Aims: Polypharmacy is associated with multiple adverse health outcomes. The objective of this systematic review and meta‐analysis was to explore the association between polypharmacy and depression.Methods and results: A systematic literature review was conducted by searching MEDLINE, Scopus, Science Direct, and CINAHL Complete to identify studies assessing the association between polypharmacy and depression published until November 2020. A meta‐analysis was performed using random effect models. Heterogeneity was assessed using theI²‐statistic. Nineteen studies were included in the meta‐analysis. We found that an increase in the number of drugs was associated with an increased risk of depression (OR = 1.55 [95% CI: 1.01, 2.36;I² = 62%, n = 2]). Further, polypharmacy defined as the concurrent use of five or more medications was associated with an increased risk of depression (OR = 1.73 [95% CI: 1.39, 2.14],I² = 83%, n = 8).Conclusion: This meta‐analysis revealed that polypharmacy, both discretely and categorically defined, was associated with an increased risk of depression.

This is the first comparative of tunicate cellulose nanocrystalline (t-CNC) from colonial and solitary tunicates. The t-CNC from the colonial tunicate Eudistoma sp. (CL1) was compared with solitary tunicates Polycarpa reniformis (CL2) and Phallusia nigra (CL3). Tunicate samples were extracted by methanol. Residues from the methanol extraction were then subjected to further cellulose purification using pre-hydrolysis, kraft-cooking, bleaching, and sulfuric acid hydrolysis to yield t-CNC. The solitary tunicates yielded higher microfibril contents after the bleaching step but obtained similar t-CNC content to the colonial one after acid hydrolysis. The isolated t-CNC were characterized using Fourier transform infrared spectroscopy, X-ray diffraction, thermalgravimetric analysis, and transmission electron microscopy. Both colonial and solitary tunicates yielded cellulose type I. The pure cellulose type I was successfully isolated from solitary tunicates whereas high inorganic impurities were observed in colonial tunicates. The isolate t-CNC showed high aspect ratios. The solitary and colonial tunicates provided t-CNC with crystallinity indexes over 97% and 35%, respectively. The crystalline size of t-CNCs ranged from 55-124 Å. The thermal stability of all isolated t-CNC was slightly decreased due to the sulfate functional groups gained after acid hydrolysis. We concluded that solitary tunicates were better than colonial tunicates as a source of t-CNC preparation.

Background: Pineapple has an important role in ethnopharmacology and its enzyme, bromelain, has been extensively investigated for its medicinal properties. Aim: This systematic review and meta-analysis aimed to assess clinical evidence concerning the efficacy and safety of bromelain. Methods: A systematic search was conducted from conception to August 2022 using CINAHL Complete, MEDLINE, ScienceDirect, Scopus, and Thai Journal Online (TJO). The risk of bias was assessed using Risk of Bias 2 or ROBIN-I. A random-effect model with inverse variance weighting and DerSimonian and Laird method was used for meta-analysis. The heterogeneity was evaluated by I² statistics. Results: We included 54 articles for qualitative summary and 39 articles for meta-analysis. The systematic review found that bromelain presented in serum with retained proteolytic activity after oral absorption. Bromelain may be effective against sinusitis but was not effective for cardiovascular diseases. Pain reduction from oral bromelain was slightly but significantly better than controls (mean difference in pain score = -0.27; 95% CI: −0.45, −0.08; n = 9; I² = 29%). Adverse events included flatulence, nausea, and headache. Topical bromelain significantly reduced the time to complete debridement (mean difference in time = -6.89 days; 95% CI: −7.94, −5.83; n = 4; I² = 2%). Adverse events may be irrelevant and include burning sensation, pain, fever, and sepsis. Conclusions: Moderate-quality studies demonstrated the potential of oral bromelain in pain control and topical bromelain in wound care. Major health risks were not reported during the treatment with bromelain.