Predictor variables and screening protocol for depressive and anxiety disorders in cancer outpatients

Background Cancer patients are at increased risk of persistent depressive and anxiety symptoms and disorders compared to the general population. However, these issues are not always identified, which may worsen the prognosis and increase morbidity and mortality. Therefore, the objectives of this study are to identify predictor variables (demographic and clinical) for the development of mood and anxiety disorders in cancer outpatients and to propose a probabilistic screening protocol considering these variables and certain standardized screening instruments. Methods A total of 1,385 adults, of both genders, receiving outpatient cancer care were evaluated using a questionnaire and screening instruments. Thereafter, 400 of these subjects responded to the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-IV) by telephone to confirm or rule out the presence of a Current Major Depressive Episode (CMDE) or Anxiety Disorder (AD). Results Of the patients surveyed, 64% met the criteria for CMDE and 41% for AD. Female gender was found to be a risk factor for both disorders, and the presence of previous psychiatric history and marital status (divorced and widowed) were risk factors for anxiety disorders. When scoring above the recommended cutoff score, the screening instruments also indicated a risk of the studied disorders. Based on these findings, a screening protocol and nomograms were created for the quantification, combination and probabilistic estimate of risk, with accuracy indicators >0.68. Conclusion The prevalence rates for the disorders under study are extremely high in cancer patients. The use of the proposed protocol and nomogram can facilitate rapid and wide screening, thus refining triage and supporting the establishment of criteria for referral to mental health professionals, so that patients can be properly diagnosed and treated.info:eu-repo/semantics/publishedVersio

The Effects of Sevoflurane Anesthesia and Cardiopulmonary Bypass on Renal Function in Cyanotic and Acyanotic Children Undergoing Cardiac Surgery

Background: There are few data on the effects of anesthesia and cardiopulmonary bypass (CPB) on perioperative renal function in children with cyanotic congenital heart disease undergoing open heart surgery. This study aims to investigate the perioperative renal function in cyanotic versus acyanotic children undergoing sevoflurane anesthesia for open heart surgery. Methods: After receiving ethical committee approval, 12 acyanotic patients (preoperative oxygen saturation: SaO(2) > 85%) and 12 cyanotic children (SaO(2) < 85%) were included. Sevoflurane was administered at concentration levels of 2% before CPB and 1-2% during CPB after standard anesthesia induction. Inorganic fluoride, electrolytes, creatinine, urea nitrogen in serum and urine samples, and N-acetyl-beta-D-glucosaminidase (NAG) in urine samples were measured before induction, before CPB, during CPB, after CPB, at the end of surgery, and at 24th h postoperatively. Results: The levels of serum uric acid levels were higher in the cyanotic group (p < 0.05). There were no differences in the levels of serum creatinine and urine creatinine, urea nitrogen, and electrolytes between the two groups. Serum inorganic fluoride levels were always higher in the acyanotic group than in the cyanotic group, but these differences between the groups reached statistical significance at two measurement times (before CPB and end of surgery) (p < 0.05). Urinary inorganic fluoride levels increased with time in both groups. Although urinary NAG increased significantly after the CPB in the cyanotic group, the differences between the two groups did not reach statistical significance. Conclusions: We have concluded that renal function was not affected during open heart surgery with sevoflurane anesthesia, in both cyanotic and acyanotic children.WoSScopu

Heavy precipitation events over East Africa in a changing climate: results from CORDEX RCMs

The study assesses the performance of 24 model runs from five COordinated Regional climate Downscaling Experiment (CORDEX) regional climate models (RCMs) in simulating East Africa’s spatio-temporal precipitation characteristics using a set of eight descriptors: consecutive dry days (CDD), consecutive wet days (CWD), simple precipitation intensity index (SDII), mean daily annual (pr_ANN), seasonal (pr_MAM and pr_OND) precipitation, and representatives of heavy precipitation (90p) and very intense precipitation (99p) events. Relatively better performing RCM runs are then used to assess projected precipitation changes (for the period 2071–2099 relative to 1977–2005) over the study domain under the representative concentration pathway (RCP) 8.5 scenario. The performance of RCMs is found to be descriptor and scope specific. Overall, RCA4 (r1i1p1) forced by CNRM-CERFACS-CNRM-CM5 and MPI-M-MPI-ESM-LR, REMO2009 (r1i1p1) forced by MPI-M-MPI-ESM-LR, and RCA4 (r2i1p1) forced by MPI-M-MPI-ESM-LR emerge as the top four RCM runs. We show that an ensemble mean of the top four model runs outperforms an ensemble mean of 24 model simulations and ensemble means for all runs in an RCM. Our analysis of projections shows a reduction (increase) in mean daily precipitation for MAM(OND), an increase(decrease) in CDD(CWD) events, and a general increase in SDII and the width of the right tail of the precipitation distribution (99p–90p). An increase in SDII and 99p–90p implies a possibility of occurrence of heavy and extreme precipitation incidences by the end of the twenty-first century. Our findings provide important information to support the region’s climate change adaptation and mitigation efforts