Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials

Abstract Background: To evaluate the efficacy and safety of prolotherapy with hypertonic dextrose in patients with knee osteoarthritis. A systematic search was performed in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar. Main body: We searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis. These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions. Ten randomized clinical trials were included in this systematic review, the total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency. Conclusions: In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effect in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.

Evaluación psicológica de la agresividad impulsiva/predeterminada y factores asociados: Un estudio transversal en usuarios de los servicios de salud en Tabasco, México / Psychological evaluation of impulsive/premeditated aggression and associated factors: a cross-sectional study in users of health services in Tabasco, Mexico

Resumen: INTRODUCCIÓN: La conducta suicida es un problema de salud pública. Se sugiere que la personalidad impulsiva o predeterminada participa en los actos de agresividad como el suicidio. OBJETIVO: En este estudio se identificaron diferencias sociodemográficas, de intento de suicidio y la presencia de depresión entre individuos con característica de agresividad impulsiva o predeterminada. MÉTODOS: Se realizó un estudio de tipo transversal que incluyó a 200 residentes de Villahermosa, Tab., México, usuarios de los servicios de salud en ese Estado. La agresividad predeterminada o impulsiva se caracterizó usando la Escala de Agresión Impulsiva/Predeterminada (IPAS). Las características sociodemográficas, de intento de suicidio y de depresión fueron divididas de acuerdo al tipo de agresividad. Subsecuentemente fueron comparadas las características entre los dos grupos. RESULTADOS: Los resultados psicológicos revelaron que la agresividad impulsiva está presente en 62.71 % de la población. Estar desempleado y ser mujer fueron asociadas con la agresividad predeterminada. De igual forma, la mayor proporción de personas con depresión se observó en el grupo de personas predeterminadas (x2 = 18.29, gl = 1, p = 0.001). La proporción de personas con por lo menos un intento de suicidio a lo largo de la vida es similar en las impulsivas y las predeterminadas (6.06% y 6.30%, respectivamente). DISCUSIÓN Y CONCLUSIÓN: El presente estudio no muestra relación entre la personalidad y la proporción del intento de suicidio en los usuarios de los servicios de salud en Tabasco. Sin embargo, el estado de ánimo podría estar asociado con la toma de decisiones.

Abstract: INTRODUCTION: Suicidal behaviour is a public health problem. It has been suggested that impulsive or premeditated personality interferes with aggressive acts such as suicide. OBJECTIVE: In this study, we identified the socio-demographic differences when attempting suicide, as well as the concomitant depression among individuals characterized by impulsive or premeditated aggression. METHODS: We performed a transversal study that included 200 residents of Villahermosa, Tabasco, Mexico, who regularly use the city's General Health Services. The premeditated or impulsive aggression was evaluated using the Impulsive/Premeditated Aggression scale (IPAS). The sample was divided in two groups: impulsive and premeditator individuals. Suicidal attempt, presence of depression and socio-demographic characteristics were evaluated after wards and compared between groups. RESULTS: The psychological evaluation revealed that impulsive aggression is present in 62.71% of the population. We observed that being unemployed and/or being a woman were characteristics associated with premeditated aggression. The premeditators group had the higher proportion of concomitant depression (x2 = 18.29, gl = 1, p = 0.001). The proportion of people that had attempted suicide at least once during their lives was similar in both groups (impulsive = 6.06%, premeditators = 6.30%). DISCUSSION AND CONCLUSION: This study does not show any association between the personality (impulsive or premeditative) and the frequency of suicide attempts in the Tabascan General Health Services users. Nevertheless, the frame of mind (depression) could be associated with taking decisions when attempting suicide.