Randomised trials relevant to mental health conducted in low and middle-income countries: a survey

<p>Abstract</p> <p>Background</p> <p>A substantial proportion of the psychiatric burden of disease falls on the world's poorest nations, yet relatively little is known about randomised trials conducted in these countries. Our aim was to identify and describe a representative sample of mental health trials from low and middle-income countries.</p> <p>Methods</p> <p>6107 electronic records, most with full text copies, were available following extensive searches for randomised or potentially randomised trials from low and middle-income countries published in 1991, 1995 and 2000. These records were searched to identify studies relevant to mental health. Data on study characteristics were extracted from the full text copies.</p> <p>Results</p> <p>Trials relevant to mental health were reported in only 3% of the records. 176 records reporting 177 trials were identified: 25 were published in 1991, 45 in 1995, and 106 in 2000. Participants from China were represented in 46% of trials described. 68% of trials had <100 participants. The method of sequence generation was described in less than 20% of reports and adequate concealment of allocation was described in only 12% of reports. Participants were most frequently adults with unipolar depression (36/177) or schizophrenia (36/177). 80% of studies evaluated pharmacological interventions, a third of which were not listed by WHO as essential drugs. 41% of reports were indexed on PubMed; this proportion decreased from 68% in 1991 to 32% in 2000.</p> <p>Conclusion</p> <p>In terms of overall health burden, trial research activity from low and middle-income countries in mental health appears to be low, and in no area adequately reflects need.</p

Platelet-rich plasma protocols can potentiate vascular emboli: Contraindications to platelet-rich plasma

Platelet-rich plasma (PRP) is a regenerative therapy strategy used to address surgical wounds, dermatological conditions, and musculoskeletal conditions, such as lateral epicondylosis. However, there exists significant uncertainty and speculation about antiplatelet agents' effects on PRP and optimal approaches to cessation of agents such as aspirin prior to PRP therapy. We present a rare case report that provides an example of temporary antiplatelet agent cessation complications in the context of a PRP therapy regimen for lateral epicondylosis, which was followed by microemboli to the brain. Given Class B evidence for PRP for lateral epicondylosis, we feel that this case of a nontraumatic brain injury sequelae can present more frequently given the increased popularity of this regenerative strategy, particularly if certain precautions are not evaluated

Cell-Based Therapies for Rotator Cuff Injuries: An Updated Review of the Literature

This review focuses on non-surgical treatment options for rotator cuff injuries and highlights the potential of mesenchymal stem cells (MSCs) as a potential regenerative approach. MSCs, sourced from various tissues like bone marrow and adipose tissue, exhibit promising mechanisms in vitro, influencing tendon-related gene expression and microenvironment modulation. Animal studies support this, showcasing MSCs’ ability to reduce inflammation, improve tissue remodeling, and enhance repaired tendon strength. Human trials, while varied and limited, suggest that MSCs might lower retear rates and enhance post-repair outcomes, but randomized controlled trials yield mixed results, emphasizing the necessity for standardized investigations. Ultimately, while cell-based therapies demonstrate an excellent safety profile, more rigorous clinical trials are necessary to determine their efficacy in improving patient outcomes and achieving lasting structural changes in rotator cuff injuries

The Role of Low-Intensity Pulsed Ultrasound on Cartilage Healing in Knee Osteoarthritis: A Review

Ultrasound (US) is a therapeutic modality that has been used in the treatment of musculoskeletal conditions for decades. In recent years, there have been technological advancements using low-intensity pulsed ultrasound (LIPUS) as a clinical modality. The purpose of this review was to critically examine the medical literature to determine the effects of LIPUS on the chondrogenic properties of knee osteoarthritis. A literature search of 3 major databases (PubMed, Scopus, and EMBASE) was performed. Two independent physician reviewers screened titles and abstracts, yielding a total of 18 relevant articles after the inclusion and exclusion criteria were applied. Results favored that LIPUS has a promising effect on the cellular elements in articular cartilage, specifically on chondrocytes in knee osteoarthritis. Although the use of LIPUS is encouraging based on basic science and preclinical data, there is a paucity of evidence with respect to humans. Consequently, there is insufficient evidence to recommend for or against LIPUS in clinical OA populations. We suggest future directions for research centered on LIPUS in both human and animal models to delineate the effect on the biologic properties of cartilage in knee osteoarthritis