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PubMed2003

[Clinicophysiological assessment of physical performance in patients recovering from hemorrhagic fever with renal syndrome].

Tolerance of physical load was investigated in 50 convalescents of hemorrhagic fever with renal syndrome (HFRS) at bicycle exercise test (BET). Calculations were made of maximal oxygen consumption and energy consumption at the threshold load. It is shown that for three months after HFRS physical performance of the convalescents remained low. By the end of the expected disability objective recovery of physical performance was registered only in 33-37% convalescents. More than for 3 months disability persisted in reconvalescents engaged in professions with energy consumption above 4.1 kkal/min throughout the working day. Use of BET in the practice of medical labour expertise of HFRS convalescents provides an objective assessment of their working ability and feasible job.

Convalescence↗
PubMed1991

[Level of estradiol and progesterone in blood serum during the menstrual cycle in woman with acute hepatitis b].

The study was aimed at the determination of blood serum levels of the ovarian hormones (estradiol and progesterone) in women during the first menstrual cycle occurring in the course of hospitalization because of the acute viral hepatitis of type B, and in the same women during the first menstrual cycle occurring in the course of early convalescence after leaving the hospital. The observed group consisted of 20 women of age between 18 and 35 years treated because of acute hepatitis without coexisting diseases including gynecological ailments. All the women had a regular 28-day menstrual cycle. Twenty healthy women served as a control group. The blood serum concentrations of estradiol and progesterone were determined in all the subjects on 6-th, 12-th, 14-th, 18-th and 22-nd day of the menstrual cycle by RIA method using the ready made reagent kits. A significant decrease in the mean value of estradiol was found in the group of sick women as compared to the control group and to the same group of women in the course of early convalescence. On the other hand the value obtained during the first menstrual cycle after discharge from the hospital did not differ from that observed in healthy women. Mean value of blood serum progesterone concentration was higher in sick women than those in the control group and in the same women during convalescence all the time except on the 22-nd day of the cycle. These values did not differ significantly when comparing the group of sick women during convalescence and the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2005

[Study on the dynamics of IgG antibody in 311 patients with severe acute respiratory syndrome].

OBJECTIVE: To detect the level and dynamic change of severe acute respiratory syndrome (SARS)-coronavirus-specific IgG antibody in conavalescent SARS patients, and to provide information for prevention and vaccine development. METHODS: IgG antibody against coronavirus was detected by ELISA in the blood of 311 convalescent SARS patients for every 2 - 4 weeks. Stata 7.0 statistics software was used to analyse the results. RESULTS: IgG antibody was detected positive on each testing of all the convalescent patients and its peak appeared 35 days after recovery. IgG antibody level showed a 35.8% decrease within one year. CONCLUSION: Data showed that all the SARS convalescent patients had generated high level of specific IgG antibody against coronavirus in the early stage of recovery, but the antibody level declined along with the progress of convalescence, suggesting that the detection of the IgG antibody should go on until it disappeared.

Adolescent↗
PubMed1985

Protection and recovery in influenza virus-infected mice immunosuppressed with anti-IgM.

BALB/c mice, immunosuppressed from birth with goat anti-mouse IgM, were able to recover from influenza virus infection in the absence of detectable serum and nasal antibody. Recovery was delayed a few days when compared with control animals. Antibody-deficient mice, that had recovered from an initial influenza virus infection, i.e., convalescent mice, were subsequently rechallenged with homologous influenza virus in order to study the importance of nasal and serum antibody in prevention of infection. Convalescent mice were susceptible to reinfection when nasal and serum antibody were not detectable. The mice were resistant to reinfection when serum and/or nasal antibody was detectable by radioimmunoassay. Normal mice that were passively immunized with high titer mouse anti-influenza virus serum were susceptible to challenge with homologous influenza virus. The serum antibody levels in these mice were higher than most of those found in the immune convalescent mice suppressed with anti-IgM, thereby suggesting that the serum antibody, found in convalescent suppressed mice, is not protective. We conclude that 1) mice can recover from influenza virus infection in the absence of detectable levels of nasal and serum antibody, thus indirectly confirming the role of cell-mediated immunity in recovery; 2) serum IgM, IgG2A, IgG2B, IgG3, and probably IgG1 antibody levels are not responsible for protection against influenza virus infection of the upper respiratory tract; and 3) nasal IgA antibody correlates best with protection against reinfection of the upper respiratory tract, but some other locally protective agent cannot be excluded.

Animals↗
PubMed1987

[A new method physical loading tests in the evaluation of functional status and the development of rehabilitation programs for patients with acute infectious diseases].

The authors studied the potentialities of employment of a new method of exercise tests (cyclic bicycle ergometry) for the assessment of convalescents' function and working capacity following acute communicable diseases. The above method showed the relationship of convalescents' function and working capacity with a nosological form and stage of convalescence. It was established that some indices of patients' function did not return to normal by discharge. Different mechanisms were shown to lie in the basis of disturbances in various infections. A conclusion was made that convalescents were in need of differentiated pathogenetically founded and purpose-oriented recovery therapeutic measures which should be taken into account in drawing up programs for their rehabilitation and follow-up after acute communicable diseases.

Acute Disease↗
PubMed1972

Gastric acidity in cholera and noncholera diarrhoea.

Gastric acid production, unstimulated and following stimulation with betazole hydrochloride, was measured in Indian men with cholera or acute vibrio-negative diarrhoea-Measurements were made during acute illness and after different periods of convalescence. Men from the same socioeconomic group and from a higher one served as controls. Stimulated acid production was severely reduced during diarrhoea caused by V. cholerae and related vibrios but not during acute vibrio-negative diarrhoea. Acid production returned to stable convalescent values 1-3 days after cessation of diarrhoea. Stimulated acid production was significantly lower in controls from the lower socioeconomic group than in those from the higher socioeconomic group. Achlorhydria that did not respond to betazole administration occurred in 32% of the convalescent cholera patients but in none of the controls or convalescent vibrio-negative diarrhoea patients. It is concluded from these results that diarrhoea produced by V. cholerae and related vibrios is accompanied by transient inhibition of gastric acid secretion, that cholera occurs largely in a population with impaired acid secretion, and that preexisting achlorhydria may predispose to infection with V. cholerae.

Acute Disease↗
PubMed1993

Bronchoalveolar lavage cell analysis in measles viral pneumonia.

Although the immunological changes due to measles virus infection, such as suppression of delayed skin reactivity and increase in soluble CD8 in peripheral blood, have been demonstrated, the immunological changes in the lung during measles viral pneumonia (MVP) have not been reported. The aim of this study was to clarify the intrapulmonary immunological changes in MVP. We analysed cell differentials and lymphocyte surface antigens of bronchoalveolar lavage (BAL) cells, both in the acute and the convalescent phase of MVP by flow-cytometry, using CD4+, CD8+, CD8+CD11b+ and CD8+CD11b- monoclonal antibodies in five patients and six healthy control subjects. The absolute numbers of CD8+ and CD8+CD11b- cells were significantly greater both in the acute and the convalescent phase compared with those in controls. The percentages of CD8+ and CD8+CD11b- cells in the acute phase were significantly greater than those in controls and the convalescent phase. The CD4/CD8 ratios in the acute phase were significantly smaller than those in the convalescent phase and controls. In conclusion, the intrapulmonary immunological changes with an increase in CD8+ and CD8+CD11b- cells in BAL fluid of MVP are thought to be the primary reaction in measles virus-infected lungs.

Acute Disease↗
PubMed1989

Immunoblot analysis of the serological response in Hantavirus infections.

Sera from patients with nephropathia epidemica (NE) or Korean hemorrhagic fever (KHF) were tested for specific antibody response to antigens of Hällnäs virus and Hantaan virus strain 76-118. A Vero E6 derived cell line persistently infected with Hällnäs virus strain B1, and Vero E6 cells freshly infected with Hantaan virus type strain 76-118 were used as antigens in the immunofluorescence assay (IFA) and the immunoblot. Blots were prepared from whole cell lysates. The convalescent-phase sera of NE patients tested in this study regularly revealed a marked reaction with a 52 kilodalton (Kd) protein of Hällnäs virus and a 50 Kd protein of Hantaan virus. A convalescent serum from a patient with Korean hemorrhagic fever and a rat antiserum against Hantaan virus could recognize the 50 Kd band of Hantaan virus but showed no apparent reactivity with the 52 Kd component of Hällnäs virus in the standard dilutions. Some sera could additionally identify minor bands in the 55 Kd and/or 67 Kd region of the blots. A one-way cross reactivity between Hantaan and Hällnäs viruses was also evident from the results of the immunofluorescence assays in that NE convalescent sera reacted with both viruses, whereas KHF convalescent or anti-Hantaan sera gave strongly positive results with Hantaan virus but only faint reaction with Hällnäs virus.

Antibodies, Viral↗
PubMed1977

Serological relationships between rotaviruses from different species as studied by complement fixation and neutralization.

Human, piglet, mouse, foal, lamb, calf and rabbit rotaviruses all infected, but could not readily be subcultured in LLC MK2 cells. Cells infected with mouse and calf rotaviruses reacted by indirect immunofluorescence (FA) with convalescent serum from children, piglets, mice, foals, lambs, calves or rabbits, taken after rotavirus infection. Human, calf, piglet, mouse and foal rotaviruses reacted with human, calf, mouse, foal and lamb convalescent serum by complement fixation (CF). It was not possible to distinguish between different rotaviruses by CF or FA. Neutralization tests, however, detected species-specific rotavirus antigens. Any virus was neutralized by a much higher dilution of homologous species convalescent serum than by any heterologous serum. With the exception of the mouse virus there was very little cross reaction. However, in sera with a very high neutralizing titre for the homologous virus the titre was proportionately raised against heterologous virus. It is, therefore, now possible to type to species an unknown rotavirus by a neutralization test in LLC MK2 cells using convalescent serum from each species.

Animals↗
PubMed1981

Kupffer cell hyperplasia in liver diseases. Demonstration by scanning electron microscopy of biopsy samples.

Kupffer cells were observed in liver biopsy tissues of 9 cases of liver diseases by scanning electron microscopy to prove Kupffer cell proliferation numerically. Kupffer cell count per 0.01 mm2 of cracked surface of liver lobule was 1.2 +/- 0.3 in the convalescent stage of a mild acute hepatitis case and 1.2 +/- 0.1 in a chronic persistent hepatitis case with slight inflammation. Whereas it was increased to 2.4-5.5 (P less than 0.01) in the convalescent stage of moderate to severe acute hepatitis cases, 1.8 +/- 0.1 (p less than 0.05) in a chronic active hepatitis case, 2.5 +/- 0.3 (p less than 0.001) in an alcoholic portal fibrosis case and 2.2 +/- 0.4 (p less than 0.001) in a liver cirrhosis case. Kupffer cell count per mm3 of liver lobule was estimated roughly 3,500 in the convalescent stage of a mild acute hepatitis case and in a mild chronic persistent hepatitis case and 7,000 to 16,000 in the convalescent stage of moderate to severe acute hepatitis cases.

Acute Disease↗
PubMed1997

A study of the factors affecting the metabolic clearance of quinine in malaria.

OBJECTIVE: To assess the factors that contribute to impaired quinine clearance in acute falciparum malaria. PATIENTS: Sixteen adult Thai patients with severe or moderately severe falciparum malaria were studied, and 12 were re-studied during convalescence. METHODS: The clearance of quinine, dihydroquinine (an impurity comprising up to 10% of commercial quinine formulations), antipyrine (a measure of hepatic mixed-function oxidase activity), indocyanine green (ICG) (a measure of liver blood flow), and iothalamate (a measure of glomerular filtration rate) were measured simultaneously, and the relationship of these values to the biotransformation of quinine to the active metabolite 3-hydroxyquinine was assessed. RESULTS: During acute malaria infection, the systemic clearance of quinine, antipyrine and ICG and the biotransformation of quinine to 3-hydroxyquinine were all reduced significantly when compared with values during convalescence. Iothalamate clearance was not affected significantly and did not correlate with the clearance of any of the other compounds. The clearance of total and free quinine correlated significantly with antipyrine clearance (rs = 0.70, P = 0.005 and rs = 0.67, P = 0.013, respectively), but not with ICG clearance (rs = 0.39 and 0.43 respectively, P > 0.15). In a multiple regression model, antipyrine clearance and plasma protein binding accounted for 71% of the variance in total quinine clearance in acute malaria. The pharmacokinetic properties of dihydroquinine were generally similar to those of quinine, although dihydroquinine clearance was less affected by acute malaria. The mean ratio of quinine to 3-hydroxyquinine area under the plasma concentration-time curve (AUC) values in acute malaria was 12.03 compared with 6.92 during convalescence P = 0.01. The mean plasma protein binding of 3-hydroxyquinine was 46%, which was significantly lower than that of quinine (90.5%) or dihydroquinine (90.5%). CONCLUSION: The reduction in quinine clearance in acute malaria results predominantly from a disease-induced dysfunction in hepatic mixed-function oxidase activity (principally CYP 3A) which impairs the conversion of quinine to its major metabolite, 3-hydroxyquinine. The metabolite contributes approximately 5% of the antimalarial activity of the parent compound in malaria, but up to 10% during convalescence.

Adolescent↗
PubMed2004

The role of tumor necrosis factor-alpha in Henoch-Schonlein purpura.

Henoch-Schonlein purpura (HSP) is one of the most common types of vasculitis disorders in childhood and is characterized by a rash, arthritis, abdominal pain, and renal involvement. The factors that determine and mediate the severity of HSP and its renal involvement remain poorly understood, although it is likely that pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), are involved in the pathogenesis. Serum and urine levels of TNF-alpha were measured in children with HSP in the acute and convalescent phases by ELISA. Serum TNF-alpha levels were significantly higher in proteinuric HSP in the acute phase (36.6+/-8.5 pg/ml) compared with those with HSP without renal involvement and those with hematuric HSP (25.4+/-4.5 and 27.1+/-3.9 pg/ml) (P<0.005). However, these significantly higher levels disappeared in the convalescent phase. Using matched serum samples from the same patients, serum TNF-alpha levels of proteinuric HSP patients were significantly lower in the convalescent phase (29.9+/-4.6 pg/ml, P <0.05) than in the acute phase (39.1+/-8.2 pg/ml). Although urine TNF-alpha levels were higher in proteinuric HSP in the acute phase and reduced in the convalescent phase, there were no significantly high or low levels. These results suggest that increased TNF-alpha levels in the serum induce a series of functional and morphological changes in the glomerular cells in the acute phase and may be used as markers for monitoring the disease activity of HSP with severe renal involvement.

Adolescent↗
PubMed1983

Pituitary and adrenal hormones in patients after myocardial infarction under ergometer load.

The levels of human growth hormone (HGH), ACTH and cortisol in the plasma of 100 middle-aged men were measured by means of radioimmunoassay (12 patients in the phase of hospitalization after myocardial infarction, 47 patients in convalescence, 31 patients in post-convalescence, 10 healthy men). Twenty patients in the phase of convalescence and all patients in post-convalescence did exercises on bicycle ergometer with submaximal loading. Patients after myocardial infarction showed significantly lower basic levels of HGH than healthy persons, and the increase in the HGH level induced by exercise was significantly lower. The hormones ACTH and cortisol showed only slight differences. The secretion of the pituitary hormones, mainly HGH, seems to be altered in patients after myocardial infarction.

Adrenocorticotropic Hormone↗
PubMed1988

Dynamics of the protein metabolic response to burn injury.

The protein metabolic response to burn injury was assessed in 17 children aged 7.1 +/- 1.1 years (mean +/- SEM) and a mean burn size of 65 +/- 7% total body surface area (TBSA) during the acute, flow, convalescent, and recovery phases. Stable isotopes of leucine, valine, lysine, and urea were infused in postabsorptive patients in order to measure protein kinetics. The absolute rate of protein breakdown was assessed from the plasma flux of the essential amino acids (EAA), and the rate of urea production (Ra urea) was used as an index of net protein catabolism. Compared to values obtained in recovered patients, the plasma fluxes of all three EAAs were significantly increased (P less than .05), indicating an increased protein breakdown, during the acute, flow, and convalescent phases of injury. Ra urea, however, was only significantly increased during the flow phase (P less than .01), suggesting that protein breakdown was adequately counteracted in the acute and convalescent phases by elevations in protein synthesis but not in the flow phase. The protein kinetic response did not correlate with changes in the metabolic rate since resting energy expenditure (REE) was significantly increased above predicted levels during the acute and flow phases (by 40% and 50%, respectively), and returned to normal in convalescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids, Essential↗
PubMed1994

Glycerol metabolism in severe falciparum malaria.

Gluconeogenesis and liver blood flow (LBF) in severe falciparum malaria were assessed from the clearance and metabolic response to intravenously administered glycerol (0.3 g/kg) and Indocyanine Green ([ICG] 0.4 mg/kg), respectively. Fasting baseline blood glycerol concentrations (mean +/- SD) were significantly higher in acute malaria (133 +/- 65 mumol/L, n = 14), than in convalescence (65 +/- 31 mumol/L, n = 9, P = .01), but basal triacylglycerol concentrations were similar. Estimated glycerol turnover was also more than twice as high in acute malaria compared with convalescence (1.36 +/- 0.87 v 0.54 +/- 0.15 mumol.min-1.kg-1, P = .015). The increment in plasma glucose (AUC0-55 min) following glycerol infusion was greater during acute malaria compared with convalescence (median [range], +31.6 [-0.9 to +107.6] v +14.5 [-103 to +27.1] mmol.min-L-1, P < .05), but the insulin increments were similar (P = .9), indicating reduced tissue insulin sensitivity. The increment in venous lactate (AUC0-55 min) was higher in severely ill patients (17.2 [-7.8 to +53.4] mmol.min.L-1, n = 10) compared with patients with moderately severe malaria (-3.1 [-8.7 to 3.2] mmol.min-L-1, n = 4, P = .01). LBF estimated from ICG clearance was lower during acute illness than in convalescence (mean +/- SD, 15.5 +/- 2.3 v 18.6 +/- 2.9 mL.min-1.kg-1, P = .007) and correlated inversely with the basal venous lactate concentration (rs = .53, P < .05). LBFs less than 15 mL.min-1.kg-1 were associated with hyperlactatemia, and all four fatal cases had LBFs of less than 12 mL.min-1.kg-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Identification of native foot-and-mouth disease virus non-structural protein 2C as a serological indicator to differentiate infected from vaccinated livestock.

Cattle and pigs which have been vaccinated against foot-and-mouth disease can be distinguished from convalescent animals by radio-immunoprecipitation and sodium dodecyl sulphate polyacrylamide gel electrophoresis of the virus-induced proteins reacting with the respective sera. Baby hamster kidney cells infected with foot-and-mouth disease virus (FMDV) (serotype A24) were labelled with 35S-methionine and the virus-induced proteins were precipitated with sera from vaccinated and subsequently challenged animals, convalescent animals retained for over 300 days, animals vaccinated or infected with viruses belonging to all serotypes of FMDV, and animals infected with encephalomyocarditis (EMC) or porcine or bovine enteroviruses. In addition to the structural proteins of the virus, the non-structural proteins 2C, 3ABC, 3C, 3CD and 3D were precipitated by convalescent sera, but only 3D was precipitated by serum from vaccinated animals. Proteins L, 2C and 3C were precipitated only after challenge with a heterotypic virus (serotype O1 Tunisia), indicating that virus replication of the challenge virus had taken place. No precipitation was detected with sera from EMC or enterovirus-infected animals. The results indicate that protein 2C, and to a lesser extent the polypeptide 3ABC, could be used to differentiate potential carrier convalescent animals from vaccinated livestock.

Animals↗
PubMed1992

Anistreplase versus alteplase in acute myocardial infarction: comparative effects on left ventricular function, morbidity and 1-day coronary artery patency. The TEAM-3 Investigators.

OBJECTIVES: This double-blind, randomized, multicenter trial was designed to compare the effects of treatment with anistreplase (APSAC) and alteplase (rt-PA) on convalescent left ventricular function, morbidity and coronary artery patency at 1 day in patients with acute myocardial infarction. BACKGROUND: Anistreplase (APSAC) is a new, easily administered thrombolytic agent recently approved for treatment of acute myocardial infarction. Alteplase (rt-PA) is a rapidly acting, relatively fibrin-specific thrombolytic agent that is currently the most widely used agent in the United States. METHODS: Study entry requirements were age less than or equal to 75 years, symptom duration less than or equal to 4 h, ST segment elevation and no contraindications. The two study drugs, APSAC, 30 U/2 to 5 min, and rt-PA, 100 mg/3 h, were each given with aspirin (160 mg/day) and intravenous heparin. Prespecified end points were convalescent left ventricular function (rest/exercise), clinical morbidity and coronary artery patency at 1 day. A total of 325 patients were entered, stratified into groups with anterior (37%) or inferior or other (63%) acute myocardial infarction, randomized to receive APSAC or rt-PA and followed up for 1 month. RESULTS: At entry, patient characteristics in the two groups were balanced. Convalescent ejection fraction at the predischarge study averaged 51.3% in the APSAC group and 54.2% in the rt-PA group (p less than 0.05); at 1 month, ejection fraction averaged 50.2% versus 54.8%, respectively (p less than 0.01). In contrast, ejection fraction showed similar augmentation with exercise at 1 month after APSAC (+4.3% points) and rt-PA (+4.6% points), and exercise times were comparable. Coronary artery patency at 1 day was high and similar in both groups (APSAC 89%, rt-PA 86%). Mortality (APSAC 6.2%, rt-PA 7.9%) and the incidence of other serious clinical events, including stroke, ventricular tachycardia, ventricular fibrillation, heart failure within 1 month, recurrent ischemia and reinfarction were comparable in the two groups; and mechanical interventions were applied with equal frequency. A combined clinical morbidity index was determined and showed a comparable overall outcome for the two treatments. CONCLUSIONS: Convalescent rest ejection fraction was high after both therapies but higher after rt-PA; other clinical outcomes, including exercise function, morbidity index, and 1-day coronary artery patency, were favorable and comparable after APSAC and rt-PA.

Anistreplase↗
PubMed2006

Comparison of results and complications of surgical and Amplatzer device closure of perimembranous ventricular septal defects.

BACKGROUND: Surgery for perimembranous ventricular septal defects (VSD) is widely accepted procedure with minimal operative mortality. Recent publications have reported the feasible, safe, and effective with the new Amplatzer VSD occluder. This study was done to compare the effectiveness, cost, and complications of both the techniques. METHODS: One hundred twenty-one consecutive patients from 2 to <18 years of age underwent VSD closure: 48 patients were treated surgically and 73 patients were treated with percutaneous Amplatzer occluder. Success rate, complications, cost, hospital stay, and home convalescent times were measured. RESULTS: The closure rate was similar in the 2 groups: 48/48 patients (100%) in the surgical group versus 71/73 patients in the Amplatzer group (97%). Procedure complications affecting management occurred in four patients of the Amplatzer group (5.5%) and four patients of surgical patients (8.3%) (p=NS). The complications that did not need treatment were observed 25/48 patients (52%) in the surgical group versus 14/73 patients (19%) in the Amplatzer group (p<0.01). Both hospital stay and home convalescent times were significantly shorter after Amplatzer closure (median hospital stay: Amplatzer three days and surgery eleven days; median convalescent time: Amplatzer two weeks and surgery six weeks). Median cost was similar for both groups. CONCLUSIONS: The closure rate was similar in the Amplatzer VSD closure and surgical closure. There were more complications in the surgical group but the majority of these was minor and did not require any change in management. Hospital stay and home convalescent times were significantly shorter after Amplatzer closure. The cost of both techniques was similar. Nevertheless, the surgeon's ability to close any VSD, regardless of anatomy, remains an important advantage of surgery.

Adolescent↗