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PubMed1997

[Factors associated with convalescence and role reprisal in women after a coronary artery bypass].

The goal of this study was to describe how psychosocial, cultural, and sociodemographic factors influence the convalescent phase of women who have had an aorto coronary bypass graft (CABG) and to explore the relationship between those factors, the perception of health, and the recovery process. The women participating in this study were recruited during the preoperative period and contacted during the 9th and 12th week post surgery. It was observed that these women had psychosocial difficulties in the preoperative period. The study results demonstrated that some of those factors were influencing their health perception during the preoperative period. There did not appear to be any relation between their health perception and their recovery. Additional analysis demonstrated that their health perception in the postoperative period was better than during the preoperative period, and that their status improved according to the New York Heart Association Classification. Recommendations for future research and nursing practice are proposed.

Adaptation, Psychological↗
PubMedDate not supplied

[Sexual activity in the convalescent from acute myocardial infarct. Bibliographic review].

There is little information in the medical literature about the renewal of sexual activity in patients who have suffered an MI. The knowledge which the internist and the cardiologist have are normally insufficient. The equivalents in energetic cost of a sexual relation of a middle aged adult, are similar to those of: a) a simple Master test of two stairs, b) walking rapidly the length of a street, c) climbing two flights of stairs. d) a test with ergometer to 100 watts or 600 kg-m-m, e) to walk the endles band at 3.5 miles/hour, f) to carry out activities equivalent to 6 cal/min. The average of the maximum cardiac frequency which is reached during coitus is from 115 to 120, equivalent to approximately 4-5 mets., during 20-36 seconds. In the post and preorgasmic period (1 min, before and after) the energetic cost is close to 4 mts. It should be emphasized that there should not exist an exact limit after which the patient who has had an MI is permitted to have sexual relations. The sexual activity should be advised if the patient has satisfactorily passed any of the equivalent tests mentioned above. The cardiologist should know these facts and not wait until the patient asks about them; he should have the initiative to openly discuss them with the patient and his partner from the period interhospitalary convalescence of the MI.

Adult↗
PubMedDate not supplied

[The effect of rehabilitative treatment on left ventricular performance in myocardial infarct patients in the convalescent phase].

There have been studied the left ventricular performance at 71 patients (66 B/5 F) with myocardial infarction during the convalescence period, admitted in the Department of Clinical Rehabilitation in a period of time between 01.01.1992-31.10.1993. Mean age was 49.9 +/- 4.3 years. Most of the patients had antero-septal (33 patients--46%) and posteroinferior (29 patients--41%) myocardial infarction. The left ventricular performance was assessed by the study of exercise electrocardiography (TTI), of the systolic intervals using the Weissler equations and echocardiography (M-mode and 2D). After the period pf training (21 days), we saw a significant reduction of TTI at the same step of the test. The systolic intervals significantly modified after the training were PEVS (p < 0.025), PEP/PEVS (p < 0.025), EF (p < 0.025). EF and SF measured echographically do not indicate significant differences after the training. There are not important improvements of the wall motion disorders at the end of the period.

Adult↗
PubMed2003

Heart rate variability in early phase of acute myocardial infarction and convalescence.

OBJECTIVE: This study was done to evaluate the degree of change in autonomic activity, manifested as heart rate variability (HRV), from acute phase of MI to convalescent period of AMI. DESIGN: Single center, observational prospective study. PLACE AND DURATION OF STUDY: Department of Cardiology, Shaikh Zayed Hospital, Lahore. The study was completed in one year from June 2000 to July 2001. SUBJECTS AND METHODS: Thirty consecutive patients presenting within 24 hours of an ST segment elevation AMI with or without thrombolysis were included. First 24 hour Holter recording was done within 24-36 hours after AMI and the second was done before discharge. RESULTS: The mean hospital stay was 7.07 +/- 2.56 days. Mean duration between the two recordings was 5.47 +/- 2.36 days. The mean standard deviation of normal sinus interval (SDNN) was 65.07 +/- 25.11msec & 63-97 +/- 23.38msec; mean standard deviation of averaged sinus beats for 5 minutes segments of entire recording (SDANN) was 51.27 +/- 18.57msec and 55.83 +/- 19.65msec and mean SDDN index was 34.57 +/- 17.15msec and 30.57 +/- 14.89msec during early phase of acute MI & pre-discharge recordings respectively. There was no statistically significant difference in HRV between early phase of acute myocardial infarction and of pre-discharge recordings. CONCLUSION: HRV may be monitored for risk stratification at any time post AMI prior to discharge.

Death, Sudden, Cardiac↗
PubMed1998

Estimated susceptibility to asymptomatic secondary immune response against measles in late convalescent and vaccinated persons.

Serological evidence indicates that measles virus (MV) could circulate in seropositive, fully protected populations. Among individuals fully protected against disease, those prone to asymptomatic secondary immune response are the most likely to support subclinical MV transmission. The serological characteristics of protected subjects who developed secondary immune response after reexposure to measles have been described recently [Huiss et al. (1997): Clinical and Experimental Immunology 109:416-420]. On the basis of these data, a threshold of susceptibility was defined to estimate frequencies of secondary immune response competence in different populations. Among measles, late convalescent adults (n = 277) and vaccinated high school children (n = 368), 3.2-3.9% and 22.2-33.2%, respectively, were considered susceptible to secondary immune response. A second vaccination did not seem to lower this incidence. Even when estimates of symptomatic secondary immune response (e.g., secondary vaccine failure) were taken into account, susceptibility to subclinical secondary immune response was still 5-8 times higher after vaccination than after natural infection. Although viral transmission between protected individuals has never been directly demonstrated, the data describe a population in which protected but infectious persons could potentially be of epidemiological importance.

Adolescent↗
PubMed1999

[Coping and convalescence course after lumbar disk operations].

BACKGROUND: Aim of the present prospective longitudinal study was the statistical foundation and thus further replication of recent findings of Hasenbring [13], who postulated a significant importance of specific, within the psychological pain research long neglected pain coping strategies as risk factors concerning pain chronification: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. METHODS: In contrast to Hasenbring's heterogeneous chronic pain patients sample (first plus repeated surgical or conservative treatment) the present 82 low back pain patients with acute radicular pain and simultaneous lumbar disc prolapse all underwent first time lumbar nucleotomy. Prior to treatment we conducted an extensive psychological and neurological examination. The psychological tests included a general depression scale (Allgemeine Depressionsskala; ADS) and the Kiel Pain Inventory (KPI). Based on these scales a cluster analysis was performed, which allocated patients to four distinct groups resembling the group structure ascertained by Hasenbring [12, 13]: A first group of patients characterized by a positive mood and marked endurance strategies (n=7); another cluster with depressive mood and simultaneous cognitive appeals to stick it out (n=10); a third group of emotionally depressed patients who preferably applied social and physical avoidance strategies in their coping with chronic pain (n=29), plus a last cluster without any psychological risk factors (n=26). RESULTS: As treatment outcome criteria to evaluate the quality of the convalescence process six months later we assessed the pain intensity (11-point self-rating scale), the ability to work, and whether the patients had applied for early retirement or not. Results showed no significant differences in pain intensity between the groups at the 6-month follow up. Concerning the two other outcome variables the two clusters characterized by cognitive or behavioural endurance tendencies turned out to be high risk groups: At the 6-month follow up patients of both groups seemed less likely to return to work. The patients typified by endurance strategies and positive mood had more often applied for early retirement than those patients without psychological risk factors. DISCUSSION: These results corroborate the finding that this subgroup of chronic low back pain patients might indeed carry a bad prognosis and call for further research into this area, especially with regard to rehabilitation potential and facilities of reintegration into working life.

English Abstract↗
PubMed1984

The use of Lassa fever convalescent plasma in Nigeria.

Lassa fever convalescent plasma (LFCP) has been administered to 27 patients in hospitals at Jos and Vom, Nigeria. Among serologically or virologically confirmed cases of Lassa fever (LF) given plasma on or before the 10th day, all eight survived, as did two of three possible LF cases. Of eight patients given LFCP after the 10th day, five died, as did all three possible LF cases. LFCP was also administered to five patients subsequently shown not to have LF, and to a suspected case contact; all survived without complications of therapy. There were 15 cases of LF during this time who did not receive plasma; 11 survived. Most cases of LF who received plasma and survived showed a rapid response to therapy, in contrast with the gradual recovery in those who did not receive LFCP.

Adolescent↗
PubMed1987

Kinetics of humoral response during the acute and the convalescent phase of human trichinosis.

After a common source outbreak of trichinosis in Bitburg, FRG, 107 patients, for whom time and source of infection were precisely known, were prospectively studied for a period of eight months in order to investigate the kinetics of the humoral immune response. Antibodies were assessed by IHA, and by ELISA to quantify IgG, IgM and IgE isotypes. For four different periods of the observation time sensitivity and predictive value of tests to identify acute or convalescent trichinosis were determined. The results demonstrated characteristic kinetics of the different antibody isotypes and varying diagnostic value of the tests. Only IgG-ELISA and double-sandwich IgM-ELISA reliably identified diseased patients shortly after onset of clinical illness and showed a negative predictive value of almost 100% from seven weeks to eight months after infection. IgE antibodies and elevation of total serum IgE occurred only in about 20% of patients and showed no consistent pattern during the course of the disease. Circulating immune complexes were moderately increased four weeks after infection. They rapidly returned to normal values, after the symptoms of the acute phase had disappeared.

Acute Disease↗
PubMed1997

Characteristics of asymptomatic secondary immune responses to measles virus in late convalescent donors.

Among 44 fully protected, late convalescent adults re-exposed to measles, four developed an asymptomatic secondary immune response (SIR) with a significant increase in measles virus (MV)-specific IgG and low IgM. The boosted antibodies were mainly of the IgG1 subclass and reacted with the nucleoprotein and the haemagglutinin protein. About 30 weeks after re-exposure, antibody levels had decreased by 35-50%, suggesting that the booster effect may only be transient. SIR was only found in individuals with a pre-exposure IgG level below a well defined threshold. Antibody levels above this threshold fully protected against SIR. SIR seems to be an 'all or none response' where the magnitude of increase in specific IgG is independent of pre-exposure antibody levels as long as these are below the above threshold. In combination with pre-exposure neutralizing and haemagglutination inhibiting titres, a threshold was defined below which SIR is likely to occur. This may be useful to predict susceptibility to SIR in a given population, since individuals undergoing clinically inapparent SIR are among seropositive subjects, the most likely candidates to support transmission of virus.

Adult↗
PubMed1997

Frequent detection of hepatitis A viral RNA in serum during the early convalescent phase of acute hepatitis A.

The diagnosis of type A hepatitis is performed mainly by immunoglobulin M (IgM) anti-hepatitis A antibody assay, but it has not been established whether there is a correlation between changes in viremia and the clinical course of type A hepatitis. We examined hepatitis A virus (HAV) RNA in the sera from type A and non-A, non-B, non-C acute hepatitis and analyzed the relation of HAV viremia with alanine aminotransferase (ALT) and IgM-HA levels. Two hundred sera from 38 patients with type A acute hepatitis and 20 patients with non-A, non-B, non-C acute hepatitis were examined for the presence of HAV RNA. HAV RNA was detected by nested reverse transcription-polymerase chain reaction (RT-PCR) with primers located at the 5' non-translated region of HAV. HAV RNA was detected in 35 of 38 (92%) type A hepatitis patients and in 60 of 156 (38%) serum samples. In contrast, it was detected in none of 44 serum specimens from 20 non-A, non-B, non-C acute hepatitis patients. In type A hepatitis, the mean ALT level in HAV RNA positive specimens was 1,481 +/- 2,042 (range, 20-10,370) IU/L and that in HAV RNA negative specimens 186 +/- 330 (range, 8-1,698). The positivity of HAV RNA was correlated with the level of transaminase at the time of sample collection. The mean duration from the onset of symptoms to disappearance of HAV RNA was 18 +/- 14 days. The mean titer of IgM-HA in HAV RNA positive cases was 5.0 +/- 1.4, in negative cases 5.7 +/- 1.1, with no statistical difference. Our results indicate that HAV RNA in serum is detectable in the majority of type A hepatitis cases in their early convalescent phase by nested RT-PCR.

Acute Disease↗
PubMed1961

Studies on primary atypical pneumonia. III. A factor in normal serum which enhances the reaction between PAP virus and convalescent serum.

A factor present in fresh normal human or guinea pig serum enhances the primary atypical pneumonia (PAP) antibody titers in serological reaction with its homologous virus as tested by indirect fluorescent antibody staining. This factor is not properdin. It has many properties similar to complement but may not be identical with complement. The addition of this enhancement factor to human sera convalescent from primary atypical pneumonia has made the serological test more sensitive without affecting its specificity.

Complement System Proteins↗
PubMed1999

Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee.

Between 6 and 22 June 1995, 8 patients in Kikwit, Democratic Republic of the Congo, who met the case definition used in Kikwit for Ebola (EBO) hemorrhagic fever, were transfused with blood donated by 5 convalescent patients. The donated blood contained IgG EBO antibodies but no EBO antigen. EBO antigens were detected in all the transfusion recipients just before transfusion. The 8 transfused patients had clinical symptoms similar to those of other EBO patients seen during the epidemic. All were seriously ill with severe asthenia, 4 presented with hemorrhagic manifestations, and 2 became comatose as their disease progressed. Only 1 transfused patient (12.5%) died; this number is significantly lower than the overall case fatality rate (80%) for the EBO epidemic in Kikwit and than the rates for other EBO epidemics. The reason for this low fatality rate remains to be explained. The transfused patients did receive better care than those in the initial phase of the epidemic. Plans should be made to prepare for a more thorough evaluation of passive immune therapy during a new EBO outbreak.

Adolescent↗
PubMed1990

An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility.

An outbreak of acute gastroenteritis (AGE) occurred in a 201-bed geriatric convalescent facility in Los Angeles County during December 1988 through January 1989. The attack rate was 55% among residents and 25% among employees. Illnesses were characterized by vomiting and diarrhea to a lesser extent, and the absence of fever. Bacterial and parasitic tests in a sample of patients were negative. A 27 nm small round structured virus (SRSV) was identified in one of 30 stools studied by immune electron microscopy (IEM). While rotavirus and influenza A and B were found in three, one and three cases, respectively, no alternative etiologic agent could be demonstrated for most cases. The outbreak met Centers for Disease Control (CDC) clinical and epidemiologic criteria for Norwalk-like gastroenteritis. The death rate of residents was not elevated beyond baseline during the outbreak; however, one healthy employee had diarrhea and dehydration and died after developing an arrhythmia. An autopsy showed moderate, diffuse lymphocytic and neutrophilic myocarditis, and viral studies found influenza A in left ventricular tissue. Fourteen (25%) of 57 employee cases worked in occupations without routine stool or patient contact. At least nine of these employees lacked evidence of direct fecal contact, and transmission of infection in these cases may have been airborne.

Acute Disease↗
PubMed1987

A modified, solid phase radioimmunoassay for the differential diagnosis of acute and convalescent phases of hepatitis A infection.

The commercial assays for diagnosing the presence of hepatitis A antibodies (HAVAB; Abbott Laboratories, North Chicago, IL) or the presence of IgM class anti-hepatitis A virus antibodies (HAVAB-M; Abbott) do not provide precise information as to the timing of the acute infection. IgM class antibodies are detected as late as six months after the acute infection. In this study the authors describe a modified HAVAB test that inactivates the IgM class antibodies. It thus measures the proportion of IgG antibodies out of the total anti-hepatitis A virus antibodies. In a study of 139 patients with impaired liver function, the available and modified tests showed good agreement except for the convalescent phase of hepatitis A. During serial testing for three months after the acute infection, the commercial tests continuously detected IgM class antibodies. The modified test detected predominantly IgG class antibodies from four weeks on. By six weeks, 85% of the patients had predominantly IgG class antibodies. The modified test thus provides information on the timing of recent hepatitis A infection.

Acute Disease↗
PubMed1982

Presence of interferon in acute- and convalescent-phase sera of humans with influenza or influenza-like illness of undetermined etiology.

Interferon (IFN;titer, greater than 10 units) was present in the acute-phase sera of 30 of 40 subjects with culture and/or serologically documented, naturally acquired influenza A/Brazil/78 (H1N1) and in the acute-phase sera of five of 27 subjects with an influenza-like illness of undetermined etiology. No statistical correlation existed between the quantity of IFN in acute-phase serum and the course of the clinical illness. Antiviral activity in all of nine acute-phase sera and three of four sera obtained on the fifth to seventh days of illness was neutralized to greater than 50% by antibody to virus-induced human leukocyte IFN (HuIFN-alpha). In contrast, none of five sera collected between 21 and 23 days after the onset of illness contained IFN sensitive to neutralization by antibody to HuIFN-alpha. Resistance of IFN in convalescent-phase sera to neutralization by antibody to HuIFN-alpha suggests that multiple IFN species may evolve during viral infections.

Adult↗
PubMed1988

Molecular epidemiology of rotavirus infection in a room for convalescing newborns.

In a prospective study, all patients admitted to a unit for convalescing newborns on an infant-toddler ward between January and April 1985 were tested every other day for rotavirus (RV) excretion by using an enzyme-linked immunosorbent assay. RNA electrophoresis of the RV strains identified in this population were analyzed to determine whether specific strains of virus were associated with infections in newborns. RV strains infecting older, symptomatic children from the infant-toddler ward were used for comparison. Among the 39 patients enrolled in the study, RV was detected in the stools of 13 (33%), 11 (86%) of whom were asymptomatic. Three different electropherotypes were seen among the newborns who were RV positive; these electropherotypes were identical to those identified in older children with community-acquired diarrhea and nosocomial-acquired diarrhea who were hospitalized on the infant-toddler ward during the same study period. Each of the three strains was first identified in the general ward and subsequently detected in the room with newborns within three to six days. We failed to identify a particular strain that exclusively infected newborns.

Cross Infection↗
PubMed2007

Comparison of inpatient bed rest and home convalescence following split thickness skin grafting to the lower leg.

There has been a substantial move towards care of patients in an outpatient setting. This study was performed to determine if discharge home following split thickness skin grafting to the lower leg compromised graft results or morbidity compared with admission to hospital. Cases were reviewed retrospectively from the dermatology department's surgical records. All split thickness skin grafts to the lower legs over a 12-month period were included. All clinical notes were reviewed and phone calls made to patients and relatives. A total of 61 cases were included: 31 admitted as inpatients, 30 discharged home. There was no significant difference between the two groups' age, sex or comorbidities. A trend was seen in inpatients towards increased infection (P = 0.19) and venous thrombosis (P = 0.34). There is a lack of significant difference between admitted and discharged patients in all outcomes including bleeding, number of dressing clinic follow ups and graft loss. These results suggest that home convalescence after split thickness skin grafting to the lower legs compares favourably with inpatient care.

Aged↗
PubMedDate not supplied

Haemodynamic effects of isometric handgrip exercise in patients convalescent from myocardial infarction.

1. Cardiac performance in response to 30% maximal isometric handgrip exercise was studied in fourteen patients convalescing uneventfully from a first myocardial infarction. In each patient, heart rate, mean arterial blood pressure and cardiac index were measured, and total peripheral resistance was calculated. The covariance of changes in the mean arterial blood pressure and cardiac index in these patients was matched against tolerance limits calculated from published data for normal subjects. 2. All patients had normal haemodynamic values at rest, and showed the usual rise of heart rate and mean arterial pressure during handgrip exercise. However, in six patients (group 1) the rise in mean arterial pressure was, as in normal subjects, accounted for mainly by a rise in cardiac index, with no consistent change in peripheral resistance. In eight patients (group 2), the mean arterial pressure rose to the same level as in group 1, but with a consistent increase in peripheral resistance and a smaller rise in the cardiac index. 3. It is suggested that in a substantial proportion of patients who are making a seemingly uncomplicated recovery from myocardial infarction, it may be possible to unmask an impairment of left ventricular function by means of isometric handgrip exercise.

Adult↗