Association between Late Manifestations of Testicular Dysgenesis Syndrome and Anogenital Distance: A Systematic Review and Meta-analysis.

Background: In 2001, Skakkebæk et al. proposed that certain male reproductive disorders might be grouped into a syndrome called testicular dysgenesis syndrome (TDS), as they all appear to be associated with disruption of the embryonic and foetal programming of gonadal development. TDS may be manifested in early life by the presence of genital malformations (hypospadias and cryptorchidism) and in adult life as disorders represented by low sperm counts and testicular cancer. Changes in androgen hormones during the foetal development, in addition to resulting in TDS, can also cause permanent changes in anopenile anogenital distance (AGDap) and anoscrotal anogenital distance (AGDas). Aims: The objective of this study was to determine whether there is a relationship between late manifestations of TDS and reduced anogenital/anoscrotal distance. Materials and Methods: The present study is a systematic review and meta-analysis. The research included papers from 2001 to 2020, comprising a total of 737 articles, and 13 articles were selected. Results: Linear regression analysis was performed to evaluate the relationship between the two anogenital distance measures, which showed a significant positive association (P = 0.039). A meta-analysis was also performed and compared AGDap and AGDas between control and case groups, with cases defined as men with any late TDS manifestation. These data showed a significant reduction in AGDas in the affected population (P = 0.04), but no differences in the AGDap measure (P = 0.59). Conclusion: Our study confirmed a significant relationship between reduced AGDas and late manifestations of TDS, providing further support to the association between prenatal androgen deficiency and late-onset reproductive disorders.

Segurança do paciente em cirurgia plástica: revisão sistemática / Patient safety in plastic surgery: a systematic review

Introdução: A segurança do paciente tem se tornado um tema cada vez mais presente nas pesquisas na área da saúde. A cirurgia plástica é uma especialidade em evidência e torna-se necessário adequar a segurança do paciente as suas particularidades. Métodos: Revisão sistemática com a finalidade de investigar as ações relacionadas à segurança do paciente em cirurgia plástica. Para localizar os estudos foram escolhidas a MEDLINE e SCIELO. Na Base de dados MEDLINE foram usados os descritores: "patient safety" and "plastic surgery". Na SCIELO foram usados os descritores: "segurança do paciente" e "cirurgia plástica". Em ambos os casos o período das publicações foi entre 2012-2018, somando um total de 15 artigos. Resultados: Os países que mais publicaram sobre o assunto foram os Estados Unidos e o Brasil. A preocupação mais frequentemente encontrada foi a segurança relacionada à formação do residente de cirurgia plástica. Também ferramentas como o checklist têm sido usadas para a melhoria da segurança. Outra preocupação que exige mais estudos seria se os finais de semana apresentam maiores complicações em relação às cirurgias realizadas durante a semana. Porém, parece ter fundamentos mais sólidos na segurança do paciente o prontuário médico bem formulado, assim como o termo de consentimento informado (TCI). A consulta pré-anestésica também parece favorecer a segurança do paciente. E, por fim, o uso do WhatsApp que parece ser uma ferramenta segura e que incrementa o atendimento da equipe médica. Conclusão: Ressalta-se a necessidade de estudos mais aprofundados sobre esta temática, considerandose que nenhum protocolo sistematizado foi encontrado.

Introduction: patient safety has become an increasingly present topic in health research. Plastic surgery is a specialty in evidence, and it is necessary to adapt patient safety to its particularities. Methods: Systematic review to investigate actions related to patient safety in plastic surgery. MEDLINE and SCIELO were chosen to locate the studies. The descriptors: "patient safety" and "plastic surgery" were used in the MEDLINE database. In SCIELO, the descriptors: "segurança do paciente" e "cirurgia plástica" were used. In both cases, the publication period was between 2012-2018, totaling 15 articles. Results: The countries that published the most on the subject were the United States and Brazil. The most frequent concern was safety related to the training of plastic surgery residents. Tools like the checklist have also been used to improve security. Another concern that requires more study will be if the weekends have higher complications with surgeries performed during the week. However, well-formulated medical records, as well as the Informed Consent Form (ICT), appear to have a more solid basis in patient safety. Pre-anesthetic consultation also seems to favor patient safety. Furthermore, finally, the use of WhatsApp seems to be a safe tool, and that improves the care provided by the medical team. Conclusion: The need for more in-depth studies on this topic is emphasized, considering that a systematized protocol was not found.

Canabinoides como uma nova opção terapêutica nas doenças de Parkinson e de Alzheimer: uma revisão de literatura / Canabinoid as a new therapeutic option in Parkinson's and Alzheimer's diseases: a literature review

Os derivados canabinoides podem ser vistos como novos potenciais terapêuticos para o tratamento da doença de Parkinson e Alzheimer. Assim, esta revisão teve como objetivo descrever os efeitos terapêuticos e adversos do uso de canabidiol e de delta-9-tetrahidrocanabinol nas doenças de Parkinson e de Alzheimer. Para tanto, foi realizada uma busca na base de dados Medline no período entre 2007 e 2017. Os descritores utilizados foram (Tetrahydrocannabinol OR Cannabidiol) AND (Parkinson OR Alzheimer) AND (Treatment OR Therapeutics). Os resultados mostraram efeitos terapêuticos promissores do canabidiol e do delta-9-tetrahidrocanabinol nestas doenças, tais como redução de sintomas motores e cognitivos, e ação neuroprotetora. Estes resultados podem ser explicados, em parte, pelos efeitos antioxidante, antiinflamatório, antagonista de receptores CB1, ou pela ativação de receptores PPAR-gama produzido por estas substâncias. Além disso, poucos efeitos adversos foram descritos, como boca seca e sonolência. Nesse contexto, estes resultados evidenciam a necessidade de novas pesquisas a respeito dos efeitos terapêuticos e adversos de canabinoides com maiores doses e períodos de exposição, para quem sabe, em um futuro próximo, ser possível olhar estas substâncias como uma opção terapêutica mais eficaz e segura para estes pacientes.

Cannabinoid derivatives can be viewed as a novel therapeutic potentials for the treatment of Parkinson's and Alzheimer's disease. Thus, this review aimed to describe the therapeutic and adverse effects of the use of cannabidiol and delta-9-tetrahydrocannabinol in Parkinson's and Alzheimer's disease. A search of the Medline database was carried out between 2007 and 2017. The descriptors used were (Tetrahydrocannabinol OR Cannabidiol) AND (Parkinson OR Alzheimer) AND (Treatment OR Therapy). The results showed promising therapeutic effects of cannabidiol and delta-9-tetrahydrocannabinol in Parkinson and Alzheimer's diseases, such as the reduction of motor and cognitive symptoms and neuroprotective action. These results may be explained, in part, by the anti-inflammatory and antioxidant effects, by CB1 receptor antagonism, or by the activation of PPAR-gamma receptors, produced by these substances. In addition, few adverse effects have been reported, such as dry mouth and drowsiness. In this context, these results highlight the need for further research on the therapeutic and adverse effects of cannabinoids with higher doses and periods of exposure, for whom, in the near future, it is possible to view these substances as a more effective and safe therapeutic option for these patients.

Supplementation with Pfaffia glomerata (Sprengel) Pedersen does not affect androgenic-anabolic parameters in male rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Paffia spp (Amaranthacea) has a widespread use of in Brazil as a possible hormonal supplement and a substitute of Panax ginseng, although information on its reproductive effects is missing. AIM OF THE STUDY: To evaluated possible anabolic-androgenic or anti-androgenic effects of Pfaffia glomerata (PG) extract using intact eight-months-old male rats and pre-pubertal castrated rats. MATERIALS AND METHODS: Three different dose levels of PG (8.5, 30 and 85 mg/kg/day) were administered to eight-months-old rats for 28 days or to castrated males for 7 days (Hershberger assay). In the experiment with intact animals, 24h fecal samples were collected for quantification of fecal metabolites of androgens throughout treatment. At the end of the treatment period, animals were euthanized for evaluation of serum testosterone, reproductive organ weights, number of spermatids per testis, diameter of seminiferous tubules and cross-sectional area of soleus muscle fibers. In the Hershberber assay, androgenic or anti-androgenic effects were evaluated by the weights of androgen-dependent tissues: ventral prostate, seminal vesicle, glans penis and levator ani muscle/bulbocavernosus muscle. RESULTS: No effects were observed in the concentrations of fecal metabolites of androgens monitored during the treatment of intact eight-months-old rats. Moreover, at the end of treatment, no changes were seen in any of the investigated parameters. In the Hershberger assay, the PG extract did not induce androgenic or anti-androgenic effects at the dose levels tested. Significant effects were only observed in animals treated with testosterone and testosterone plus flutamide, which were used as positive controls for androgenicity and anti-androgenicity, respectively. CONCLUSIONS: At the dose levels tested, PG extract does not induce anabolic-androgenic or anti-androgenic effects in rats.

Effects of Angiotensin-Converting Enzyme Inhibitor Derived from Tropaeolum majus L. in Rat Preimplantation Embryos: Evidence for the Dehydroepiandrosterone and Estradiol Role.

Although several studies have shown the inhibitory effects of Tropaeolum majus extracts (HETM) on angiotensin-converting enzyme (ACE) activity, no studies have been carried out during the beginning of pregnancy, when humoral and hormonal imbalance may affect zygote and early embryo transport. This study investigates whether HETM can affect embryonic development when administered during the one-cell-blastocyst period. Pregnant Wistar rats received orally the HETM (3, 30, and 300 mg/kg/day) from the 1st to the 7th gestational day. Rats were killed on the 8th day of pregnancy and the following parameters were evaluated: clinical symptoms of toxicity (including organ weights), number of corpora lutea, implants per group, preimplantation losses ratio, and the serum levels of dehydroepiandrosterone (DHEA), estradiol, and progesterone. No clinical symptoms of maternal toxicity were evidenced. On the 8th day of pregnancy, the levels of DHEA and estradiol were increased and significant preimplantation losses were observed at all doses used. The present study reveals that the HETM can raise levels of DHEA and estradiol and induce difficulty in the embryo implantation in the early stages of pregnancy. The data contributes significantly to the safety aspects of using this natural product when trying to get pregnant or during pregnancy.

Study on the developmental toxicity of combined artesunate and mefloquine antimalarial drugs on rats.

Antimalarial drug combinations containing artemisinins (ACTs) have become first choice therapies for Plasmodium falciparum malaria. Data on safety of ACTs in pregnancy are limited and no previous study has been conducted on the developmental toxicity of artesunate-mefloquine combinations on the first trimester of gestation. To evaluate the developmental toxicity of an artesunate/mefloquine combination, pregnant rats were treated orally with artesunate (15 and 40 mg/kg bwt/day), mefloquine (30 and 80 mg/kg bwt/day) and artesunate/mefloquine (15/30 and 40/80 mg/kg bwt/day) on gestation days 9-11. Dams were C-sectioned on day 20, and their uteri and fetuses removed and examined for soft tissue and skeleton abnormalities. Artesunate increased embryolethality and the incidence of limb long bone malformations on the absence of overt maternal toxicity. Mefloquine (80 mg/kg bwt/day) was maternally toxic and enhanced fetal variations. Combination of artesunate and mefloquine did not enhance their toxicity compared to the toxicity observed after its separate administration. Embryotoxicity of artesunate was apparently attenuated when it is co-administered with mefloquine.

Sodium fluoride does not alter sperm production or sperm morphology in rats

The aim of the present study was to evaluate the effects of sodium fluoride (NaF) on the male reproductive system. Adult male rats were exposed to NaF in drinking water for 30 days at three concentrations: 1.54 (control, tap water), 50 and 100 ppm. Body and organ weights, daily sperm production, sperm number and morphology were investigated. No difference was observed on the sperm number and morphology among the groups, as well as body weight and organ absolute and relative weights. Overall, despite the presence of a mild degree of dental fluorosis in the higher dose group, the results indicated that exposure to NaF at the doses used in the present study did not adversely affect sperm production and morphology of male rats.

Screening for in vivo (anti)estrogenic and (anti)androgenic activities of Tropaeolum majus L. and its effect on uterine contractility.

ETHNOPHARMACOLOGICAL RELEVANCE: Tropaeolum majus L. (Tropaeolaceae) is a medicinal herb popularly used in Brazil for treatment of inflammatory and cardiovascular diseases. Despite some published data on its efficacy, there are still few toxicological data describing the safety of this plant. The aim of this study was to evaluate the (anti)estrogenic and (anti)androgenic activity of the hydroethanolic extract obtained from Tropaeolum majus L. (HETM), as well as its possible effects on uterine contractility. MATERIALS AND METHODS: Three experimental protocols were performed, (a) uterotrophic assay, (b) Hershberger assay and (c) an ex vivo test to investigate the effects of maternal administration of HETM on uterine contractility at the end of pregnancy. In all protocols three doses of the HETM were administered to Wistar rats: 3, 30 and 300mg/kg. RESULTS: In vivo tests for detection of (anti)androgenic and (anti)estrogenic activities did not show any significant alterations. Similarly, no alterations were observed on uterine contractility induced by oxytocin and arachidonic acid. CONCLUSIONS: HETM was unable to produce (anti)estrogenic or (anti)androgenic activities in the short-term in vivo screening assays performed. In addition, there was no evidence that HETM can affect uterine contractility following gestational exposure of rats.