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PubMed1982

His-bundle electrogram in the convalescent stage of inferior myocardial infarction complicated with complete A-V block.

Twelve patients with inferior wall myocardial infarction complicated with complete atrioventricular block during the acute stage were studied. The His-bundle electrogram was studied in the convalescent stage at an average of 6 months after the acute attack. The age of the patients was 62 +/- 16 years. The width of the QRS complex was within the normal range and the PR interval was less than 200 msec. AH time was 74 +/- 18 msec (mean +/- SD). No split H activity was observed. HV time however, was significantly prolonged in the 12 patients; 54 +/- 12 msec vs. 42 +/- 9 msec in the control group (p less than 0.02). Five patients had HV time equal to or more than 60 msec. Intra-His block was suggested to exist in a high frequency in the patients who had previous complete AV block during the acute stage of myocardial infarction of the inferior wall.

Blood Pressure↗
PubMed2003

Development and validation of an instrument to predict probability of home discharge from a geriatric convalescence unit in Spain.

OBJECTIVES: To develop and validate an instrument to predict probability of home discharge upon hospital admission. DESIGN: Prospective cohort study. SETTING: Geriatric convalescence unit (GCU) in Spain. PARTICIPANTS: Seven hundred eighty-one patients aged 65 and older consecutively admitted to a GCU over a 4-year period. The total sample was randomized and divided into two subgroups; the first (n = 575) was used to construct the predictive instrument (development subgroup) and the second (n = 206) for the validation process (validation subgroup). MEASUREMENTS: All patients were evaluated within the first 72 hours after admission. Age, sex, functional status before admission, diagnostic categories, functional status on admission, comorbidity, cognitive function, and social support were assessed. RESULTS: Logistic regression analysis identified three patient characteristics as independent predictors of home discharge in the development subgroup: higher scores on functional status at admission (Barthel index), normal Mini-Mental State Examination scores, and lower scores on Social Familial Evaluation Scale. A scoring system ranging from 0 to 5 was constructed using these variables to predict probability of home discharge (PHD). Different PHD scores (0-1, 2, 3, 4, and 5) identified patients with different probabilities of returning home on discharge in the validation subgroup (36.5%, 53.6%, 60.8%, 83.3%, and 100%, respectively). PHD scores of 4 and 5 demonstrated substantially higher posttest than pretest probability, with moderate and high clinical effect value. Scores of 0 or 1 demonstrated substantially lower posttest than pretest probability. CONCLUSION: A PHD instrument may be useful in identifying patients most likely to be discharged to home from the GCU. Patients with low probability of home discharge may also be identified early.

Aged↗
PubMed2003

Phagocytosis of Bordetella pertussis incubated with convalescent serum.

Convalescent serum samples were examined for the ability to promote phagocytosis of Bordetella pertussis by human neutrophils. One sample promoted phagocytosis, and 11 of the 51 samples caused a statistically significant reduction in phagocytosis, compared with that of bacteria not incubated with serum. Phagocytosis was influenced by interactions between antibodies that promoted phagocytosis and antibodies that inhibited phagocytosis. Adenylate cyclase toxin (ACT) has been shown to block phagocytosis by neutrophils. Antibodies to ACT were removed from the sample that promoted phagocytosis, by incubation with ACT-coated paramagnetic beads, and the depleted serum no longer enhanced phagocytosis. The adhesin filamentous hemagglutinin (FHA) has been shown to mediate attachment of B. pertussis to neutrophils in a way that promotes phagocytosis. Depletion of antibodies to FHA from samples that blocked phagocytosis improved phagocytosis, compared with the no-antibody control. These results suggest that antibodies to ACT can promote phagocytosis, whereas antibodies to FHA can counteract beneficial opsonins.

Adenylate Cyclase Toxin↗
PubMed1994

A two-centre, randomized, double-blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects.

In a double-blind trial, 194 ambulatory elderly patients (mean age, 74 +/- 8 years) recovering from acute illnesses were randomly assigned to receive either ornithine oxoglutarate (OGO) or a placebo. Nine subjects withdrew during the study, six in the OGO group and three in the placebo group. OGO and the placebo were administered once daily at a dose of 10 g after lunch for 2 months; the patients were monitored for a total of 4 months. Efficacy was evaluated in terms of nutritional variables, quality of life and total cost of medical treatment. The analysis involved a total of 185 patients (93 in the placebo group and 92 in the OGO group). The two groups were comparable at inclusion. After 30 and 60 days of treatment, there was a significant improvement in the following variables in the OGO group relative to the placebo group: appetite (p < 0.001), body weight (p < 0.001) and independence (p < 0.01). Two months after the end of treatment, there was still a significant improvement in the quality-of-life index (p < 0.001) and the medical-cost index (p < 0.03) in the OGO group, with an overall cost saving of 37%. We conclude that OGO seems to be a cost-effective nutritional supplement for elderly convalescent patients.

Activities of Daily Living↗
PubMed1976

Evaluation of isoosmotic tube feeding formula in the diets of convalescent malnourished infants and children.

The quality of the protein in a complete tube feeding formula intended for use in adults was evaluated in convalescent malnourished children. The casein-soy protein isolate blend was found to be similar to casein by comparative nitrogen balance studies carried out in five children, with protein providing 6.4% of calories. Three- and four-hour postprandial plasma free amino acid determinations at the same level of protein intake did not show the drop of plasma free methionine or of the methionine/total essential amino acid molar fraction characteristically seen when this amino acid is first limiting for protein synthesis. Three additional children were fed the formula, altered only by the addition of water, for periods of up to 3.6 months to test the tolerance to and completeness of the diet. No untoward effects nor signs of specific nutrient deficiency were encountered. Linear growth was appropriate for the stage of recuperation. The failure to achieve a normal (greater than 3.8 g/dl) serum albumin concentration in two of the three children may have been due to their rapid weight gain. Although it is intended for the adult, our results indicate that the formula could meet the nutritional requirements of infants and children.

Amino Acids↗
PubMed2001

Pathogenicity and convalescent excretion of Campylobacter in rural Egyptian children.

Campylobacter infection in developing countries has not received much public health attention because of the observation that infections are not associated with disease beyond the first 6 months of life. A cohort of 397 Egyptian children aged less than 3 years, who were observed twice weekly during 1995--1998, experienced an incidence of 0.6 episodes of Campylobacter diarrhea per child-year. A total of 13% of the Campylobacter diarrheal episodes were characterized by severe dehydration. Age-specific incidence rates (episodes per year) were 0.9 in infants aged less than 6 months, 1.5 in those 6--12 months, and 0.4 and 0.2 in the second and third years of life, respectively. Convalescent excretion of Campylobacter after a diarrheal episode might be enhancing transmission and contributing to this high incidence. Observed risk factors for Campylobacter diarrhea were poor hygienic conditions and the presence of animals in the house. Regardless of the child's age, a first infection by Campylobacter was associated with diarrhea (odds ratio = 2.45; 95% confidence interval: 1.61, 3.71); however, subsequent infections were associated with diarrhea only in children aged less than 6 months. This observation that natural infection did not confer protection during the first 6 months of life poses a challenge to vaccine development.

Age Distribution↗
PubMed1981

A 27-nm virus isolated during an outbreak of acute infectious nonbacterial gastroenteritis in a convalescent hospital: a possible new serotype.

An outbreak of acute infectious nonbacterial gastroenteritis began among elderly patients in a convalescent hospital in Marin County in northern California in March 1978 and persisted through May 1978. The overall clinical attack rate was 51% of 187 residents and 12% of 180 employees. A 27-nm viruslike particle was observed by immune electron microscopy in stools obtained at or near the onset of illness from four of 32 patients. Seroresponses to the 27-nm particles were found by immune electron microscopy in 16 of 18 patients. In addition, serologic evidence of infection with this or a related agent was demonstrated in persons who developed illness in another large outbreak of acute infectious nonbacterial gastroenteritis which occurred in a nearby county. This agent is morphologically similar to but serologically unrelated to the Norwalk and Hawaii gastroenteritis agents and has been designated the Marin agent pending further classification.

Acute Disease↗
PubMedDate not supplied

Does inhalation injury limit exercise endurance in children convalescing from thermal injury?

The cardiopulmonary performance levels in children who are convalescing from thermal injury are unknown. This investigation was designed to evaluate cardiopulmonary function in children with and without inhalation injury. Forty children with a mean time since burn injury of 2.6 +/- 1.9 years and a mean burn size of 44% +/- 22% total body surface area were selected for the study and divided into two groups: inhalation injury (group 1) and non-inhalation injury (group 2). Pulmonary function studies and cardiopulmonary stress testing were completed on all patients. Both groups reached the same endurance level on the treadmill; however, patients in group 1 did so with an increased expired volume, respiratory rate, and ratio of dead space ventilation to total ventilation which indicated that there were greater demands on the respiratory system. Spirometry and lung volumes at rest showed that 64% of patients in group 1 had abnormal lung function compared with only 27% of patients in group 2.

Adolescent↗
PubMed2004

Evaluation of the built environment at a children's convalescent hospital: development of the Pediatric Quality of Life Inventory parent and staff satisfaction measures for pediatric health care facilities.

In preparation for the design, construction, and postoccupancy evaluation of a new Children's Convalescent Hospital, focus groups were conducted and measurement instruments were developed to quantify and characterize parent and staff satisfaction with the built environment of the existing pediatric health care facility, a 30-year-old, 59-bed, long-term, skilled nursing facility dedicated to the care of medically fragile children with complex chronic conditions. The measurement instruments were designed in close collaboration with parents, staff, and senior management involved with the existing and planned facility. The objectives of the study were to develop pediatric measurement instruments that measured the following: (1) parent and staff satisfaction with the built environment of the existing pediatric health care facility, (2) parent satisfaction with the health care services provided to their child, and (3) staff satisfaction with their coworker relationships. The newly developed Pediatric Quality of Life Inventory scales demonstrated internal consistency reliability (average alpha = 0.92 parent report, 0.93 staff report) and initial construct validity. As anticipated, parents and staff were not satisfied with the existing facility, providing detailed qualitative and quantitative data input to the design of the planned facility and a baseline for postoccupancy evaluation of the new facility. Consistent with the a priori hypotheses, higher parent satisfaction with the built environment structure and aesthetics was associated with higher parent satisfaction with health care services (r =.54, p <.01; r =.59, p <.01, respectively). Higher staff satisfaction with the built environment structure and aesthetics was associated with higher coworker relationship satisfaction (r =.53; p <.001; r =.51; p <.01, respectively). The implications of the findings for the architectural design and evaluation of pediatric health care facilities are discussed.

Attitude of Health Personnel↗
PubMed2001

Convalescent phase outpatient parenteral antiinfective therapy for children with complicated appendicitis.

BACKGROUND: Children with a perforated or gangrenous appendix become clinically stable after medical and/or surgical therapy but often remain in the hospital solely to complete parenteral antibiotic therapy. This prospective study investigates the outcomes when children who meet specified criteria are discharged to complete parenteral antibiotic therapy at home. METHODS: Children age 1 to 17 years with appendicitis complicated by generalized peritonitis or intraabdominal abscess were eligible to participate. Subjects whose fever was decreasing, who were able to tolerate oral liquids and for whom further parenteral antibiotic therapy was deemed necessary were discharged from the hospital to receive outpatient parenteral antiinfective therapy (OPAT) with meropenem. Therapy was administered by a family member and supervised by home care nurses. Study personnel visited the home daily to collect data on adverse events, compliance and resource utilization. Pa tients served as their own controls in models of reduced hospitalization and net cost savings. RESULTS: Discharged on average on the fourth postoperative day, 87 children received 4.5 +/- 2.1 days of OPAT. Six (7%) children were subsequently readmitted for complications including bowel obstruction (4 children), intraabdominal abscess (1 child) and pleural effusion (1 child). Another child developed a viral syndrome during OPAT. All other patients recovered uneventfully. Six (7%) children discontinued meropenem prematurely because of rash (4 patients) or diarrhea (2 patients). According to models in which each day of OPAT replaced a day of inpatient care, discharge to OPAT reduced hospitalization by 42 +/- 15% and saved a median of $2908 (10th to 90th percentile range, $1,077 to $4,707) per patient. CONCLUSION: Convalescent phase OPAT is a cost-effective alternative to continued hospitalization for children with complicated appendicitis who are clinically stable yet require further parenteral antibiotic therapy.

Abdominal Abscess↗
PubMed2003

Mother-daughter relationships expressed in the food context of postpartum convalescence --- findings from a preliminary study.

The aim of this study was to explore mother-daughter interaction as represented by provision of food during the traditional month-long postpartum convalescence. The clinical field research method was employed. A convenience sample of three pairs of mothers and postpartum daughters were recruited from a medical center. Data from recorded interviews were analyzed. Content analysis was applied to analyze the interaction between the mothers and daughters. The study demonstrated that the mothers exhibited caring behavior toward their daughters during this period. The postpartum daughters reacted to their mothers with approach, nostalgia, and appreciation behaviors. The results of this study deserve the cognitive recognition of nurses, so that they can be aware of and respect the indigenous beliefs and practices that link the events of childbearing, the health status of women, and family relationships especially between the woman and her own mother in order to provide better maternity care for postpartum women.

Adult↗
PubMed1992

Heterogeneity of linear B cell epitopes of the measles virus fusion protein reacting with late convalescent sera.

B cell epitopes of the measles virus fusion protein were mapped, by reacting sera from late convalescent donors with synthetic overlapping pentadecapeptides, segments covering the whole F protein sequence. Unselected individual sera recognized 7 to 20% of the total sequence. Cumulation of the binding patterns of 30 sera identified eight to 10 clusters of antibody-binding peptides spread over most of the sequence. The B cell epitopes included regions of transition between the more hydropathic (including the N-terminal end of the F1 and F2 protein) and hydrophilic sequences. When the regions of antibody binding were compared with the predicted secondary structure of the F protein, no detectable pattern became apparent. Exposed sequences as well as sequences hidden in the viral membrane or in the protein core of both the F1 and F2 polypeptides were recognized by the antibodies. The heterogeneity of the binding patterns was not merely dependent on the anti-measles virus titre. The importance of antibodies recognizing linear epitopes of the measles virus fusion protein for the immune protection is presently not known.

Adult↗
PubMed2003

Identification of a novel antigen of pathogenic Leptospira spp. that reacted with convalescent mice sera.

The virulence of leptospires isolated from human patients against C3H/HeJ mice was investigated. Infection with clinical isolates from patients with severe leptospirosis was lethal to C3H/HeJ mice, suggesting that C3H/HeJ mice are suitable as an acute lethal model of severe leptospirosis. Using this model, a novel antigen of pathogenic Leptospira spp. (named LAg42), which reacted with convalescent mice sera, was identified. LAg42 is a 42 kDa inner-membrane protein and its immunogenic region is located in the C-terminal region. The gene for LAg42 is conserved among pathogenic leptospires but not among non-pathogenic leptospires, which suggests its involvement in virulence.

Animals↗
PubMed1972

Comparison of fluorescent antibody induced by rubella virus in vaccinee and convalescent individuals.

Specific rubella antibody detectable by indirect immunofluorescence developed in response to immunization with attenuated rubella vaccine, HPV-77, DK-12. Fluorescent antibody (FA) was found when vaccinee sera were reacted with antigens synthesized in three different acutely infected continuous cell lines: BHK-21, LLCMK-2, and RK-13. FA titers were high, and they correlated with antibody titers obtained by hemagglutination-inhibition tests. Levels of FA in vaccinated individuals were slightly lower than those found in persons recovered from natural rubella infections. Rubella FA persists a long time in convalescent individuals and appears to be maintained for at least 19 months in vaccinees.

Animals↗
PubMed2000

Detection of 23 immunogenic pneumococcal proteins using convalescent-phase serum.

A genomic expression library of Streptococcus pneumoniae was screened with a convalescent-phase serum for immunoreactive proteins. Six known and 17 unknown pneumococcal proteins were detected. Five of the known proteins were surface-located virulence factors, and eight of the unknown proteins were putative membrane proteins.

Antibodies, Bacterial↗
PubMed2002

Reactivity of convalescent-phase hemolytic-uremic syndrome patient sera with the megaplasmid-encoded TagA protein of Shiga toxigenic Escherichia coli O157.

A cosmid library of Shiga toxigenic Escherichia coli (STEC) O157:H7 strain EDL933 DNA was screened for clones capable of reacting with convalescent-phase serum from a patient with hemolytic-uremic syndrome (HUS), in an attempt to identify candidate virulence genes. One of the immunoreactive clones contained a portion of the large plasmid pO157, and the immunoreactive gene product was identified as TagA. The function of this 898-amino-acid protein is unknown, but it exhibits 42% amino acid sequence identity and 63% similarity to a 312-amino-acid region of a ToxR-regulated lipoprotein of Vibrio cholerae. Antibodies to E. coli O157 TagA were detected in sera from other HUS patients with O157 STEC infection but not in those from patients whose illnesses were caused by other STEC types or in healthy controls. These data demonstrate that TagA is expressed in vivo and provide circumstantial evidence for a role in the pathogenesis of the disease. The tagA gene is present only in STEC strains belonging to serogroup O157, and so antibodies to TagA are a potentially useful serological marker for infections due to such strains.

Antibodies, Bacterial↗
PubMed1982

Training for independent living unit: its function in a rehabilitation convalescent setting.

This article describes a Geriatric Self-Care Unit in a 92 bed Rehabilitation Convalescent Hospital. Ten beds are set aside for this unit. The overall goal of the Self Care Unit (S.C.U.) is to facilitate the patients' discharge into the community. This pilot project has been in effect for six months with 47 patients having completed the program. Results of the program, its problem areas and progress are outlined.

Activities of Daily Living↗
PubMed2000

Oral absorption of clarithromycin in acute illness and during convalescence in patients with community-acquired pneumonia.

STUDY OBJECTIVE: To compare the extent of oral clarithromycin absorption in patients during an illness and in health. DESIGN: Sequential two-phase prospective study including an acutely ill pneumonia phase (PP) and a subsequent convalescent phase (CP). STUDY POPULATION: Patients >/= 18 years old with radiographically confirmed community-acquired pneumonia (CAP) who were admitted to the hospital. METHODS: During both study phases, patients received one single 500-mg dose of oral clarithromycin. Serial blood samples were drawn over a 24-h period in order to characterize the plasma concentration-time curves. Area under the curve from zero to 24 h (AUC(0-24)), maximum plasma concentration (Cmax), and time to maximum concentration (Tmax) were determined for both clarithromycin and its metabolite, 14-hydroxyclarithromycin, and compared between the two phases. RESULTS: Twelve patients completed both phases of the study. For clarithromycin, there was a significant increase AUC(0-24) (47.37 +/- 8.51 microg/h/mL vs 36.22 +/- 6.09 microg/h/mL) in favor of the PP. There were no significant differences detected with respect to Cmax (4.32 +/- 0.63 microg/mL vs 3.57 +/- 0.46 microg/mL), or Tmax (3.50 +/- 0.50 h vs 2.83 +/- 0.59 h) between PP and CP. For 14-hydroxyclarithromycin, the AUC(0-24) and Cmax were significantly higher (5.84 +/- 1.08 microg/h/mL vs 8.84 +/- 1.92 microg/h/mL; 0.42 +/- 0.08 microg/mL vs 0.76 +/- 0.23 microg/mL) in the CP as compared to the PP. Tmax remained unchanged. CONCLUSION: The extent of absorption of oral clarithromycin was not diminished during an acute illness with CAP.

Absorption↗