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PubMed1987

Pharmacokinetics of ciprofloxacin in acutely ill and convalescent elderly patients.

The pharmacokinetics of ciprofloxacin were evaluated in 13 elderly patients with serious infections who were receiving 750 mg orally every 12 hours. The acute evaluations were performed within 24 hours of admission (n = 13), whereas the convalescent evaluations were performed at the end of therapy (n = 7). Serum and urine concentrations of ciprofloxacin were measured using high-performance liquid chromatography. Peak serum concentration (Cmax), terminal elimination half-life (t1/2 beta), apparent total body clearance (CL/f), and apparent volume of distribution (Vd/f) of ciprofloxacin were 5.97 +/- 2.95 mg/liter, 5.31 +/- 2.00 hours, 8.12 +/- 3.83 ml/kg/minute, and 3.63 +/- 1.91 liters/kg during the period of acute illness. Cmax and Vd/f values were moderately increased during the convalescent phase (8.56 +/- 3.43 mg/liter versus 5.87 +/- 2.25 mg/liter, p = 0.138, and 5.95 +/- 3.23 liters/kg versus 3.46 +/- 1.40 liters/kg, 0.05 less than p less than 0.1). The CL/f and t1/2 beta (four to 12 hours) values, however, were not significantly altered. The observed pharmacokinetic characteristics, which are consistent with those derived from single-dose studies in healthy elderly subjects, are markedly different from previous observations in young adult volunteers. However, acute illness does not alter the pharmacokinetics of ciprofloxacin in the elderly. Dosage alterations because of the presence of acute illness in the elderly do not appear to be warranted.

Administration, Oral↗
PubMed1987

Antibodies against Vibrio cholerae lipopolysaccharide, cell-bound haemagglutinin and toxin in the intestinal fluid during convalescence.

Specific antibodies to V. cholerae lipopolysaccharide (LPS), cell-bound haemagglutinin (CHA) and toxin (CT) in the intestinal lavages of healthy Thais and Thai cholera patients during the convalescence period were determined by enzyme-linked immunosorbent assay. Only IgM and IgA specific antibodies were detectable in the specimens. All of the persons who were just recovered from cholera had IgA anti-CT and IgA anti-LPS and 82.4% had IgA anti-CHA. The IgA anti-CT, anti-LPS and anti-CHA were detected also in the gut fluids of 70.6%, 94.1% and 88.2%, respectively, of the healthy controls. The mean levels of the IgA antibodies of all specificities between the two groups of individuals were not different. However, the IgM anti-CT and IgM anti-LPS of the cholera patients increased during the convalescence period. The levels, therefore, were significantly higher than those of the controls. The ratios of IgA anti-CT: IgM anti-CT and IgA anti-LPS: IgM anti-LPS among the patients were 2.93:1 and 2.02:1, respectively while those of the controls were 10:1 and 34:1, respectively. IgA antibodies predominated in the lavages of both groups of the individuals.

Antibodies, Bacterial↗
PubMed1985

Anti-pertussis toxin IgG and anti-filamentous hemagglutinin IgG production in children immunized with pertussis acellular vaccine and comparison of these titers with the sera of pertussis convalescent children.

Serum was taken from 195 infant pertussis patients several times at appropriate intervals, and antibodies to pertussis toxin and filamentous hemagglutinin were evaluated by the ELISA. The geometric mean titers were low for both IgG antibodies at the onset of the disease, and rose to about 30 U/ml for both antibodies in the convalescent sera. All convalescent sera showed high titers of anti-PT IgG antibody. Paired serum samples were collected from 685 children before and four weeks after the second primary dose of immunization with the component vaccine. The titers were less than 1.0 and 1.8 U/ml for anti-PT and anti-FHA IgG, respectively for pre-immunization, and 22 and 66 U/ml for anti-PT and anti-FHA IgG, respectively for after immunization. When children six months of age were immunized with the component vaccine, good antibody responses were seen and no significant differences of antibody response by age were observed. There were 71 children who were immunized twice with the component vaccine and were considered to be exposed to infection by household members. Nine children out of 71 had weak or typical attacks of pertussis, and the attack rate was about 13% (9/71). It was concluded that the newly developed vaccine is suitable for children with respect to immunogenicity, and it was assumed that 20 to 30 ELISA U/ml of anti-PT and anti-FHA IgG is sufficient for protection from pertussis.

Age Factors↗
PubMed1983

Reaction of convalescent bovine antisera with strain-specific antigens of parapoxviruses.

Two strains of papular stomatitis (PS) virus, 1 of milker's nodules (MN) virus and 1 of contagious ecthyma (CE) virus possessed 2 distinct external structures when examined by electron microscopy. The innermost, designated coat was closely apposed to the tubular surface, whereas the outer envelope loosely surrounded the virion. When convalescent sera from cattle infected with PS virus were used for immunoelectron microscopy, antibody reacted with coats and envelopes of the PS virus strains, but only with coats of MN and CE viruses. Convalescent sera from cattle infected with PS or MN virus contained complement-dependent antibodies cytolytic to cells infected with the homologous virus. In an indirect immunofluorescence test, the sera reacted with homologous strains to higher titers than with heterologous strains.

Animals↗
PubMed1982

Studies on Neisseria gonorrhoeae strains from test-of-cure specimens. Correlation between the in vitro susceptibility to penicillin and the sensitivity to the complement-dependent bactericidal activity of normal and convalescent human serum.

Sixty-seven out of 88 Neisseria gonorrhoeae strains isolated from test-of-cure (TOC) specimens during a five-months' period were included in the study. For 62 patients sufficient information was obtained in order to distinguish between relapse (34 ptt) and re-infection (28 ptt). For comparison with strains from these two groups of patients, 63 urogenital and 21 pharyngeal gonococcal strains isolated during the same period of time were randomly selected. The distributions according to susceptibility to penicillin for TOC strains and control strains corresponded to those found for the total number of TOC strains (275) and other strains (3,345) tested in 1979, respectively. The TOC strains did not differ from the control strains in sensitivity to the complement-dependent. The TOC strains did not differ from the control strains in sensitivity to the complement-dependent bactericidal activity of normal human serum. However, gonococcal strains less susceptible to penicillin in vitro (MIC values within the range 0.1-2.0 microgram/ml) were significantly more sensitive to the complement-dependent activity of normal human serum (P less than 0.01) than strains fully susceptible to penicillin (MIC less than 0.01 microgram/ml.) Penicillin-resistant strains (MIC greater than 2.0 microgram/ml) did not differ from strains susceptible to less than 0.1 microgram penicillin/ml and were slightly more serum-resistant than the less susceptible strains (P less than 0.05). No difference in serum-sensitivity of urogenital and pharyngeal isolates could be demonstrated. The level of bactericidal activity of homologous convalescent serum was unrelated to the presence of antibodies either to gonococcal pili or crude gonococcal antigen preparations. The sensitivity to normal human serum of a certain strain was not correlated with sensitivity to homologous convalescent serum.

Blood Bactericidal Activity↗
PubMedDate not supplied

The accuracy of esophageal pressure measurements in convalescent and sick intubated infants.

Assessment of the esophageal pressure technique for measuring dynamic lung compliance (Cdyn) showed that accurate results were obtained in only 5 of 15 studies of sick intubated infants, whereas they were obtained in 6 of 6 studies of convalescent nonintubated infants. In sick infants, inaccuracy was due to large variations in esophageal pressure change (delta Pes) at different esophageal depths and difficulties validating Pes using the occlusion test. Methods of assessing lung stiffness that depend on the measurement of esophageal pressure are unreliable and should not be used in sick intubated infants.

Bronchopulmonary Dysplasia↗
PubMed1996

Persistence of vesicular stomatitis virus New Jersey RNA in convalescent hamsters.

Persistence of vesicular stomatitis virus New Jersey (VSV-NJ) was studied in experimentally infected hamsters (Mesocricetus auratus). We used reverse transcription and nested polymerase chain reaction (RT-NPCR) to probe tissues of hamsters inoculated with VSV-NJ Hazelhurst. Viral genomic RNA was detected in the brain, cerebellum, spleen, liver, kidney, and lung 2 months after infection, but only in the central nervous system at 10 and 12 months. Viral messenger RNA was detected in the brain of one hamster at 2 months after infection. Replicative intermediate was detected in the spinal cord of one hamster at 12 months. These results suggest that VSV-RNA persists in animals for long periods following infection, disease, and convalescence. However, infectious virus was not recovered from tissues by conventional serial passages of tissue extracts in Vero cells or by cocultivation.

Animals↗
PubMed1996

Vesicular stomatitis New Jersey virus RNA persists in cattle following convalescence.

To test the hypothesis that vesicular stomatitis New Jersey virus (VSV-NJ) persists in convalescent cattle, we used explant cultures and reverse transcription nested polymerase chain reactions to probe for viral genomic, replicative intermediate, and mRNA in two cows experimentally inoculated in the tongue 5 months earlier and three cows naturally infected 4-14 months previously. Virus was not isolated from any tissues of any animal. Sequences of the viral polymerase and nucleocapsid genes were consistently identified in the tongue and lymph nodes draining the tongue of both experimentally infected animals but not in the three naturally infected animals. Replicative intermediate but not messenger RNA sequences were detected. These results showed for the first time the long term persistence of VSV-NJ RNA in its bovine host.

Animals↗
PubMed1994

Eradication of convalescent-phase Salmonella carriage in children with two oral doses of pefloxacin.

Fifteen children (age range 1.5 months to 7.2 years), who were excluded from schools or nurseries due to asymptomatic convalescent-phase non-typhoidal Salmonella carriage, received two oral doses of pefloxacin (12 mg/kg on days 1 and 4) and were examined on days 10, 30, 45 and 60. Definitive eradication was observed in 13 patients, all of whom had initial low Salmonella counts in stools and were culture-negative by day 10. In the two patients who failed to respond, the same treatment was effective when repeated 4 and 6 months later respectively. No side-effects were observed. In six other children, considered as controls, eradication by day 10 was observed in only one case after administration of amoxicillin for eight days. Two oral doses of pefloxacin could be a useful and safe means for eliminating Salmonella carriage in young children.

Administration, Oral↗
PubMed2005

[Fast-track surgery in radical retropubic prostatectomy. First experiences with a comprehensive program to enhance postoperative convalescence].

Fast-track surgery is a comprehensive program for the optimization of perioperative care in elective surgery reducing potential postoperative complications and speeding up convalescence. Recent data from randomized colon resection trials emphasize that fast-track surgery is possible in most major operations. Our initial results in radical retropubic prostatectomy fast-track surgery have been encouraging. Fast-track surgery in major urological operations needs validation using randomized trials.

Clinical Trials as Topic↗
PubMed2001

Convalescence in the first week after laparoscopic cholecystectomy: results from a detailed questionnaire on morbidity and recovery of daily activities.

BACKGROUND: The aim of this study was to evaluate postoperative morbidity and return to daily activities after laparoscopic cholecystectomy. METHODS: Thirty-five patients were asked to keep daily detailed structured diaries for 1 week. RESULTS: Half of the patients were discharged from hospital on the 1st postoperative day (POD1); another third were released on POD2. Distressing pain subsided on POD2, but disturbing pain occurred in 10% of the patients on POD5-7. On POD7, mild pain at rest appeared in 30% of the patients and when moving in 60% of them. Although pain was the most common complaint, the mean consumption of analgesics was low. Even though one-fifth of the patients felt nauseated on POD2-3, and one-seventh again as late as POD7, drinking and eating did not pose problems. At the end of the week, one-third of the subjects experienced slight disorders in night rest and vigilance. Moving and walking were disturbed in one-third of the patients, and bending over and lifting objects were relatively difficult for 60% of the patients on POD7. Thirty percent of the 21 patients who were employed reported that they were capable of returning to work on POD7. CONCLUSION: To account for the variability in the rate of convalescence, the length of sick leave after laparoscopic cholecystectomy should be individualized.

Adult↗
PubMed1994

Plasma neuropeptide Y levels in the acute and early convalescent phase after myocardial infarction.

The sympathetic nervous system is activated in acute myocardial infarction (MI). Scarce data exist, however, regarding the release of the sympathetic cotransmitter neuropeptide Y (NPY) during the acute and early convalescent phases after acute MI. Plasma NPY determination was obtained on days 1 and 3 after admission from 47 patients with acute MI and from eight control patients with acute chest pain without MI. Samples were also obtained on day 30 from the 39 survivors from the original MI cohort. Plasma NPY peaked on day 3 in the MI group (day 1: mean = 46.0 pmol/L, SEM = 6.4 pmol/L; day 3: mean = 60.8 pmol/L, SEM = 5.7 pmol/L; day 30: mean = 27.2 pmol/L, SEM = 4.1 pmol/L; days 1 to 3: p = 0.002; days 3 to 30: p < 0.001), whereas in the control group a nonsignificant decrease from day 1 (mean = 42.6 pmol/L, SEM = 12.3 pmol/L) to day 3 (mean = 34.0 pmol/L, SEM = 5.6 pmol/L) was observed. Plasma NPY levels were significantly increased in patients with MI on day 3 (p = 0.044), but not at baseline compared with the control group. No significant association between plasma NPY and plasma catecholamines, clinical heart failure, or 1-month survival was evident. These results suggest that increased plasma levels of the vasoconstrictory and cardiodepressant sympathetic neurotransmitter NPY are present in the recovery phase of MI, but with a plasma profile distinct from that of catecholamines.

Age Factors↗
PubMed1989

Cerebrospinal fluid autoantibodies to myelin basic protein in multiple sclerosis patients. Detection during first exacerbations and kinetics of acute relapses and subsequent convalescent phases.

In order to determine if free (F) and bound (B) levels of autoantibodies to myelin basic protein (anti-MBP) are present from the onset of multiple sclerosis (MS), 201 patients referred to our clinic were clinically divided into a group diagnosed as having an initial MS relapse and a group of non-MS controls. Ninety-four of 106 patients thought to have an initial MS relapse had increased CSF anti-MBP, while only 14 of 95 controls had elevated antibody levels; 9 of these 14 positive controls were subsequently shown to have MS by magnetic resonance imaging and/or clinical follow-up. CSF anti-MBP was more frequently abnormal than 3 estimates of intrathecal IgG synthesis in the group with suspected MS. Kinetics of F and B CSF anti-MBP were determined in a group of 29 patients with clinically definite MS during an acute relapse and 97.4 +/- 54 days later in the subsequent convalescent phase when in clinical remission. F and B anti-MBP levels were highly dependent on the timing of the CSF sampling; generally, as patients entered into clinical remission F anti-MBP declined, B antibody levels rose and F/B anti-MBP ratios initially above unity gradually declined towards zero. These data suggest that anti-MBP may be involved in the mechanism of MS.

Acute Disease↗
PubMed1984

Virologic, immunologic, and clinical observations on a patient during the incubation, acute, and convalescent phases of infectious mononucleosis.

One patient with infectious mononucleosis (IM) was studied from the probable time of Epstein-Barr virus (EBV) infection (38 days before the onset of clinically overt disease), during the incubation and acute phases, until 6 months after clinical remission. Analysis of spontaneous outgrowth of EBV-carrying lymphoblastoid cells, by limiting dilution on feeder layer cultures, showed that virus containing B lymphocytes are already present early during the incubation period. Also low interferon serum levels were detected early after infection, and only before the onset of clinical disease. All other studied clinical laboratory and virus-associated variables were within normal range during the incubation phase, but changed to a pattern characteristic of IM in parallel to the clinical symptoms. During the acute disease EBV-associated nuclear antigen (EBNA)-positive cells could be directly detected among the lymphocytes, and antibodies to EBV antigens appeared. Lymphocytes stained by monoclonal antibodies, detecting Ia-like determinants (activated cells) and suppressor cells, increased dramatically, in parallel to a strong increase of functional suppressor cell activity, measured by inhibition of blastogenesis and PWM-induced immunoglobulin production. During the acute phase there was also a decrease of spontaneous cytotoxicity against the NK-sensitive cell line K562, while cytotoxicity (spontaneous) against an autologous EBV-positive lymphoblastoid cell line (LCL) was detected only during this phase. These reactions correlated to the presence of blasts, and the autologous reaction was exerted mainly by Fc-receptor-negative cells. Lymphokine production in response to EBV antigens was also initiated during the acute phase. During the convalescence period the serological and cellular immune parameters adjusted to the pattern of a normal EBV-seropositive person.

Adolescent↗
PubMed2006

Development of a clinical pathway for near-term and convalescing premature infants in a Level II nursery.

A subcategory of premature infants, those born near term at 34 to 36 and 6/7 weeks gestation, may represent a previously unrecognized at-risk neonatal population. Evidence-based practice guidelines, crafted specifically for this population, are needed to effectively manage their care. In an effort to meet the needs of the near-term infant (NTI) population, and concurrently address the needs of the convalescing premature infants reverse transported to a Level II nursery setting, a multidisciplinary team of clinicians designed tools to provide a more consistent approach to care for and discharge these infants. This article describes the design, implementation, and evaluation of an evidence-based multidisciplinary clinical pathway specific to the needs of the NTI, including care plans, a standardized physician admission and discharge order set, evidence-based interventions, parent education, and recommendations for follow-up after hospital discharge that were developed for use in a Level II nursery. The use of the premature and near-term infant pathway has now been expanded to NTIs cared for in the newborn nursery, thereby ensuring safe, consistent, quality care for this population, regardless of their setting.

Bottle Feeding↗
PubMed2004

Previous cognitive impairment and failure to thrive syndrome in patients who died in a geriatric convalescence hospitalization unit.

Cognitive impairment and depression are commonly associated with poor outcomes in geriatric patients. Both are part of the "failure to thrive syndrome" (FTS), that is a combined group of symptoms as a result from progressive functional, mental and nutritional impairment status in older patients. This paper was aimed at evaluating the presence of FTS in the patients who died in a geriatric convalescence unit (GCU) (intermediate care facility) and comparing the characteristics of patients with primary FTS (not associated with an evident identifiable disease) and secondary FTS (associated with an evident identifiable disease). Finally, we wanted to analyze if the presence of cognitive impairment before admission was associated with the type of FTS. We analyzed 78 patients retrospectively. The presence of the next three conditions was necessary to define the FTS: (i) Impaired functional status and malnutrition. (ii) Cognitive impairment and/or depression. (iii) Absence of improvement, after a specific geriatric intervention program during the hospitalization. Functional status for basic and instrumental activities of daily living (ADL and IADL) and the presence of symptoms cognitive impairment before admission were evaluated. Of the 78 analyzed patients, there were 30 (38.4%) with symptoms of FTS. Seventeen of them (56.6%) had a secondary FTS and 13 (43.3%) a primary one. This last group of patients had a significantly higher mean age (84.7 +/- 5.8 vs. 78.6 +/- 7.2; p < 0.02) and before admission they were significantly more dependent for ADL: 10 patients (76.9%) vs. 7 (41.0%) chi2 = 3.833, p < 0.05. A higher proportion of subjects with cognitive impairment before admission was found in the group of patients with primary FTS, than in those secondary FTS, although this difference did not reach statistical significance. Patients with primary FTS seem to be older and more dependent for ADL before admission, than those with secondary FTS.

Aged↗
PubMed2004

Evaluation of functional improvement in older patients with cognitive impairment, depression and/or delirium admitted to a geriatric convalescence hospitalization unit.

Cognitive impairment, depression and delirium are problems of high prevalence in older patients. The geriatric convalescence unit (GCU) is a hospitalization facility offering an interdisciplinary geriatric intervention program that may be more appropriate for these patients. This study intended to analyze the functional improvement (FI) in older patients with cognitive impairment, depression and/or delirium admitted to a GCU. A group of 107 patients received specific nurse care, habitually performed in GCU and they also were included in a rehabilitation program. Cognitive impairment, depression and delirium were diagnosed according to standardized protocols. The analyzed variables were: age, functional status (Barthel index) before admission (BBA), at admission (BA) and at discharge(BD), diagnostic categories, cognitive function (mini mental state examination: MMSE) and post-discharge destination. The corrected Heinemann index (CHI) was used to evaluate FI obtained during GCU-stay, where CHI = 100 x (BD-BA)/(BBA-BA), and the efficiency index(El) was used to analyze the relationship between FI and the length of stay in the GCU,where El = (BD-BA)/(days in GCU). According to CHI, patients were divided in three groups. Group I: CHI = 0 or negative (patients who lost functional capacity during hospitalization,those who died or were transferred to hospital owing to acute deterioration. Group II: CHI < 35 % (high FI). Mean age was 77.6 +/- 9.1 years, the diagnostic categories were: fractures/orthopedics 49 (45.7 %), neurological 27(25.2 %), pulmonary/cardiologic 6 (5.6 %) and other cases 25 (23.3 %). Mean MMSE and BA scores were 16.9 +/- 9.4 and 29.6 +/- 18.9, respectively. Post-discharge destinations were:63 patients (58.8 %) returned home, 28 (26.1 %) were definitively institutionalized, 11 (10.2%) died and finally 5 (4.6 %) were transferred to acute care hospital. In-Group I, there were 35 patients (32.7 %) with a mean value of the El = 0.12 +/-1.1; in Group II, 13 (12.1 %) and 0.26 +/- 0.38; in Group III, 59 (55.1 %) and 0.94 +/- 0.97, respectively. In spite of the presence of cognitive impairment, depression and/or delirium, a high proportion of patients (67.2 %)obtained a significant improvement in their functional capacity.35 % (moderate FI). Group III: CHI >/=

Aged↗
PubMed2004

Prevalence of delirium in a geriatric convalescence hospitalization unit: patient's clinical characteristics and risk precipitating factor analysis.

The aim was to evaluate the prevalence of delirium among patients discharged from an acute care hospital and admitted to a geriatric convalescence unit (GCU), and to analyze patient's characteristics and risk precipitating factors. Sixty-eight patients were analyzed during a 2-week period. The confusion assessment method (CAM) was used to detect delirium. The precipitating factors evaluated were: major surgery-intensive care unit(ICU) stay, pulmonary and heart failure, acute infections, metabolic disorders/anemia,psychoactive medications, other drugs, severe pain, changing environmental influences and others. According to CAM, fifteen patients presented delirium (22%), and in 14 of them(93.3 %) the delirium was developed before admission at GCU. The precipitating factors in the studied population were the following: changing environmental influences in 66 patients(97%) (15 with delirium and 51 without delirium); other drugs 56 (82.3 %) (11 vs. 45);others 56 (82.3%) (9 vs. 24); psychoactive medications 50 (73.5%) (12 vs. 38); acute infections 48 (70.5 %) (13 vs. 35); metabolic disorders/anemia 40 (58.8 %) (9 vs. 31); major surgery-ICU stay 28 (41 .1%) (8 vs. 20); severe pain 26 (38.2%) (6 vs. 20); pulmonary and heart failure 22 (32.3%) (5 vs. 17). The univariant analysis showed that, none of the precipitating factors studied was significantly related to delirium. Seventy-two patients (91.1%) had simultaneously >3 precipitating factors. There were 16 patients with >6 precipitating factors, 7 of 15 with delirium and 9 of the 53 without delirium (46.6 % vs 16.9 %) (p < 0.05). The prevalence of delirium has been 22 %. Most of the patients had developed delirium before the admission at GCU. A high proportion of patients had >3 precipitating factors. In the study the presence of > 6 precipitating factors simultaneously has been significantly related to delirium.

Aged↗