Vomiting after intrathecal chemotherapy under anesthesia in pediatric patients with hematologic cancers: A cohort study.

INTRODUCTION: Despite preventive strategies, vomiting is an adverse event affecting patients with cancer. However, literature on the incidence and risk factors for vomiting in pediatric patients with cancer are scarce. AIM: To assess the incidence and risk factors for vomiting within 24 h and goodness of fit for the Eberhart score in pediatric patients with hematologic cancers after receiving intrathecal chemotherapy under deep sedation. METHODS: This prospective cohort study included patients under 20 years of age with hematologic cancers who were scheduled to undergo intrathecal chemotherapy under anesthesia. The primary outcome was the occurrence of vomiting within 24 h after the end of anesthesia. Sociodemographic and procedure data and underlying diseases were collected. Patients were monitored during the procedure, in the postanesthesia care unit, and the day after (by phone call). RESULTS: A total of 139 patients were included, and the incidence of vomiting was 30.9% within 24 h after intrathecal chemotherapy under anesthesia, with 90.7% of vomiting prior to 6 h. Prophylactic ondansetron was administered prior to the procedure to 45.3% of patients. Risk factors for vomiting were female gender (hazard ratio: 2.47, 95% confidence interval: 1.35-4.53, p: .003), consolidation phase of treatment (hazard ratio: 2.16, 95% confidence interval: 1.10-4.24, p: .025), and history of kinetosis (hazard ratio: 2.49, 95% confidence interval: 1.31-4.70, p: .005). Incidence of vomit was higher than estimated by the Eberhart score distribution (observed incidence in patients with a score of zero: 33.3%; with a score of one: 28.8%; with a score of two: 60%). CONCLUSION: A high incidence of vomiting was observed within 24 h after intrathecal chemotherapy under propofol deep sedation. Risk factors for this outcome were established (being female, consolidation phase of treatment, and previous kinetosis), and evidence suggested that the Eberhart score was not suitable for the studied population.

Nanoremediation and Antioxidant Potential of Biogenic Silver Nanoparticles Synthesized Using Leucena's Leaves, Stem, and Fruits.

Synthetic dyes are persistent organic environmental pollutants that can cause extensive damage to living beings and to the ecosystem as a whole. Cost-effective, sustainable, and efficient strategies to deal with this type of pollution are necessary as it commonly resists conventional water treatment methods. Silver nanoparticles (AgNPs) synthesized using the aqueous extract from the leaves, stem, and fruits of Leucaena leucocephala (Leucena) were produced and characterized through UV-vis, TEM, EDS, SDL, XPS, XRD, and zeta potential, and they proved to be able to promote adsorption to remediate methylene blue and tartrazine pollution in water. The nanoremediation was performed and did not require direct exposure to sunlight or any special lamp or a specific reduction agent. The AgNPs produced using the extract from the leaves exhibited the best performance in nanoremediation and also presented antioxidant activity that surpassed the one from butylated hydroxytoluene (BHT). Consequently, it is an interesting nanotool to use in dye nanoremediation and/or as an antioxidant nanostructure.

Ocean-atmosphere turbulent CO2 fluxes at Drake Passage and Bransfield Strait.

The oceans play an important role in mitigating climate change by acting as large carbon sinks, especially at high latitude regions. The Southern Ocean plays a major role in the global carbon dioxide (CO2) budget. This work aims to investigate the behavior of turbulent CO2 fluxes and quantify it under different atmospheric and oceanic conditions in the Drake Passage and Bransfield Strait regions on high spatiotemporal resolutions when compared with traditional CO2 fluxes estimations. The atmospheric stability condition was used to corroborate the description of CO2 fluxes. In situ, satellite, and reanalysis data from 08 to 22 November 2018, were used in this work. The Bransfield Strait uptaked 38.59% more CO2 than the Drake Passage due to the cold and fresh waters, allied to the influence of glacial meltwater dilution. Which increased the CO2 solubility, directing the CO2 fluxes to the ocean. The Bransfield Strait had predominantly stable atmospheric conditions, which contributed to this region acting as a CO2 sink. The Drake Passage, on average, behaved as a CO2 sink, mainly due to physical characteristics. This research contributes to a better understanding of the Southern Ocean's role in the global carbon balance on scales that are very difficult to monitor.

Omics data reveals the phenolic fingerprint of Brazilian whole wheat flours of different technological qualities.

Common wheat (Triticum aestivum) is one of the most consumed staple foods used for bakery products. Outer layers of grain present a great diversity of bioactive compounds, especially phenolic compounds (PC). Free and bound PC were extracted from eight genotypes of whole wheat flours (WWF) presenting different technological classifications. These extracts were comprehensively characterized through untargeted metabolomics applying ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MSE) and spectrophotometric analyses. Chemical composition and colorimetry were also determined by classical analyses. Thirty-eight PC were tentatively identified by UHPLC-MSE belonging to three classes (phenolic acids, flavonoids, and other polyphenols), some of them identified in all WWF samples. Bound hydroxycinnamic acids were the main PC found in WWF, especially the trans-ferulic acid and its isomer. No difference was found in starch and protein contents, whereas low-quality flours showed a higher ash content than the superior and medium-quality flours. Total phenolic content (TPC) ranged between 124.5 and 171.4 mg GAE/100 g WWF, which bound PC were responsible for 60% of TPC. Omics data and multivariate statistical analyses were successfully applied to discern the phenolic profile of WWF from different genotypes and technological qualities. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-023-05665-8.

Glacial meltwater input to the ocean around the Antarctic Peninsula: forcings and consequences.

The Antarctic region has experienced recent climate and environmental variations due to climate change, such as ice sheets and ice shelves loss, and changes in the production, extension, and thickness of sea-ice. These processes mainly affect the freshwater supply to the Southern Ocean and its water masses formation and export, being crucial to changes in the global climate. Here, we review the influence of the glacial freshwater input on the Antarctic Peninsula adjacent ocean. We highlight each climate process' relevance on freshwater contribution to the sea and present a current overview of how these processes are being addressed and studied. The increase of freshwater input into the ocean carries several implications on climate, regionally and globally. Due to glacier melting, the intrusion of colder and lighter water into the ocean increases the stratification of the water column, influencing the sea-ice increase and reducing ocean-atmosphere exchanges, affecting the global water cycle. This study shows the role of each hydrological cycle processes and their contributions to the regional oceanography and potentially to climate.

"COVID toes": A meta-analysis of case and observational studies on clinical, histopathological, and laboratory findings.

BACKGROUND: Coronavirus disease (COVID-19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio-like skin lesions associated with COVID-19 infection. OBJECTIVE: To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio-like lesions reported in the literature. METHODS: We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory-confirmed COVID-19 with pernio-like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random-effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi-square test for dichotomous variables and the Mann-Whitney test for continuous variables. RESULTS: A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5-18.8). Feet were affected in 91.4% (87.0-94.4%) of patients in observational studies. The proportion of patients with a positive RT-PCR test was less than 15%. Lesion topography and morphology were associated with age. CONCLUSION: Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non-pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non-positivity of laboratory tests does not exclude an association with COVID-19. Pernio-like lesions may be a late manifestation of COVID-19.

Comparing community mobility reduction between first and second COVID-19 waves.

Background: In this paper, we conduct a mobility reduction rate comparison between the first and second COVID-19 waves in several localities from America and Europe using Google community mobility reports (CMR) data. Through multi-dimensional visualization, we are able to compare the reduction in mobility from the different lockdown periods for each locality selected, simultaneously considering multiple place categories provided in CMR. In addition, our analysis comprises a 56-day lockdown period for each locality and COVID-19 wave, which we analyze both as 56-day periods and as 14-day consecutive windows. Methods: We use locality-wise calibrated CMR data, which we process through seasonal-trend decomposition by LOESS (STL) to isolate trend from seasonal and noise effects. We scale trend data to draw Pareto-compliant conclusions using radar charts. For each temporal granularity considered, data for a given place category is aggregated using the area under the curve (AUC) approach. Results: In general, reduction rates observed during the first wave were much higher than during the second. Alarmingly, December holiday season mobility in some of the localities reached pre-pandemic levels for some of the place categories reported. Manaus was the only locality where second wave mobility was nearly as reduced as during the first wave, likely due to the P1 variant outbreak and oxygen supply crisis.

Assessment of allelopathic, cytotoxic, genotoxic and antigenotoxic potential of Smilax brasiliensis Sprengel leaves.

Smilax brasiliensis (Smilacaceae) is a native Brazilian plant found in the Cerrado biome and commonly used in folk medicine. The aim of this study was to evaluate the allelopathic, cytotoxic, genotoxic, and antigenotoxic potential of extract and fractions of Smilax brasiliensis leaves. Quercetin and rutin isomers were observed in the subfractions. The dichloromethane fraction (1000 µg/mL) decreased lettuce (Lactuca sativa) seed vigor, while and ethyl acetate and hydromethanol fractions (1000 µg/mL) affected the germination, and quercetin and rutin affected the vigor and germination of onion seeds. The extract, fractions, quercetin, and rutin inhibited or promoted lettuce hypocotyl and radicle growth. The extract and fractions inhibited onion hypocotyl growth at all concentrations. With regards to radicle growth, the results were diversified: growth was either inhibited or promoted. Rutin and quercetin inhibited onion hypocotyl and radicle growth at all concentrations. The extract and fractions of Smilax brasiliensis, rutin, and quercetin did not cause cytotoxic effect evaluated by mitotic index. The extract and fractions showed genotoxic effects. Quercetin and rutin did not cause genotoxic effects. On the other hand, the extract and fractions showed antigenotoxic effects at all tested concentrations, where they were able to revert chromosomal abnormalities caused by glyphosate. However, additional studies are required to evaluate the possible use of the S. brasiliensis leaf methanol extract and fractions as natural sources of bioherbicides.

A new combination rule for Spatial Decision Support Systems for epidemiology.

BACKGROUND: Decision making in the health area usually involves several factors, options and data. In addition, it should take into account technological, social and spatial aspects, among others. Decision making methodologies need to address this set of information , and there is a small group of them with focus on epidemiological purposes, in particular Spatial Decision Support Systems (SDSS). METHODS: Makes uses a Multiple Criteria Decision Making (MCDM) method as a combining rule of results from a set of SDSS, where each one of them analyzes specific aspects of a complex problem. Specifically, each geo-object of the geographic region is processed, according to its own spatial information, by an SDSS using spatial and non-spatial data, inferential statistics and spatial and spatio-temporal analysis, which are then grouped together by a fuzzy rule-based system that will produce a georeferenced map. This means that, each SDSS provides an initial evaluation for each variable of the problem. The results are combined by the weighted linear combination (WLC) as a criterion in a MCDM problem, producing a final decision map about the priority levels for fight against a disease. In fact, the WLC works as a combining rule for those initial evaluations in a weighted manner, more than a MCDM, i.e., it combines those initial evaluations in order to build the final decision map. RESULTS: An example of using this new approach with real epidemiological data of tuberculosis in a Brazilian municipality is provided. As a result, the new approach provides a final map with four priority levels: "non-priority", "non-priority tendency", "priority tendency" and "priority", for the fight against diseases. CONCLUSION: The new approach may help public managers in the planning and direction of health actions, in the reorganization of public services, especially with regard to their levels of priorities.

Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: A cohort study.

AIMS AND OBJECTIVES: To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis 'Risk for perioperative positioning injury'. BACKGROUND: Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. DESIGN: Longitudinal concept validation cohort study. METHODS: Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. RESULTS: A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes-Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation-and 13 clinical indicators. CONCLUSIONS: Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at 'Risk for perioperative positioning injury' are sensitive to patient states during the perioperative period. RELEVANCE TO CLINICAL PRACTICE: Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.

Toxicity of different fatty acids and methyl esters on Culex quinquefasciatus larvae.

The Culex quinquefasciatus mosquito is a vector of several diseases, and its control has been performed with synthetic insecticides, which may have human and environmental side effects. Thus, the use of new and safe molecules are important, and this study evaluated the toxicity of active substances against this mosquito. The oleic, linoleic, linolenic, palmitic and stearic acids and their respective methyl esters were tested against fourth instar C. quinquefasciatus larvae. Oleic, linoleic and linolenic acids had LC50 values of 8.58, 10.04 and 19.78 mg/L, respectively. Histological analysis showed that these three compounds caused cell instability with an increase in the number of vesicles in the fat body and in the midgut cells. Based on these results, glucose, triglyceride, and protein levels were evaluated after 1 h of acid exposure. These compounds decreased in insects treated with linoleic acid. Linolenic acid also caused a significant increase in acetylcholinesterase activity. These results show that oleic, linoleic, and linoleic acids have a lower LC50 for C. quinquefasciatus, affecting its metabolism and the morphology of midgut and fat body.

Antibacterial activity of Lamiaceae plant extracts in clinical isolates of multidrug-resistant bacteria.

The antibacterial activity of plant extracts of the Lamiaceae family was evaluated against clinical isolates of multi-resistant Gram-negative bacteria by broth microdilution technique. Promising results were obtained considering that all extracts were active for at least two bacterial species with MIC ranging from 0.5 to 2.0 mg/mL.

Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study.

BACKGROUND: Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. PROCEDURE: A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients. Sociodemographic, clinical, and TIVAP insertion-related variables were evaluated, with the endpoint being the first CLABSI. A Kaplan-Meier analysis was performed to determine CLABSI-free catheter survival. RESULTS: Overall, 188 children were evaluated over 77,541 catheter days, with 94 being diagnosed with CLABSI (50%). Although coagulase-negative staphylococci were the pathogens most commonly isolated, Gram-negative microorganisms (46.8%) were also prevalent. In the multivariate analysis, factors that increased the risk for CLABSI were TIVAP insertion prior to chemotherapy (risk ratio [RR] = 1.56; P < 0.01), white blood cell count less than 1,000 mm-3 on the day of implantation (RR = 1.64; P < 0.01), and chronic malnutrition (RR = 1.41; P < 0.05). Median time without CLABSI following TIVAP insertion was 74.5 days. CONCLUSIONS: Risk factors for CLABSI in pediatric cancer patients with a TIVAP may be related to the severity of the child's condition at catheter insertion. Insertion of the catheter before chemotherapy and unfavorable conditions such as malnutrition and bone marrow aplasia can increase the risk of CLABSI. Protocols must be revised and surveillance increased over the first 10 weeks of treatment.

Larvicidal activity of vegetable oils and esterified compounds against Culex quinquefasciatus (Diptera: Culicidae).

Control of Culex quinquefasciatus using chemical insecticides may result in the selection of resistant mosquito strains. Thus, the use of plant-derived products has been studied as alternative for the mosquito control. Fatty acid methyl esters (FAMEs) obtained by transesterification of vegetable oils may result in compounds with larvicidal potential against C. quinquefasciatus. However, little is known about the morphological, physiological or biochemical effects that these FAMEs may have on mosquito larvae. The present study reports the effects of these FAMEs in mosquito larvae. The FAMEs were obtained by transesterification of canola, corn, sunflower, and soybean oils with acid catalysis and the determination of FAMEs composition was done by gas chromatography-mass spectrometry (GC-MS). Larvae of C. quinquefasciatus were exposed to different concentrations of the vegetable oils and FAMEs. Thereby, different FAMEs showed LC50 values ranging from 42.32 to 196.27mg/L against C. quinquefasciatus larvae. The methyl ester obtained from sunflower oil showed the lowest LC50. Histology of C. quinquefasciatus larvae exposed to LC50 of FAMEs was performed and changes in the midgut and fat body morphology were identified. Therefore, larval mortality and changes in the internal organs suggested that FAMEs might be a promising new class of larvicidalcompounds. Cytotoxicity of FAMEs compounds was assessed with the HeLa human cell line and no effect was observed.

Antifungal and antioxidant activity of fatty acid methyl esters from vegetable oils.

Fatty acid methyl esters (FAMEs) were obtained from vegetable oils of soybean, corn and sunflower. The current study was focused on evaluating the antifungal activity of FAMEs mainly against Paracoccidioides spp., as well as testing the interaction of these compounds with commercial antifungal drugs and also their antioxidant potential. FAMEs presented small IC50 values (1.86-9.42 µg/mL). All three FAMEs tested showed antifungal activity against isolates of Paracoccidioides spp. with MIC values ranging from 15.6-500 µg/mL. Sunflower FAMEs exhibited antifungal activity that extended also to other genera, with an MIC of 15.6 µg/mL against Candida glabrata and C. krusei and 31.2 µg/mL against C. parapsilosis. FAMEs exhibited a synergetic effect with itraconazole. The antifungal activity of the FAMEs against isolates of Paracoccidioides spp. is likely due to the presence of methyl linoleate, the major compound present in all three FAMEs. The results obtained indicate the potential of FAMEs as sources for antifungal and antioxidant activity.

Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised controlled trial.

BACKGROUND: Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial. OBJECTIVE(S): To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction. DESIGN: Randomised clinical trial. SETTING: A tertiary care teaching hospital. PATIENTS: In total, 84 children (aged 4 to 8 years; American Society of Anesthesiologists I and II) undergoing minor-to-moderate elective surgical procedures and their parents/guardians. INTERVENTIONS: Children were randomised into four groups: control group, in which the parent/guardian was verbally informed about the anaesthetic procedure; the informed group, in which the parent/guardian was also provided with an information leaflet about the anaesthetic procedure; the smartphone group, in which the parent/guardian was verbally informed and the child received a smartphone application to play with while in the holding area before entering the operating room and the smartphone and informed group, in which the parent/guardian also received an information leaflet and the child, a smartphone application to play with while in the holding area before entering the operating room. MAIN OUTCOME MEASURES: Children's anxiety at two time points: in the holding area of the surgical centre and in the operating room during induction of anaesthesia by facemask. RESULTS: Median (IQR) anxiety levels were greater at time point operating room for children in the control group (55.0; range: 30.0 to 68.4) than in the other groups: informed group, 28.4 (23.4 to 45.0); smartphone group, 23.4 (23.4 to 30.0); smartphone and informed group, 23.4 (23.4 to 25.9). CONCLUSION: The behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02246062.

The Influence of Fatty Acid Methyl Esters (FAMEs) in the Biochemistry and the Na(+)/K(+)-ATPase Activity of Culex quinquefasciatus Larvae.

Culex quinquefasciatus is the main vector of lymphatic filariasis and combating this insect is of great importance to public health. There are reports of insects that are resistant to the products currently used to control this vector, and therefore, the search for new products has increased. In the present study, we have evaluated the effects of fatty acid methyl esters (FAMEs) that showed larvicidal activity against C. quinquefasciatus, on glucose, total protein, and triacylglycerol contents and Na(+)/K(+)-ATPase activity in mosquito larvae. The exposure of the fourth instar larvae to the compounds caused a decrease in the total protein content and an increase in the activity of the Na(+)/K(+)-ATPase. Furthermore, the direct effect of FAMEs on cell membrane was assessed on purified pig kidney Na(+)/K(+)-ATPase membranes, erythrocyte ghost membranes, and larvae membrane preparation. No modifications on total phospholipids and cholesterol content were found after FAMEs 20 min treatment on larvae membrane preparation, but only 360 µg/mL FAME 2 was able to decrease total phospholipid of erythrocyte ghost membrane. Moreover, only 60 and 360 µg/mL FAME 3 caused an activation of purified Na(+)/K(+)-ATPase, that was an opposite effect of FAMEs treatment in larvae membrane preparation, and caused an inhibition of the pump activity. These data together suggest that maybe FAMEs can modulate the Na(+)/K(+)-ATPase on intact larvae for such mechanisms and not for a direct effect, one time that the direct effect of FAMEs in membrane preparation decreased the activity of Na(+)/K(+)-ATPase. The biochemical changes caused by the compounds were significant and may negatively influence the development and survival of C. quinquefasciatus larvae.

Physical activity and better medication compliance improve mini-mental state examination scores in the elderly.

In addition to hypertension, dyslipidemia, atherosclerosis, and diabetes, a sedentary lifestyle plays a pivotal role in cerebro- and cardiovascular disease and progressive cognitive decline, including vascular dementia and Alzheimer's disease. The present study investigated whether controlling the key risks and participating in physical activity have a beneficial impact on these disorders. Elderly volunteers were enrolled in a 3-month program that consisted of structured exercise three times per week. The daily routine, medical treatment, and vital parameters were evaluated and correlated with the subjects' neuropsychiatric status. High blood pressure was found in 40% of the participants, with no significant differences between the sexes. A higher proportion of females (55%) than males (18%) forgot to take their medication during the observation period. Significant negative correlations were found between Mini-Mental State Examination (MMSE) scores and age, lack of a caregiver, and increased pulse rate before or after exercise. These results suggest that the presence of home assistance and subsequent improvement in medication compliance, vital parameter optimization, and regular physical activity may yield better MMSE results and a lower risk for cerebro- and cardiovascular disease.

Psychological and Cognitive Profile of Hypertensive and Diabetic Patients.

Chronic disorders such as hypertension and diabetes mellitus are often associated with depressive and anxiety symptoms, as well as cognitive decline. Once developed, psychological support is essential for improving the quality of life. This study is aimed at identifying impaired mental health in connection with these systemic metabolic disorders. A total of 34 patients were included in this cross-sectional study: 17 hypertensive individuals with a mean age of 59 ± 10 years, and 17 diabetic patients aged 54 ± 10 years. The following psychometric tests were used: Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and self-reporting questionnaire (SRQ-20). A large number of patients with high blood pressure or diabetes was associated with mental health problems (82% or 65%, respectively; p = 0.246). Affective disorder, especially moderate to severe depression, was seen mainly in diabetic patients (76%), whereas hypertensive individuals had higher prevalence of anxiety (64%). There was no cognitive impairment in this middle-aged population. This study shows a high proportion of depression and anxiety symptoms in patients with hypertension or diabetes mellitus, reinforcing the importance of psychiatric support for appropriate control of these metabolic disorders.

Lumbar punctures in thrombocytopenic children with cancer.

INTRODUCTION: Lumbar punctures (LP) in patients presenting thrombocytopenia are linked to the possibility of bleeding and spinal hematomas. The minimum platelet count required for the safe performance of spinal procedures is still under discussion. Children with some oncology diseases require routinely lumbar punctures; such patients often present thrombocytopenia, making this group an ideal population to study the association between lumbar puncture in thrombocytopenic patients and complications. OBJECTIVES: To determine the platelet count of oncology children undergone lumbar punctures and the occurrence of spinal hematomas. METHOD: Observational longitudinal study. It included a retrospective analysis of electronic medical records of oncology patients submitted to LP for intrathecal chemotherapy between January 2004 and October 2011, carried out at the 'Instituto de Medicina Integral Prof. Fernando Figueira (IMIP)', Recife, Brazil. RESULTS: We evaluated 9088 lumbar punctures performed in 440 patients. The platelet count distribution before lumbar punctures was as follows: 25 punctures had zero to 10,000 platelets per mm(3), 67 punctures had between 10,000 and 20,000 platelets per mm(3), 88 had between 20,000 and 30,000 platelets per mm(3), 92 punctures had between 30,000 and 40,000 platelets per mm(3), 107 punctures had between 40,000 and 50,000 platelets per mm(3), and 729 punctures had between 50,000 and 100,000 platelets per mm(3). In this series, the incidence of bloody tap was 16.9% (1112 lumbar punctures of 6552 had more than ten erythrocytes). No complications were observed. CONCLUSIONS: Even in thrombocytopenic patient, an epidural hematoma would be a relatively rare complication following lumbar puncture. Despite the large number of punctures performed on patients with platelet counts below 100,000 mm(-3) (n = 1108), further studies are necessary in order to determine a lower safe platelet count threshold for the performance of lumbar punctures in healthy patients undergoing neuraxial anesthesia.