Montecatini, for the kind welcome and the invitation to participate in this interesting project to impluse the practice of a better balneotherapy.