Effectiveness of melatonin adjuvant treatment in cisplatin to prevent depletion of ovarian follicles in mice: systematic review†.

INTRODUCTION: Cisplatin-based chemotherapy is the standard cancer therapy; however, this treatment causes depletion of ovarian follicles in women of reproductive age. Adjuvant treatment with melatonin can protect the ovaries from oxidative stress, reducing the side effects of chemotherapy. The objective was to evaluate the effects of the use of melatonin on the ovarian follicles of mice treated with cisplatin. METHODOLOGY: A systematic review was performed. The search strategy used the terms: "cisplatin", "melatonin," and "ovarian". MEDLINE EMBASE, Cochrane Library, and gray literature (Google Scholar) were used as databases. The search was limited to experimental studies, performed on animals, with no language restrictions. RESULTS: The search identified 30 studies and 5 primary studies, published between 2016 and 2021, and met the inclusion criteria, with a total of 115 mice. For the p-FOX3a/FOXO3a pathway, the meta-analysis showed a standard mean difference (SMD) of -4.79 (95% CI -6.16 to -3.42; P < 0.00001, two studies, 38 mice; I2 = 0%). For the p-PTEN pathway, the meta-analysis showed an SMD of -1.65 (95% CI -2.71 to -0.59; P = 0.002, two studies, 38 mice; I2 = 47%). CONCLUSION: Melatonin variation in efficacy varies according to the dose used in mice previously exposed to cisplatin. However, melatonin was able to alter the p-PTEN and p-FOX3a/FOXO3a pathways.

Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review.

BACKGROUND: The decline in postmenopausal serum estrogen concentration results in several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause, including symptoms such as vaginal atrophy. AIM: To evaluate the effects of hyaluronic acid in vaginal atrophy. METHODS: A search strategy was developed using the following terms: "Hyaluronic Acid vaginal gel," "vaginal estrogens," "Vaginitis, Atrophic," and "Postmenopause." This strategy was used in major databases such as MEDLINE, EMBASE, Scopus, Cochrane library, Web of Science, Virtual Health Library (BVS), Congress Abstracts, and Gray Literature (Google Scholar and British Library) for studies published until June 2020. OUTCOMES: A systematic review was carried out to assess the results of atrophic vaginitis/vaginal dryness, dyspareunia, vaginal pH, and cell maturation of the studies found by the search strategy. RESULTS: A total of 833 studies were identified, 528 studies were directed for reading titles and abstracts, and 515 were excluded for not meeting the selection criteria. A total of 13 studies were selected for reading the full text. 5 primary studies involving 335 women met the criteria and were included. The studies were published between the years 2011 and 2017. It was not possible to perform meta-analysis owing to the substantial heterogeneity present in the studies. The results presented suggest that treatment with hyaluronic acid, when compared with the use of estrogens, does not present a significant difference in the results obtained for the outcomes: epithelial atrophy, vaginal pH, dyspareunia, and cell maturation. CLINICAL TRANSLATION: Hyaluronic acid appears to be an alternative to non-hormonal treatments for the signs of vaginal atrophy and dyspareunia. STRENGTHS & LIMITATIONS: The analysis of the studies in this systemic review suggests that hyaluronic acid has efficacy similar to vaginal estrogens for the treatment of the signs of vaginal atrophy and dyspareunia. However, the included studies measured the data in different ways, causing the performance of meta-analysis to be impaired. CONCLUSION: The comparisons presented suggest that hyaluronic acid has a profile of efficacy, safety, and tolerability comparable with vaginal estrogens for the treatment of symptoms of vaginal atrophy. It is a possible alternative for women who cannot use hormonal treatment. dos Santos CCM, Uggioni MLR, Colonetti T, et al. Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. J Sex Med 2021;18:156-166.

Evaluation of the arachidonic acid pathway in bipolar disorder: a systematic review.

Bipolar disorder (BD) is a mood psychiatric disorder described by changes between depressive, hypomanic, or manic episodes. The aimed of the present study was evaluated possible changes in the AA pathway in BD through a systematic review of observational studies. A search in the electronic databases was proceeded, on Cochrane Library, MEDLINE, EMBASE, PsycINFO, Google Scholar and the British Library for studies published until August 2020. A search strategy was developed using the terms: "Bipolar Disorder" and "Phospholipase A2" or "Arachidonic Acids" or "Cyclooxygenase 2" or "Prostaglandins E" as text words and Medical Subject Headings (i.e., MeSH and EMTREE). Seven primary studies were included in the systematic review, with a total of 246 BD patients, 20 depression patients, and 425 heathy controls (HC). The studies showed contradictory results in the AA and PLA2, no primary articles with COX and PGE2 assessments were included in this review. According to the Newcastle-Ottawa quality score scale (NOS), our systematic review presented high quality. The investigation of the inflammatory pathway of AA still needs further investigation and evidence, given the growing number of studies suggesting the efficacy of anti-inflammatory drugs as adjunctive therapy in the pharmacological treatment of BD.

Nutritional Interventions in Children with Brain Injuries: A Systematic Review.

BACKGROUND: Brain injury has several consequences throughout life, its increased incidence has caused great public concern. The aim was identifying the main nutritional therapies recommended for children with brain injuries. METHODS: A systematic review was carried out using the terms in the search strategy: "Brain Injuries", "Nutrition Therapy", and "Child" and their synonyms, from database inception up to August 2020. The search was conducted in the following databases: MEDLINE, EMBASE, Scopus, Cochrane library, LILACS, and grey literature. Two reviewers independently selected the included studies, according to the eligibility criteria and extracted data from the included articles. RESULTS: A total of 1196 studies resulted from electronic searches, and out of these, 27 studies were read in full and eight studies were included. For early enteral nutritional support (<48 h), results suggest benefit in increasing survival rates. Type of dietary protein seems to be related to decreasing gastric emptying by 40%. The use of fibers seems to reduce gastrointestinal discomfort and increase stool frequency. CONCLUSIONS: The evidence mapped was extracted from small studies analyzing different outcomes, so any decision making should be analyzed considering the context. We present the direction of the effect, but the magnitude is still unclear.