Abstract Objective Summarize the evidence on drug therapies for obstructive sleep apnea. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 17th, 2023. A search strategy retrieved randomized clinical trials comparing the Apnea-Hypopnea Index (AHI) in pharmacotherapies. Studies were selected and data was extracted by two authors independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. RevMan 5.4. was used for data synthesis. Results 4930 articles were obtained, 68 met inclusion criteria, and 29 studies (involving 11 drugs) were combined in a meta-analysis. Atomoxetine plus oxybutynin vs placebo in AHI mean difference of -7.71 (-10.59, -4.83) [Fixed, 95 % CI, I2 = 50 %, overall effect: Z = 5.25, p < 0.001]. Donepezil vs placebo in AHI mean difference of -8.56 (-15.78, -1.33) [Fixed, 95 % CI, I2 = 21 %, overall effect: Z = 2.32, p = 0.02]. Sodium oxybate vs placebo in AHI mean difference of -5.50 (-9.28, -1.73) [Fixed, 95 % CI, I2 = 32 %, overall effect: Z = 2.86, p = 0.004]. Trazodone vs placebo in AHI mean difference of -12.75 (-21.30, -4.19) [Fixed, 95 % CI, I2 = 0 %, overall effect: Z = 2.92, p = 0.003]. Conclusion The combination of noradrenergic and antimuscarinic drugs shows promising results. Identifying endotypes may be the key to future drug therapies for obstructive sleep apnea. Moreover, studies with longer follow-up assessing the safety and sustained effects of these treatments are needed. PROSPERO registration number CRD42022362639. apnea MetaAnalyses Meta Analyses PRISMA (PRISMA followed PubMed Embase Scopus Science SciELO LILACS Trials ClinicalTrialsgov ClinicalTrials gov 17th th 2023 ApneaHypopnea Apnea Hypopnea (AHI pharmacotherapies independently tool 54 5 4 5.4 synthesis 493 obtained 6 criteria 2 involving 1 metaanalysis. metaanalysis meta analysis. analysis meta-analysis 7.71 771 7 71 -7.7 10.59, 1059 10 59 (-10.59 4.83 483 83 -4.83 Fixed, Fixed [Fixed 9 CI I effect 525 25 5.25 0.001. 0001 0.001 . 001 0.001] 8.56 856 8 56 -8.5 15.78, 1578 15 78 (-15.78 1.33 133 33 -1.33 232 2.32 0.02. 002 0.02 02 0.02] 5.50 550 -5.5 9.28, 928 28 (-9.28 1.73 173 73 -1.73 3 286 86 2.86 0.004. 0004 0.004 004 0.004] 12.75 1275 12 75 -12.7 21.30, 2130 30 (-21.30 4.19 419 19 -4.19 292 92 2.92 0.003. 0003 0.003 003 0.003] results Moreover followup follow up needed CRD42022362639 CRD 202 5. 49 7.7 77 -7. 10.59 105 (-10.5 4.8 48 -4.8 52 5.2 000 0.00 00 8.5 85 -8. 15.78 157 (-15.7 1.3 13 -1.3 23 2.3 0.0 5.5 55 -5. 9.28 (-9.2 1.7 17 -1.7 2.8 12.7 127 -12. 21.30 213 (-21.3 4.1 41 -4.1 2.9 CRD4202236263 20 7. -7 10.5 (-10. 4. -4. 8. -8 15.7 (-15. 1. -1. 2. 0. -5 9.2 (-9. 12. -12 21.3 (-21. CRD420223626 - 10. (-10 -4 15. (-15 -1 9. (-9 21. (-21 CRD42022362 (-1 (- (-2 CRD4202236 ( CRD420223 CRD42022 CRD4202 CRD420 CRD42 CRD4

Abstract Objective: This meta-analysis of randomized controlled trials (RCTs) aimed to update evidence on the effectiveness and safety of laser therapy for treating genitourinary syndrome of menopause (GSM). Data sources: Manuscripts published until May 2023 were systematically searched in PubMed; Embase; Scopus; Web of Science; CENTRAL; CINAHL; and clinical trial databases (www.trialscentral.org, www.controlled-trials.com, and clinicaltrials.gov), with no language and year of publication restriction. Studies selection: RCTs with women diagnosed with GSM, and the intervention was vaginal laser therapy (CO2-laser or Er: YAG-laser) comparing with placebo (sham therapy), no treatment or vaginal estrogen therapy. Data collection: Two authors evaluated the publications for inclusion based on the title and abstract, followed by reviewing the relevant full-text articles. Disagreements during the review process were addressed by consensus, with the involvement of a third author. Data synthesis: Twelve RCTs, representing a total of 5147 participants, were included in this review. Vaginal health index (VHI) significantly improved in the carbon dioxide laser (CO2-laser) therapy group (MD=2.21; 95% CI=1.25 to 3.16), while dyspareunia (MD=−0.85; 95% CI=−1.59 to −0.10), dryness (MD=−0.62; 95% CI=−1.12 to −0.12) and burning (MD= −0.64; 95% CI=−1.28 to −0.01) decreased. No serious adverse effects were reported. Conclusion: CO2-laser increases VHI score and decreases dyspareunia, dryness and burning, especially when compared to sham-laser. However, the certainty of the evidence is low, thus preventing the recommendation of laser therapy for GSM management. Objective metaanalysis meta analysis (RCTs GSM. . (GSM) sources 202 PubMed Embase Scopus Science CENTRAL CINAHL www.trialscentral.org, wwwtrialscentralorg www trialscentral org (www.trialscentral.org www.controlledtrials.com, wwwcontrolledtrialscom www.controlled trials.com, com www.controlled-trials.com clinicaltrials.gov, clinicaltrialsgov clinicaltrials.gov , clinicaltrials gov clinicaltrials.gov) restriction selection CO2laser COlaser CO2 CO Er YAGlaser YAG YAG-laser sham therapy, therapy) collection abstract fulltext full text articles consensus author synthesis 514 participants (VHI MD=2.21 MD221 MD 2 21 (MD=2.21 95 CI125 CI 1 25 CI=1.2 3.16, 316 3.16 3 16 3.16) MD=−0.85 MD085 0 85 (MD=−0.85 CI159 59 CI=−1.5 −0.10, 010 −0.10 10 −0.10) MD=−0.62 MD062 62 (MD=−0.62 CI112 12 CI=−1.1 −0.12 012 MD= (MD −0.64 064 64 CI128 28 CI=−1.2 −0.01 001 01 decreased reported Conclusion shamlaser. shamlaser laser. sham-laser However low management (GSM 20 www.trialscentral.org controlledtrials www.controlledtrials.com wwwcontrolled trialscom trials.com 51 MD=2.2 MD22 (MD=2.2 9 CI12 CI=1. 31 3.1 MD=−0.8 MD08 8 (MD=−0.8 CI15 5 CI=−1. −0.1 MD=−0.6 MD06 6 (MD=−0.6 CI11 −0.6 06 −0.0 00 MD=2. MD2 (MD=2. CI1 CI=1 3. MD=−0. MD0 (MD=−0. CI=−1 −0. MD=2 (MD=2 CI= MD=−0 (MD=−0 CI=− −0 MD=− (MD=− −

Resumo Objetivo Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. Fontes de dados Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. Seleção dos estudos Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. Coleta de dados Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. Síntese dos dados Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07–0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96–4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52–0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. Conclusão O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes. eficácia PubMed Scopus Embase Science clinicaltrials.gov clinicaltrialsgov clinicaltrials gov (clinicaltrials.gov relevantes texto 2022 aplicada 67 6 7 6/ estudados 8087 8 087 8.08 selecionados V51 V 5 1 V.5. The Collaboration Oxford Kingdom. Kingdom . Kingdom) dicotômicos OR, OR inglês IC (IC 95 estudo padrão I2 I MVA, (MVA inglês, , 0,16 016 0 16 IC95 0,07–0,36. 007036 0,07–0,36 07 36 0,07–0,36) 3,00 300 3 00 95CI CI 1,96–4,59, 196459 1,96–4,59 96 59 1,96–4,59) 0,65 065 65 0,52–0,80. 052080 0,52–0,80 52 80 0,52–0,80) tratamentos 202 808 08 8.0 V5 V.5 9 0,1 01 IC9 00703 0,07–0,3 3,0 30 19645 1,96–4,5 0,6 06 05208 0,52–0,8 20 8. V. 0, 0070 0,07–0, 3, 1964 1,96–4, 0520 0,52–0, 2 007 0,07–0 196 1,96–4 052 0,52–0 0,07– 19 1,96– 05 0,52– 0,07 1,96 0,52 0,0 1,9 0,5 1,

Abstract Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07–0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96–4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52–0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients. efficacy safety miscarriage PubMed Scopus Embase Science Library clinicaltrials.gov clinicaltrialsgov clinicaltrials gov (clinicaltrials.gov articles words 4 2022 applied 67 6 7 6/ included 8087 8 087 8,08 screened V51 V 5 V.5. Collaboration Oxford Kingdom. Kingdom . Kingdom) outcomes OR 95 CI (CI study test I statistic MVA, , (MVA) 0.16 016 0 16 95CI 0.07–0.36. 007036 0.07–0.36 07 36 0.07–0.36) 3.00 300 00 1.96–4.59, 196459 1.96–4.59 96 59 1.96–4.59) 0.65 065 65 0.52–0.80. 052080 0.52–0.80 52 80 0.52–0.80) treatments 202 808 08 8,0 V5 V.5 9 (MVA 0.1 01 00703 0.07–0.3 3.0 30 19645 1.96–4.5 0.6 06 05208 0.52–0.8 20 8, V. 0. 0070 0.07–0. 3. 1964 1.96–4. 0520 0.52–0. 2 007 0.07–0 196 1.96–4 052 0.52–0 0.07– 19 1.96– 05 0.52– 0.07 1.96 0.52 0.0 1.9 0.5 1.

SUMMARY OBJECTIVE: The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. METHODS: An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. RESULTS: Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386–3,302; p=0.001) and preterm delivery at <34 weeks’ gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19–5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. CONCLUSIONS: Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes. OBJECTIVE METHODS crosssectional cross sectional 202 2022 questionnaire regression RESULTS 50 2 35 14 49 eclampsia preeclampsia hypertension respectively preeclampsiaeclampsia 79.4 794 79 4 (79. vs 65% 65 RR 2,139 2139 139 95CI CI 95 95%CI 1,386–3,302 13863302 1 386 3 302 p=0.001 p0001 p 0 001 34 <3 weeks 20.5 205 20 5 (20. 6% 6 2.5 25 1.19–5.25 119525 19 p=0.01 p001 01 chronicgestational 43.9 439 43 9 (43. 27.1%, 271 27.1% , 27 27.1%) 30.7 307 30 7 (30. 19.8%, 198 19.8% 8 19.8%) 23.5 235 23 (23. 11.2% 112 11 CONCLUSIONS 79. (79 2,13 213 13 1,386–3,30 1386330 38 p=0.00 p000 00 < 20. (20 2. 1.19–5.2 11952 p=0.0 p00 43. (43 27.1 30. (30 19.8 23. (23 11.2 (7 2,1 21 1,386–3,3 138633 (2 1.19–5. 1195 p=0. p0 (4 27. (3 19. 11. ( 1,386–3, 13863 1.19–5 119 p=0 1,386–3 1386 1.19– p= 1,386– 138 1.19 1,386 1.1 1,38 1. 1,3 1,

SUMMARY OBJECTIVE: The aim of this study was to evaluate and compare Maternal Near Miss prevalence and outcomes before and during the coronavirus disease 2019 pandemic. METHODS: This retrospective study was carried out in a university maternity hospital of high complexity. The population was divided into two groups: G1, 1 year before the coronavirus disease 2019 pandemic period (August 2018–July 2019) and G2, 1 year during the pandemic period (August 2020–July 2021). All pregnant/postpartum women hospitalized up to 42 days after the end of pregnancy/childbirth were included, and pregnant women who were admitted with coronavirus disease 2019/flu symptoms were excluded. The association of variables with “Maternal Near Miss” was estimated using logistic regression. RESULTS: A total of 568 women from G1 and 349 women from G2 fulfilled the Maternal Near Miss criteria. The prevalence of Maternal Near Miss in pre-pandemic was 144.1/1,000 live births and during the pandemic was 78.5/1,000 live births. In the analysis adjusted for G1, the factors of days of hospitalization (PR: 1.02, CI: 1.0–1.0, p<0.05), pre-eclampsia (PR: 0.41, CI: 1.4–2.2, p<0.05), and sepsis/severe systemic infection (PR: 1.79, CI: 0.3–0.4, p<0.05) were crucial for women with the Maternal Near Miss condition to have a greater chance of being admitted to the intensive care unit. In G2, low education (PR: 0.45, CI: 0.2–0.9, p<0.05), eclampsia (PR: 5.28, CI: 3.6–7.6, p<0.05), and use of blood products (PR: 6.48, CI: 4.7–8.8, p<0.05) increased the risk of admission to the intensive care unit. CONCLUSION: During the pandemic, there was a lower prevalence of Maternal Near Miss in high-risk pregnancies, fewer hospitalizations, and more deaths compared to the non-pandemic period. OBJECTIVE 201 METHODS complexity groups G August 2018July July 2018 2020July 2020 2021. 2021 . 2021) pregnantpostpartum postpartum 4 pregnancychildbirth pregnancy childbirth included 2019flu flu excluded regression RESULTS 56 34 criteria prepandemic pre 14411000 144 000 144.1/1,00 7851000 78 5 78.5/1,00 PR (PR 102 02 1.02 CI 1010 0 1.0–1.0 p<0.05, p005 p p<0.05 , 05 preeclampsia 041 41 0.41 1422 2 1.4–2.2 sepsissevere sepsis severe 179 79 1.79 0304 3 0.3–0.4 unit 045 45 0.45 0209 9 0.2–0.9 528 28 5.28 3676 6 7 3.6–7.6 648 48 6.48 4788 8 4.7–8.8 CONCLUSION highrisk pregnancies hospitalizations nonpandemic non 20 202 1441100 14 00 144.1/1,0 785100 78.5/1,0 10 1.0 101 1.0–1. p00 p<0.0 04 0.4 142 1.4–2. 17 1.7 030 0.3–0. 020 0.2–0. 52 5.2 367 3.6–7. 64 6.4 478 4.7–8. 144110 144.1/1, 78510 78.5/1, 1. 1.0–1 p0 p<0. 0. 1.4–2 03 0.3–0 0.2–0 5. 36 3.6–7 6. 47 4.7–8 14411 144.1/1 7851 78.5/1 1.0– p<0 1.4– 0.3– 0.2– 3.6– 4.7– 1441 144.1/ 785 78.5/ p< 1.4 0.3 0.2 3.6 4.7 144.1 78.5 3. 4. 144. 78.

Abstract Objectives: To evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. Methods: This was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). Results: One hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. Conclusions: Radiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition. Objectives (MAFRF atrophy Methods randomized 9 days function FSFI , (FSFI) health VHI. VHI . (VHI) Maturation MV. MV) Results 40 (4 median 48 4 8 4. 3.6‒6.0 3660 3 6 0 [3.6‒6.0] 47 7 1.1, 11 1.1 1 1.1) 36 3. 2.4‒4.8. 2448 2.4‒4.8 2 [2.4‒4.8]) 23.7 237 23 (23. 2.0 20 23.5 235 5 1.9 19 14.8 148 14 (14. 2.9. 29 2.9 2.9) p 0.01 001 01 Lastly 0.001. 0001 0.001 0.001) variables protocol Conclusions condition (FSFI (VHI ( 3.6‒6. 366 [3.6‒6.0 1. 244 2.4‒4. [2.4‒4.8] 23. (23 2. 14. (14 0.0 00 000 0.00 3.6‒6 [3.6‒6. 24 2.4‒4 [2.4‒4.8 (2 (1 0. 3.6‒ [3.6‒6 2.4‒ [2.4‒4. [3.6‒ 2.4 [2.4‒4 [3.6 [2.4‒ [3. [2.4 [3 [2. [ [2

Resumo Objetivo Avaliar a eficácia das abordagens hormonais e não hormonais para os sintomas de disfunção sexual e atrofia vaginal em mulheres na pós-menopausa. Fontes de Dados Pesquisamos as bases de dados PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), e Cumulative Index to Nursing and Allied Health Literature (CINAHL), assim como bancos de dados de ensaios clínicos. Foram analisados estudos publicados entre 1996 e 30 de maio de 2020. Nenhuma restrição de idioma foi aplicada. Seleção dos Estudos Foram selecionados ensaios clínicos randomizados que avaliavam o tratamento das disfunções sexuais em mulheres na pós-menopausa. Coleta de Dados Três autores (ACAS, APFC e JL), revisaram cada artigo com base em seu título e resumo. Os dados relevantes foram posteriormente retirados do texto completo do artigo. Quaisquer discrepâncias durante a revisão foram resolvidas por consenso entre todos os autores listados. Síntese dos Dados Ao todo, 55 estudos foram incluídos na revisão sistemática. As abordagens testadas para tratar a disfunção sexual foram: lubrificantes e hidratantes (18 estudos); fitoestrogênios (14 estudos); deidroepiandrosterona (DHEA; 8 estudos); ospemifeno (5 estudos); testosterona vaginal (4 estudos); exercícios para os músculos do assoalho pélvico (2 estudos); oxitocina (2 estudos);laser de CO2 vaginal (2 estudos); lidocaína (1 estudo), e vitamina E vaginal (1 estudo). Conclusão Identificou-se falta de coerência na literatura quanto aos tratamentos propostos e medidas de resultados selecionadas. Apesar da grande diversidade de modalidades de tratamento e medidas de resultados, esta revisão sistemática pode lançar luz sobre alvos potenciais para o tratamento, que é considerado necessário para a disfunção sexual, assumindo que a maioria dos estudos randomizados foi avaliada com baixo risco de viés de acordo com a ferramenta de avaliação de risco de viés de Cochrane Collaboration. Esta revisão tem cadastro no International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488). pósmenopausa. pósmenopausa pós menopausa. menopausa pós-menopausa PubMed Embase Scopus Science SciELO CENTRAL, CENTRAL , (CENTRAL) CINAHL, CINAHL (CINAHL) 199 3 2020 aplicada ACAS, ACAS (ACAS JL, JL JL) resumo listados todo 5 18 estudos) 14 DHEA (DHEA ( 4 2 estudoslaser laser CO 1 estudo, estudo estudo) estudo. . Identificouse Identificou se selecionadas Collaboration PROSPERO (PROSPERO CRD42018100488. CRD42018100488 CRD CRD42018100488) (CENTRAL (CINAHL 19 202 CRD4201810048 20 CRD420181004 CRD42018100 CRD4201810 CRD420181 CRD42018 CRD4201 CRD420 CRD42 CRD4

Abstract Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488). women PubMed Embase Scopus Science SciELO CENTRAL, CENTRAL , (CENTRAL) CINAHL (CINAHL databases 199 30 2020 applied ACAS, ACAS (ACAS APFC JL abstract fulltext full text 5 follows 18 studies) 14 DHEA (DHEA ( 4 2 CO 1 study study) study. . measures tool PROSPERO (PROSPERO CRD42018100488. CRD42018100488 CRD CRD42018100488) (CENTRAL 19 3 202 CRD4201810048 20 CRD420181004 CRD42018100 CRD4201810 CRD420181 CRD42018 CRD4201 CRD420 CRD42 CRD4

Abstract Objectives: The authors aimed to evaluate clinical and histological changes induced by Fractional Radiofrequency (FRF) and microneedling in vulvar tissue. Methods: Thirty postmenopausal women were randomly divided into G1 (FRF) and G2 (microneedling) groups. Sub-ablative FRF was executed using disposable fractionated electrodes with an intensity of 8 mJ. Microneedling was performed using a derma roller system. The authors evaluated before and after treatment using the Vaginal Laxity Questionnaire (VLQ), EuroQol Five-Dimensional (EQ-5D) questionnaire, and the Blatt and Kupperman Menopausal Index (BKMI). Additionally, the authors performed biopsies of the labia majora for histological analysis pre- and post-treatment. Data were expressed as mean (± standard deviation). A paired t-test was used for intra-group comparison (pre- and post-treatment), with an independent t-test used to compare intergroup data (both pre- and post-treatment). Results: In the G1 group, the VLQ values showed differences compared to the pre-treatment values with the data obtained 60 days after the beginning of the sessions (p = 0.01). Similarly, the data changes of the G2 group proved to be significant (p = 0.001) across the same time interval. In comparing the groups, VLQ values were not different (p > 0.05). Regarding histological analysis, FRF demonstrated improvement concerning the number of fibroblasts, blood vessels, and fatty degeneration (p < 0.05) compared to the control. Additionally, FRF and microneedling samples showed higher type III collagen and vimentin expression in the immunohistochemical analysis (p < 0.05). Conclusions: The therapies were found to be effective in treating the flaccidity of the female external genitalia. Additionally, histological changes were observed after interventions suggesting collagen remodeling.

SUMMARY OBJECTIVE: To evaluate the sexual function of women in the puerperal period after a postpartum pelvic floor musculature training program. We also sought to evaluate correlations between sexual dysfunction in the women and their delivery type and compare the frequency of sexual dysfunction and the quality of resumed sexual function following vaginal and cesarean deliveries. METHODS: This clinical study included an intervention, carried out between July and December 2019, in which data were collected about 28 rooming-in women at a Maternity School. Data were divided into vaginal delivery and cesarean delivery. Sexual function was evaluated by the Female Sexual Function Index and the International Consultation on Incontinence Questionnaire-Short Form to assess the Incontinence Urinary and qualifies urinary loss. The intervention consisted of a muscle training exercise program. ANOVA tests were used to establish differences between groups. RESULTS: There was an improvement in all outcomes, but there was no time versus group interaction. Improvement in sexual function was observed (p<0.001), the impact of urinary incontinence on quality of life (p<0.001), and pressure of the muscles of pelvic floor muscles (p<0.001) over time. There was no time versus group interaction for sexual function (p=0.87), the impact of urinary incontinence on quality of life (p=0.88), and pressure of the pelvic floor muscles (p=0.66). CONCLUSIONS: Pelvic floor muscle exercise programs seem to be a very promising strategy concerning improving sexual activity among puerperal patients.

SUMMARY BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can affect the nervous system, triggering problems such as the Guillain-Barre Syndrome (GBS), an association that can bring complications to the patient. OBJECTIVE: This scoping review aimed to clarify the clinical features and analyze patients with GBS associated with SARS-CoV-2 infection, looking at morbidity, mortality, and neurological outcomes. SEARCH STRATEGY: The search was conducted through Medline, Web of Science, Embase, CINAHAL, Latin-American and Caribbean Literature in Health Sciences (LILACS), clinicaltrials.gov, SCOPUS, and the Cochrane Central Register of Controlled Trials. SELECTION CRITERIA: Observational studies, published after 2019, describe patients with GBS associated with SARS-CoV-2 infection. There were no language restrictions while selecting the studies. DATA COLLECTION AND ANALYSIS: Three authors, Kleyton Santos de Medeiros, Luíza Thomé de Araújo Macêdo, and Wederson Farias de Souza, independently screened the search results using titles and abstracts. Duplicate studies were excluded. The same authors then went through the entire text to determine whether the studies met the inclusion criteria. Discrepancies were resolved by other reviewers, Ana Paula Ferreira Costa, Ayane Cristine Sarmento, and Ana Katherine Gonçalves. Finally, the selection of the studies was summarized in a PRISMA flow diagram. MAIN RESULTS: Main manifestations were fever, coughing, dyspnea, sore throat, ageusia, anosmia, and respiratory failure, in addition to paresthesia of the upper and lower limbs, tetraparesis, facial diplegia, areflexia, asthenia, mastoid pain, acute ataxia, fatigue, numbness, swallowing disorder, and moderate low back pain. CONCLUSION: Coronavirus disease 2019 (COVID-19) can trigger the GBS, despite the few studies on this topic. Patients had clinical manifestations of COVID-19 infection and neurological manifestations characterizing GBS.

SUMMARY BACKGROUND: Although much has been studied about the SARS-Cov-2 virus, its effects, and the effectiveness of possible treatments, little is known about its interaction with other infectious diseases. OBJECTIVE: The aim is to study its clinical features and morbidity, and mortality outcomes of COVID-19 patients with HIV/AIDS coinfection. DATA SOURCES: MEDLINE, Web of Science, Embase, CINAHL, LILACS, Scopus, ClinicalTrials.gov, and Cochrane. STUDY ELIGIBILITY CRITERIA: Atudies in any language, published after 2019, were describing COVID-19 patients with HIV/AIDS. STUDY APPRAISAL: JBI Levels of Evidence, Joanna Briggs Institute. SYNTHESIS METHODS: As shown in the PRISMA flow diagram, two authors separately screened the search results from the obtained titles and abstracts. RESULTS: Chest CT was observed in patients with pneumonia by SARS-CoV-2 with findings of multiple ground-glass opacities (GGO) in the lungs, there is a need for supplemental oxygenation. One patient developed encephalopathy and complicated tonic-clonic seizures; four patients were transplanted (two, liver; two, kidneys), one patient developed severe SARS-CoV-2 pneumonia and 30 patients died (mortality rate, 11%). CONCLUSION: HIV did not show any relevance directly with the occurrence of COVID-19. Some studies suggest that HIV-1 infection through induction levels of IFN-I, may to some extent, stop the apparent SARS-CoV-2 infection, thus leading to undetectable RNA. Moreover, some authors suggest retroviral therapy routinely used to control HIV infection could be used to prevent COVID-19 infection.

OBJECTIVES: We aimed to evaluate the effectiveness of microablative fractional radiofrequency (MAFRF) in the non-hormonal treatment of genitourinary syndrome of menopause. METHODS: We examined the cases of 55 postmenopausal women before and after treatment with regard to their vaginal health index (VHI), vaginal microbiota, vaginal pH, and cell maturation. Three applications of MAFRF were performed in the vagina/vaginal introitus. During the treatment, six vaginal smears were obtained and stained with the Papanicolaou stain for determining the degree of cell maturation and with Gram stain for classification of vaginal flora, as per the criteria of Spiegel and Amsel. For vaginal pH determination, pH indicator strips were applied against the vaginal wall. Statistical analysis was performed using SPSS for Windows (version 17.0). Data were reported as mean±standard deviation. The differences were analyzed using the statistical method of generalized estimation equations with autoregressive correlation structure “1” and robust standard errors. RESULTS: The mean age was 59.8±4.2 years, and the mean time of menopause was 15.4±4.5 years. After treatment, there was an increase in the percentage of Lactobacillus spp. (p<0.001). Consequently, there was a progressive decrease in vaginal pH during the treatment (p<0.001). Regarding cell maturation, there was a decrease in the percentage of parabasal cells (p=0.001) and an increase in the rate of superficial cells (p<0.001). Additionally, there was an improvement in the VHI index. The mean VHI values before and after treatment were 13.2±5.6 and 22.5±3.7, respectively (p<0.001). CONCLUSION: MAFRF treatment is well tolerated and leads to improvement in the vaginal microenvironment.