Reimagining quarantine: Assuring hopefulness in nursing and healthcare.

This article aimed to explore issues of concern related to quarantine, its social consequences and influences, challenging its effects on human behavioral expressions during social isolation. The advent of the coronavirus disease 2019 (COVID-19) pandemic impacted human lives in multifarious ways, threatening the meaning of normalcy. Quarantine, lockdown, isolation, and other terms reflecting conditions limiting human freedoms have become synonymous in importance to safety, security, and survival. To understand human defiance in the face of maintaining limited mobility during the COVID-19 pandemic, reimagining situations of "unfreedoms" is explained as thinking of changes to inspire and improve the meaning of living lives meaningfully. During the pandemic, issues regarding healthcare practices and social behaviors focused much attention on interactive challenges that enhance ways to mitigate the spread of contagious diseases. Illuminating these issues, discussing concerns and highlighting recommendations to engage in alternative approaches and practices, heightens the declaration of efficiency of quarantine outcomes and effectiveness. Implications are proposed with the hope that they may lead the way forward in exercising contemporary healthcare practices.

Effect of breastfeeding promotion interventions on child growth: a systematic review and meta-analysis.

AIM: To update a previous systematic review and meta-analyses about the effect of breastfeeding promotion interventions on child growth. METHODS: Studies evaluating the effect of any type of breastfeeding promotion intervention on child weight, length (or height) and weight/height (or BMI) were screened. Papers published between 2006 and 2014 were checked using the following databases: PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Lilacs and SciELO. RESULTS: Sixteen studies were added to 19 other studies identified in the previous review, resulting in 35 studies. Meta-analyses of studies reporting on mean weight, length, weight/length or BMI showed that the interventions had no impact on weight or length/height z scores [pooled effect: 0.03 (95% confidence interval: -0.06;0.12) and 0.03 (95% confidence interval: -0.02;0.08), respectively] and had a modest, but significant, reduction in body mass index/weight-for-height z scores [z score mean difference: -0.06 (95% confidence interval: -0.12;0.00)], which was limited to studies from low- and high-incomes settings. For all three outcomes, there was important heterogeneity among studies, which should be taken into account when interpreting the results. CONCLUSION: Breastfeeding promotion interventions were not associated with significant changes in weight or length, but led to a modest, albeit significant, reduction in body mass index/weight-for-height z scores.

Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures.

BACKGROUND: Basilar skull fractures predispose patients to meningitis because of the possible direct contact of bacteria in the paranasal sinuses, nasopharynx or middle ear with the central nervous system (CNS). Cerebrospinal fluid (CSF) leakage has been associated with a greater risk of contracting meningitis. Antibiotics are often given prophylactically, although their role in preventing bacterial meningitis has not been established. OBJECTIVES: To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with basilar skull fractures. SEARCH METHODS: We searched CENTRAL (2014, Issue 5), MEDLINE (1966 to June week 1, 2014), EMBASE (1974 to June 2014) and LILACS (1982 to June 2014). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention. We also identified non-RCTs to perform a separate meta-analysis in order to compare results. DATA COLLECTION AND ANALYSIS: Three review authors independently screened and selected trials, assessed risk of bias and extracted data. We sought clarification with trial authors when needed. We pooled risk ratios (RRs) for dichotomous data with their 95% confidence intervals (CIs) using a random-effects model. We assessed the overall quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS: In this update we did not identify any new trials for inclusion. We included five RCTs with 208 participants in the review and meta-analysis. We also identified 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with basilar skull fractures. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. When we evaluated the five included RCTs, there were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality and need for surgical correction in patients with CSF leakage. There were no reported adverse effects of antibiotic administration, although one of the five RCTs reported an induced change in the posterior nasopharyngeal flora towards potentially more pathogenic organisms resistant to the antibiotic regimen used in prophylaxis. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2168 patients), which produced results consistent with the randomised data from the included studies.Using the GRADE approach, we assessed the quality of trials as moderate. AUTHORS' CONCLUSIONS: Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with basilar skull fractures, whether there is evidence of CSF leakage or not. Until more research is available, the effectiveness of antibiotics in patients with basilar skull fractures cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.

Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.

BACKGROUND: Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear. OBJECTIVES: To assess the effects of prophylactic anticonvulsants in patients with chronic subdural haematoma, in both the pre- and post-operative periods. SEARCH METHODS: We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), PubMed, LILACS, and the databases clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, and Current Controlled Trials. The search was through 27th March 2013. SELECTION CRITERIA: Randomised controlled trials comparing any anticonvulsant versus placebo or no intervention. DATA COLLECTION AND ANALYSIS: Three authors screened the search results to identify relevant studies. No studies met the inclusion criteria for the review. MAIN RESULTS: No randomised controlled trials were identified. AUTHORS' CONCLUSIONS: No formal recommendations can be made about the use of prophylactic anticonvulsants in patients with chronic subdural haematoma based on the literature currently available. There are no randomised controlled trials on this topic, and non-controlled studies have conflicting results. There is an urgent need for well-designed randomised controlled trials.

Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures.

BACKGROUND: Basilar skull fractures (BSF) predispose patients to meningitis because of the possible direct contact of bacteria in the paranasal sinuses, nasopharynx or middle ear with the central nervous system (CNS). Cerebrospinal fluid (CSF) leakage has been associated with a greater risk of contracting meningitis. Antibiotics are often given prophylactically, although their role in preventing bacterial meningitis is not established. OBJECTIVES: To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to February 2011), EMBASE (1974 to February 2011) and LILACS (1982 to February 2011). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention. We also identified non-RCTs to perform a separate meta-analysis to compare results. DATA COLLECTION AND ANALYSIS: At least two authors independently appraised trial quality and extracted data for each trial. MAIN RESULTS: We identified five RCTs and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with BSF. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the five RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality, and need for surgical correction in patients with CSF leakage. There were no reported adverse effects of antibiotic administration, although one of the five RCTs reported an induced change in the posterior nasopharyngeal flora towards potentially more pathogenic organisms resistant to the antibiotic regimen used in prophylaxis. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2168 patients), producing results consistent with the randomised data. AUTHORS' CONCLUSIONS: Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.

Effects of carbon and nitrogen sources and oxygenation on the production of inulinase by Kluyveromyces marxianus.

Cultivations of Kluyveromyces marxianus var. bulgaricus ATCC 16045 were performed on both minimal and complex media using different carbon and nitrogen sources either in the presence or absence of aeration. The results collected were worked out and compared so as to provide a useful contribution to the optimization of inulinase production. Kinetics of extracellular inulinase release were similar on glucose, fructose, and sucrose. Inulinase was detected at basal level since the beginning of batch runs on these three carbon sources and overproduced after their depletion. The highest inulinase activity in minimal medium containing 10 g/l sucrose (6.4 IU/ml) was obtained at an initial (NH(4))(2)SO(4) concentration of 5 g/l, whereas it was reduced to about one fourth of this value and detected only at the beginning under nitrogen-limited conditions. The best sucrose concentrations for the enzyme production were 30 and 20 g/l in minimal and complex media, yielding 15.4 and 208 IU/ml, respectively. In general, the enzyme activity was much higher in complex than in minimal medium under all conditions. O(2)-enriched air neither improved inulinase production nor prevented ethanol formation.

Pancreatitis aguda recidivante con enteropatía por gluten asociada. Características clínico-analíticas y evolutivas en 34 pacientes / No disponible

Objetivos: describir la frecuencia y características clínico-analíticasde la pancreatitis aguda (PA) recidivante con enteropatíapor gluten (EG) asociada.Pacientes y métodos: estudiamos de forma prospectiva loscasos de pancreatitis agudas ingresados en nuestro Servicio duranteel año 2006. Registramos un total de 185 pacientes. A lasformas recurrentes que fueron 40 en total (22%), les aplicamos unprotocolo clínico-analítico consistente en la determinación demarcadores serológicos, genéticos y biopsias duodenales, paradescartar una EG asociada.Resultados: un total de 34 pacientes (18%) cumplían criteriosclínico-biológicos de EG asociada (grupo 1) y se compararon conel resto de las PA no-EG (n = 161) (grupo 2). La edad media en laEG fue de 54 ± 25 años, ligeramente inferior al grupo 2, (61 ±14) (NS). Existía un ligero predominio de mujeres (50%) en el grupo1, respecto al grupo 2 (38,5%) (NS). Siete pacientes del grupo1 (20%) presentaron una PA grave, frente a 27 (17%) en el grupo2 (NS). La presencia de colelitiasis en el grupo 1, fue de 6 casos(18%), significativamente inferior a la del grupo 2, de 72 casos(45%) (p < 0,05). Cuatro pacientes con EG desarrollaron seudoquistes(12%) frente a 13 (8%) en el grupo 2 (NS).La transglutaminasa tisular (TGt) estaba elevada únicamente en3 casos (9%). Nueve pacientes (34%) fueron DQ2 (+) y 4 (12%)DQ8 (+), siendo el resto (54%), negativos para ambos marcadores.Existía una duodenitis difusa desde el punto de vista endoscópicoen 32 pacientes (95%). Las biopsias duodenales, mostraronatrofia vellositaria (Marsh 3) en 2 casos (6%); infiltración inflamatoriade la submucosa (Marsh 2) en 10 casos (29,4%); aumento delos linfocitos intraepiteliales (Marsh 1) en 8 casos (23,5%) y mucosanormal (Marsh 0) en 14 casos (41,2%). La respuesta a la DSGal año, fue excelente en 30 pacientes (88%).Conclusiones: la PA recidivante con EG, constituye una asociaciónrelativamente frecuente, indistinguible desde el punto devista clínico y evolutivo del resto de PA, excepto por una menorpresencia de colelitiasis (p < 0,05)

Objectives: to describe the frequency and the clinical and laboratorycharacteristics of relapsing acute pancreatitis (AP) associatedwith gluten enteropathy (GE).Patients and methods: we prospectively examined all acutepancreatitis cases admitted to our Department in 2006. Werecorded a total of 185 patients. With recurring forms, 40 (22%)in all, we used a clinical-lab protocol including serologic and geneticmarkers, and duodenal biopsy to rule out GE.Results: a total of 34 patients (18%) met clinical-biological criteriafor GE (group 1), and were compared to the remaining non-GE AP cases (n = 161) (group 2). Mean age in the GE group was54 ± 25 years, slightly younger than group 2 (61 ± 14) (NS).There was a mild predominance of women (50%) in group 1 versusgroup 2 (38.5%) (NS). Seven patients in group 1 (20%) hadsevere AP, as compared to 27 (17%) in group 2 (NS). The presenceof cholelithiasis in group 1 involved 6 cases (18%), whichwas significantly lower than in group 2 – 72 cases (45%) (p <0.05). Four patients with GE developed pseudocysts (12%) versus13 (8%) in group 2 (NS).Tissue transglutaminase (tTG) was elevated only in 3 patients(9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); therest (54%) were all negative for both markers. From an endoscopicperspective there was diffuse duodenitis in 32 patients (95%).Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients(6%); submucosal inflammatory infiltration (Marsh 2) in 10(29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases(23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%).Response to GFD after 1 year was excellent in 30 patients (88%).Conclusions: relapsing AP with GE represents a relativelycommon association that is indistinguishable from other APs froma clinical-evolutive stand point, except for a lower presence ofcholelithiasis (p < 0.05) (AU)

[Relapsing acute pancreatitis associated with gluten enteropathy. Clinical, laboratory, and evolutive characteristics in thirty-four patients]. / Pancreatitis aguda recidivante con enteropatía por gluten asociada, Características clínico-analíticas y evolutivas en 34 pacientes.

OBJECTIVES: To describe the frequency and the clinical and laboratory characteristics of relapsing acute pancreatitis (AP) associated with gluten enteropathy (GE). PATIENTS AND METHODS: We prospectively examined all acute pancreatitis cases admitted to our Department in 2006. We recorded a total of 185 patients. With recurring forms, 40 (22%) in all, we used a clinical-lab protocol including serologic and genetic markers, and duodenal biopsy to rule out GE. RESULTS: A total of 34 patients (18%) met clinical-biological criteria for GE (group1), and were compared to the remaining non-GE AP cases (n=161) (group2). Mean age in the GE group was 54 +/- 25 years, slightly younger than group 2 (61 +/- 14) (NS). There was a mild predominance of women (50%) in group 1 versus group 2 (38.5%) (NS). Seven patients in group 1 (20%) had severe AP, as compared to 27 (17%) in group 2 (NS). The presence of cholelithiasis in group 1 involved 6 cases (18%), which was significantly lower than in group 2--72 cases (45%) (p < 0.05). Four patients with GE developed pseudocysts (12%) versus 13 (8%) in group 2 (NS). Tissue transglutaminase (tTG) was elevated only in 3 patients (9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); the rest (54%) were all negative for both markers. From an endoscopic perspective there was diffuse duodenitis in 32 patients (95%). Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients (6%); submucosal inflammatory infiltration (Marsh 2) in 10 (29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases (23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%). Response to GFD after 1 year was excellent in 30 patients (88%). CONCLUSIONS: Relapsing AP with GE represents a relatively common association that is indistinguishable from other APs from a clinical-evolutive standpoint, except for a lower presence of cholelithiasis (p < 0.05). A specific diagnostic protocol is much needed in the identification of these patients since GFD is the only effective therapy to prevent new AP events from developing.

Steroids, neuroactive steroids and neurosteroids in psychopathology.

The term "neurosteroid" (NS) was introduced by Baulieu in 1981 to name a steroid hormone, dehydroepiandrosterone sulfate (DHEAS), that was found at high levels in the brain long after gonadectomy and adrenalectomy, and shown later to be synthetized by the brain. Later, androstenedione, pregnenolone and their sulfates and lipid derivatives as well as tetrahydrometabolites of progesterone (P) and deoxycorticosterone (DOC) were identified as neurosteroids. The term "neuroactive steroid" (NAS) refers to steroids which, independent of their origin, are capable of modifying neural activities. NASs bind and modulate different types of membrane receptors. The GABA and sigma receptor complexes have been the most extensively studied, while glycine-activated chloride channels, nicotinic acetylcholine receptors, voltage-activated calcium channels, although less explored, are also modulated by NASs. Within the glutamate receptor family, N-methyl-d-aspartate (NMDA) receptors, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors and kainate receptors have also been demonstrated to be a target for steroid modulation. Besides their membrane effects, once inside the neuron oxidation of Ring A reduced pregnanes, THP and THDOC, bind to the progesterone intracellular receptor and regulate gene expression through this path. The involvement of NASs on depression syndromes, anxiety disorders, stress responses to different stress stimuli, memory processes and related phenomena such as long-term potentiation are reviewed and critically evaluated. The importance of context for the interpretation of behavioral effects of hormones as well as for hormonal levels in body fluids is emphasized. Some suggestions for further research are given.

Computerized morphometry and three-dimensional image reconstruction in the evaluation of scalp biopsy from patients with non-cicatricial alopecias.

BACKGROUND: A major challenge in the histopathological examination of scalp biopsies is to perform an adequate evaluation of all the hair follicles present in the tissue. Transverse sectioning is currently the preferred technique to demonstrate every follicular structure in a punch biopsy specimen, although diagnostic accuracy is dependent on subjective evaluation of follicular morphology and hair size. OBJECTIVES: To determine if computer-based morphometry and three-dimensional (3D) image reconstruction software can be used to evaluate scalp biopsies from patients with non-cicatricial alopecias. METHODS: Nine 4-mm scalp punches were taken from nine patients with noncicatricial alopecias and step-sectioned transversely at 0.1-mm intervals from the epidermal surface to the subcutaneous fat. Each tissue section was then digitized and analysed using morphometric and 3D image reconstruction software. Morphometric data and 3D images were collated with clinical and conventional light microscopic diagnoses, as well as follow-up information. RESULTS: In four of the nine patients, results of morphometric analysis concurred with conventional clinicopathological diagnoses. In the remaining five patients, morphometry revealed a lower telogen count in one patient and higher telogen count in four patients. One of the four patients with a higher telogen count also had a low mean hair diameter and miniaturized anagen follicles in the 3D image that were suggestive of early androgenetic alopecia (AGA). 3D virtual microscopic imagery allowed the direct visualization of colour-coded, scaled hair follicles which demonstrated characteristic changes in alopecia areata, AGA and telogen effluvium. CONCLUSIONS: Our study demonstrated the feasibility of using morphometric and 3D reconstruction software to evaluate scalp biopsies. With further validation, this technique may prove to be more sensitive to detect subtle quantitative and qualitative follicular changes in non-cicatricial alopecias.