Preoperative anxiety is a common reaction exhibited by up to 80% of patients who are scheduled for surgical procedures and characterized by psychological and physical changes which may affect their perioperative period. Our aim is to report the most up-to-date evidence on preoperative anxiety in brain surgery patients through a systematic analysis of the studies produced in the last decades. We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. Data were extracted using the Population, Intervention, Comparison, Outcome framework and critically analyzed. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the Risk of bias (RoB) 2 and ROBINS tools, as was the methodological quality, following GRADE criteria. We included 27 articles, accounting for 2558 patients in twelve different countries. The prevalence of preoperative anxiety ranged from 17 up to 89%, higher in female patients. Preoperative anxiety was associated with lower quality of life and cognitive performance, higher need for information, poorer memory and attention, longer hospitalization, depressive symptoms, and increase of physical disability; no correlation with survival rate was found. Seven randomized controlled trials attested the efficacy of acupuncture, music therapy, virtual reality, and pharmacological support in lowering anxiety levels. Preoperative anxiety is a common phenomenon that could negatively affect the perioperative period of brain surgery patients: this is something that should not be neglected to achieve better care through early prevention and optimal management.

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Familial hypercholesterolaemia (FH) is a frequent genetic disorder characterised by high plasma levels of total and LDL-cholesterol and premature atherosclerosis. If left untreated, affected subjects have a high risk of cardiovascular disease, as they are exposed to very high levels of LDL-cholesterol from birth. Healthy dietary habits and lifestyle are the first treatment option and, if started from childhood, represent a milestone in the prevention of atherosclerotic disease, both as a starting point and in combination with drug therapy. In this work, based on the main consensus documents available so far, we have evaluated the most up-to-date indications of the dietetic-nutritional intervention for the treatment of FH, delving into the peculiar aspects of the diet of the child/adolescent affected by FH. After an analysis of the macro- and micronutrients and the most common dietary patterns currently recommended, we highlighted some practical aspects, some frequent errors and some risks we could fall into when dealing with paediatric nutritional treatment. In conclusion, the dietary intervention for the child/adolescent with FH is a complex task, that should be individualised and tailored taking into account, first of all, the nutritional adequacy for growth and development, but also the multiple aspects linked to the child/adolescent's age, tastes and preferences, the family they belong to, the socio-economic context and the Country they live in.

IntroductionUp to 80% of patients scheduled for surgery experience preoperative anxiety, which may implicate perioperative psychological and physical discomforts. Several studies focused on this phenomenon in neurosurgical setting, still controversial evidence exists.ObjectivesOur aim is to synthesize this evidence, investigating prevalence, implications and therapy of preoperative anxiety in brain surgery patients.MethodsWe performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. Data were extracted using the PICO framework. PRISMA guidelines were applied, and the risk of bias was assessed using the RoB 2 and ROBINS tools, as was the methodological quality of the included studies, following GRADE criteria; we excluded articles with serious risk of bias and/or low quality.ResultsWe included 27 articles, accounting for 2558 patients of twelve different countries. Prevalence of anxiety before brain surgery was up to 89%, reaching higher levels in women. Anxiety concerned mostly anesthesia and surgical outcome. No correlation emerged between level of anxiety and laterality, histological type of tumor or survival rate. Before surgery, anxious patients performed worse in cognitive tasks and had worse subjective evaluation of their cognitive abilities. After surgery, preoperative anxiety was associated with depression, longer hospitalization, increase of physical disability and lower quality of life. Effective approaches to reduce anxiety were acupuncture, music therapy, virtual reality and pharmacological support.ConclusionsPreoperative anxiety in brain surgery patients is a common experience that should not be underestimated to achieve a better perioperative care through early detection and adequate pharmacological or non-pharmacological management.