Initial Phase Of Illness Research Articles

Beyond acute infection: molecular mechanisms underpinning cardiovascular complications in long COVID.

SARS-CoV-2, responsible for the global COVID-19 pandemic, has manifested significant cardiovascular implications for the infected population. These cardiovascular repercussions not only linger beyond the initial phase of illness but have also been observed in individuals who remain asymptomatic. This extended and pervasive impact is often called the post-acute COVID-19 syndrome (PACS) or "Long COVID". With the number of confirmed global cases approaching an alarming 756 million, the multifaceted challenges of Long COVID are undeniable. These challenges span from individual health complications to considerable burdens on worldwide healthcare systems. Our review comprehensively examines the complications of the persistent cardiovascular complications associated with COVID-19. Furthermore, we shed light on emerging therapeutic strategies that promise to manage and possibly mitigate these complications. We also introduce and discuss the profound concerns regarding the potential transgenerational repercussions of SARS-CoV-2, emphasizing the need for a proactive and informed approach to future research and clinical practice.

Stigma experienced by patients with severe mental disorders: A nationwide multicentric study from India

This study aimed to evaluate the stigma and its correlates among patients with severe mental disorders. Patients with diagnosis of schizophrenia (N = 707), bipolar disorder (N = 344) and recurrent depressive disorder (N = 352) currently in clinical remission from 14 participating centres were assessed on Internalized Stigma of Mental Illness Scale (ISMIS). Patients with diagnosis of schizophrenia experienced higher level of alienation, sterotype endorsement, discrimination experience and total stigma when compared to patients with bipolar disorder and recurrent depressive disorder. Patients with bipolar disorder experienced higher stigma than those with recurrent depressive disorder in the domain of stigma resistance only. Overall compared to affective disorder groups, higher proportion of patients with schizophrenia reported stigma in all the domains of ISMIS. In general in all the 3 diagnostic groups’ stigma was associated with shorter duration of illness, shorter duration of treatment and younger age of onset. To conclude, this study suggests that compared to affective disorder, patients with schizophrenia experience higher self stigma. Higher level of stigma is experienced during the early phase of illness. Stigma intervention programs must focus on patients during the initial phase of illness in order to reduce the negative consequences of stigma.

Similarities and differences of functional connectivity in drug-na\xefve, first-episode adolescent and young adult with major depressive disorder and schizophrenia

Major depressive disorder (MDD) and schizophrenia (SZ) are considered two distinct psychiatric disorders. Yet, they have considerable overlap in symptomatology and clinical features, particularly in the initial phases of illness. The amygdala and prefrontal cortex (PFC) appear to have critical roles in these disorders; however, abnormalities appear to manifest differently. In our study forty-nine drug-naïve, first-episode MDD, 45 drug-naïve, first-episode SZ, and 50 healthy control (HC) participants from 13 to 30 years old underwent resting-state functional magnetic resonance imaging. Functional connectivity (FC) between the amygdala and PFC was compared among the three groups. Significant differences in FC were observed between the amygdala and ventral PFC (VPFC), dorsolateral PFC (DLPFC), and dorsal anterior cingulated cortex (dACC) among the three groups. Further analyses demonstrated that MDD showed decreased amygdala-VPFC FC and SZ had reductions in amygdala-dACC FC. Both the diagnostic groups had significantly decreased amygdala-DLPFC FC. These indicate abnormalities in amygdala-PFC FC and further support the importance of the interaction between the amygdala and PFC in adolescents and young adults with these disorders. Additionally, the alterations in amygdala-PFC FC may underlie the initial similarities observed between MDD and SZ and suggest potential markers of differentiation between the disorders at first onset.

Virtual Patients in Emergency Nursing Training

Emergency nurses are specialized to provide rapid assessment and treatment to patients in the initial phase of illness or trauma and often in life-threatening situations. They are required to have a lot of knowledge –not only in medical area - and to possess multiple abilities which will enable them to face different situation that may occur. Due to different constrains – time, money, ethical considerations, etc., the institutions which provide training for emergency nurses are forced to find alternative methods to reach all the outcomes required in real life situations. One of the methods is the use of virtual patients. The scope of this paper is to present the concept of virtual patients, to describe their main characteristics which recommend them to be used for training the emergency nurses and to present the main types of virtual patients.

Anxiety sensitivity in relation to sleep quality among HIV-infected individuals.

Leyro, Teresa M. PhD; Babson, Kimberly A. PhD; Bonn-Miller, Marcel O. PhD Author Information

Eating disorders: challenges in the later phases of the recovery process

Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.

560 DIAGNOSTIC ACCURACY OF MULTIPLEX REAL-TIME PCR TEST KIT FOR DIAGNOSIS OF ACUTE HEPATITIS A AND CHRONIC HEPATITIS B AND CHRONIC HEPATITIS C

single center were enrolled consecutively. Anti-HAV IgM tests were repeated in patients with negative initial serology. Anti-HAV IgM antibodies were measured using commercially available enzyme linked fluorescent assay (VIDAS; BioMerieux, France). Results: Total 652 patients with symptomatic acute hepatitis had serology for HAV infection tested, and 620 patients were diagnosed as acute hepatitis A. Anti-HAV IgM was negative initially in 68 out of 620 patients diagnosed acute hepatitis A (11%). Hepatitis A patients whose initial serologic tests for HAV were negative had shorter time lapse from onset of symptoms to initial test (2.6±1.1 vs 5.9±2.6 days), higher rate of fever (98% vs 76%), higher ratio of AST/ALT (1.2±0.3 vs 0.8±0.4, p = 0.001), and lower level of bilirubin (1.6±1.1 vs 4.9±3.5mg/dL) compared with those with positive initial serologic tests for HAV. Among patients whose initial serologic tests for HAV were negative, patients diagnosed as acute hepatitis A showed significantly higher cut-off-index (COI) value of anti-HAV IgM than those diagnosed as non-A hepatitis. Conclusion: Anti-HAV IgM antibodies were negative in 11% of hepatitis A patients at initial presentation. Hepatitis A patients with negative initial serology showed the features of initial phase of illness. In the setting highly suggestive of acute hepatitis A, anti-HAV IgM tests should be repeated especially in patients with features of initial phase of hepatitis and high COI value of anti-HAV IgM considering window period of anti-HAV IgM antibody.

561 HEV IN RENAL TRANSPLANT AND HAEMODIALYSIS PATIENTS

single center were enrolled consecutively. Anti-HAV IgM tests were repeated in patients with negative initial serology. Anti-HAV IgM antibodies were measured using commercially available enzyme linked fluorescent assay (VIDAS; BioMerieux, France). Results: Total 652 patients with symptomatic acute hepatitis had serology for HAV infection tested, and 620 patients were diagnosed as acute hepatitis A. Anti-HAV IgM was negative initially in 68 out of 620 patients diagnosed acute hepatitis A (11%). Hepatitis A patients whose initial serologic tests for HAV were negative had shorter time lapse from onset of symptoms to initial test (2.6±1.1 vs 5.9±2.6 days), higher rate of fever (98% vs 76%), higher ratio of AST/ALT (1.2±0.3 vs 0.8±0.4, p = 0.001), and lower level of bilirubin (1.6±1.1 vs 4.9±3.5mg/dL) compared with those with positive initial serologic tests for HAV. Among patients whose initial serologic tests for HAV were negative, patients diagnosed as acute hepatitis A showed significantly higher cut-off-index (COI) value of anti-HAV IgM than those diagnosed as non-A hepatitis. Conclusion: Anti-HAV IgM antibodies were negative in 11% of hepatitis A patients at initial presentation. Hepatitis A patients with negative initial serology showed the features of initial phase of illness. In the setting highly suggestive of acute hepatitis A, anti-HAV IgM tests should be repeated especially in patients with features of initial phase of hepatitis and high COI value of anti-HAV IgM considering window period of anti-HAV IgM antibody.

559 THE HEPATITIS A VIRAL LOAD AND HAV-SPECIFIC EPITOPES INDUCED IFN-g PRODUCTION DETERMINE THE SEVERITY OF ACUTE HEPATITIS A

single center were enrolled consecutively. Anti-HAV IgM tests were repeated in patients with negative initial serology. Anti-HAV IgM antibodies were measured using commercially available enzyme linked fluorescent assay (VIDAS; BioMerieux, France). Results: Total 652 patients with symptomatic acute hepatitis had serology for HAV infection tested, and 620 patients were diagnosed as acute hepatitis A. Anti-HAV IgM was negative initially in 68 out of 620 patients diagnosed acute hepatitis A (11%). Hepatitis A patients whose initial serologic tests for HAV were negative had shorter time lapse from onset of symptoms to initial test (2.6±1.1 vs 5.9±2.6 days), higher rate of fever (98% vs 76%), higher ratio of AST/ALT (1.2±0.3 vs 0.8±0.4, p = 0.001), and lower level of bilirubin (1.6±1.1 vs 4.9±3.5mg/dL) compared with those with positive initial serologic tests for HAV. Among patients whose initial serologic tests for HAV were negative, patients diagnosed as acute hepatitis A showed significantly higher cut-off-index (COI) value of anti-HAV IgM than those diagnosed as non-A hepatitis. Conclusion: Anti-HAV IgM antibodies were negative in 11% of hepatitis A patients at initial presentation. Hepatitis A patients with negative initial serology showed the features of initial phase of illness. In the setting highly suggestive of acute hepatitis A, anti-HAV IgM tests should be repeated especially in patients with features of initial phase of hepatitis and high COI value of anti-HAV IgM considering window period of anti-HAV IgM antibody.

Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis

We present four cases of confirmed anti-NMDA receptor encephalitis; three presented initially with serious psychiatric symptoms and the other developed significant psychiatric symptoms during the initial phase of illness. Brain biopsy findings of one patient are also described. Psychiatrists should consider anti-NMDA receptor encephalitis in patients presenting with psychosis and additional features of dyskinesias, seizures and catatonia, particularly where there is no previous history of psychiatric disorder.

Response to Gordon and Green Letter

Back to table of contents Previous article Next article Communications and UpdatesFull AccessResponse to Gordon and Green LetterKenneth L. Subotnik, Ph.D., Keith H. Nuechterlein, Ph.D., Joseph Ventura, Ph.D., and Stephen Marder, M.D.Kenneth L. SubotnikLos AngelesSearch for more papers by this author, Ph.D., Keith H. NuechterleinLos AngelesSearch for more papers by this author, Ph.D., Joseph VenturaLos AngelesSearch for more papers by this author, Ph.D., and Stephen MarderLos AngelesSearch for more papers by this author, M.D.Published Online:1 Sep 2011https://doi.org/10.1176/appi.ajp.2011.11030442rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The correlational relationship between psychotic symptoms and functional outcome is weak, as Gordon and Green note. However, it is another matter to conclude that antipsychotic medication is not relevant to community functioning, quality of life, and well-being. A minority of studies hint at an advantage for work functioning for unmedicated patients (1). In contrast, we and others have found a number of advantages of consistent use of antipsychotic medication that extend beyond symptom control, notably improvement in cognition (2), brain myelination (3), and work productivity (2–5).The Subotnik et al. (4) study of medication nonadherence and return of psychosis was conducted in the context of a project that aimed to help people with recent onset of schizophrenia pick up where they left off at work or school, as quickly as possible, to avoid the demoralization that accompanies chronic disability. We used individual placement and support (IPS) integrated into the treatment team at the UCLA Aftercare Research Program to accomplish this (6), and we were quite successful at getting patients back to work or school (7). We believe that there is a synergistic effect of medication and IPS, as medication improves a patient's potential for work recovery and IPS helps to actualize that potential.We also agree that individuals with schizophrenia appear to learn about their illness over time, and their awareness of having a mental disorder generally improves over the initial phase of illness (8). However, we think that the learning is optimized when a review of past symptoms occurs after the psychotic symptoms have eased, and this is most likely to happen after consistent use of antipsychotic medication.Our findings about nonadherence to risperidone are in the context of a protocol that strongly encouraged adherence to the dosage that was tailored to each individual's needs. Nonadherence was often accompanied by poor insight regarding the benefits of medication. It is possible that nonadherence was in some instances triggered by an undetected brewing storm of subclinical symptomatic and psychophysiological changes that also made the effects of brief periods of partial nonadherence even more hazardous. This situation is quite different from that of a shared decision to start an off-medication trial for a person who has been doing very well over an extended period. In that context, the return of psychosis is not as swift (approximately 8 months [9]) as it is in the case of nonadherence to medication as prescribed (approximately 2.5 months [10]). If an off-medication trial is pursued collaboratively, we recommend careful and perhaps more frequent clinical monitoring, with family involvement to alert the treatment team to any early warning signs of relapse. Physicians should not abandon their patients during an off-medication trial that reflects shared decision making, and there is no reason for patients to similarly abandon their physicians. Both need to recognize the high likelihood that psychotic symptoms will return, as well as the emerging evidence that consistent antipsychotic treatment has a neuroprotective effect (3, 11). Small increases in positive symptoms can sometimes be handled with a psychosocial intervention without a resumption of medication. However, a significant exacerbation or relapse following a period of medication nonadherence or an off-medication trial is a clear signal that medication needs to be resumed.Los AngelesThe authors' disclosures accompany the original article.Accepted for publication in June 2011.

Use of Dengue Nonstructural Protein 1 Antigen for the Early Diagnosis of Dengue Infection

To the Editors: Chuansumrit et al1 reported on the use of dengue nonstructural protein 1 antigen testing for the earlier diagnosis of dengue virus (DENV) infection after the onset of fever. The additional IgM antibody quantification upsurge in sensitivity was remarkable.1 The combined assay would improve case management during the initial phase of illness when, accompanied by viremia, clinical presentations could be ambiguous. Moreover, the positive detection rate of dengue NS1 antigen-capture enzyme-linked immunosorbent assay (ELISA) was higher even than established diagnostic test methods of virus isolation and molecular detection of dengue RNA by reverse transcriptase-polymerase chain reaction (RT-PCR), for diagnosis of acute infection.2 A rapid point-of-care diagnostic for Japanese encephalitis (JEV), DENV, chikungunya (CHIKV), and West Nile virus (WNV) would be indispensable in routine laboratories lacking facilities available in academic or research hospitals. During the late incubation period or early febrile phase, cases are highly infectious with their blood teeming with viral RNA. If the offender mosquitoes bite a person during that phase of illness, there would be viral multiplication in the mosquito, along with viral amplification and dissemination in the community. For example, any infection by JEV, DENV, CHIKV, or WNV would be highly viremic. There would be no indication for antibiotics and no specific chemotherapy would be feasible for JEV, DENV, CHIKV, or WNV, but patients would require appropriate clinical management along with a public health response. Such viral infection would occur either alone or along with others. Concurrent infection was detected during a follow-up study of a dengue outbreak in India during the 1990s. Of 30 serum samples collected, 8 cases were positive for dengue IgM antibodies, 2 were positive for all the 3 infections, namely DENV, JEV and WNV, whereas 1 sample was positive for 2 infections, namely, JEV and WNV.3 Point-of-care assay like the rapid, immunochromatographic kits for CHIKV,4 would be essential. The multifaceted rapid assays to diagnose mosquito-borne viruses in the field would deserve fiscal support. Fiscal input would be cost-effective towards the decisive aim of effective public health and clinical response against JEV, DENV, WNV, and CHIKV. Subhash C. Arya, PhD, MBBS Nirmala Agarwal, FRCOG Department of Microbiology and Infection Control Sant Parmanand Hospital Delhi, India

Superficial Hepatic Capsular Lesions in a Systemically Ill Young Woman

Superficial Hepatic Capsular Lesions in a Systemically Ill Young Woman

Private sector hospital response to the 2003 dengue outbreak in the Indian capital metropolis of Delhi

During 2003, the Indian capital metropolis of Delhi was afflicted with an outbreak of dengue. A private-sector tertiary care hospital responded instantly to the sudden influx of 162 patients during an 8-week interval. That was an unusual challenge because, until 1997, the hospital had exclusively managed patients with ophthalmic disorders. Dengue patients received fiscal concessions and several free services. A multidisciplinary cell was commissioned for case management. Apart from a diagnosis of patients with dengue and their clinical management, suspected or confirmed dengue episodes were instantly reported to health authorities. Anti-mosquito measures in the hospital premises including residential areas for the nursing personnel prevented any local virus transmission. The integrated therapeutic and public health response was associated with a 1.23% case fatality rate. The protocol developed during the dengue outbreak would address every locally reportable disease in the future.

St. Louis Encephalitis and West Nile Virus Encephalitis.

St. Louis encephalitis virus is a major cause of epidemic arboviral encephalitis in the US. Transmitted by a mosquito vector, this virus is an annual public health concern during the late summer and early fall in much of the midwest and southeast. The characteristic epidemic features of this viral encephalitis coupled with public health surveillance and vector monitoring programs have made the diagnosis readily accessible during the past decade. Recently, however, the arboviral landscape in the US changed dramatically with the emergence and persistence of West Nile virus and associated human neurologic illness in New York and the Northeast. In its New York presentation, West Nile virus encephalitis exhibited clinical and laboratory similarities to St. Louis encephalitis. Not surprisingly, this led to initial confusion in establishing the diagnosis. In anticipation of the potential geographic spread of West Nile virus beyond the northeastern US, neurologists must now consider West Nile virus along with St. Louis encephalitis when diagnosing patients with suspected epidemic mosquito-borne viral encephalitis or meningoencephalitis. Although no specific antiviral agents are yet available, patients will benefit from close monitoring during the initial phase of illness, supportive critical care, and appropriate rehabilitation.

Pretreatment symptom distress in women newly diagnosed with breast cancer.

Although the initial phase of illness is recognized as important in the overall process of adjustment after a diagnosis of breast cancer, little is known about pretreatment patterns of symptom distress. Seventy-four women ages 25 to 79 years and newly diagnosed with breast cancer were studied to determine physical, cognitive, and affective distress in the pretreatment period. Severity of distress was assessed about 11 days before primary surgery using the Symptom Distress Scale (SDS), Attentional Function Index (AFI), and Profile of Mood States (POMS). Higher levels of distress (SDS) were related to a triad of symptoms, insomnia, fatigue, and loss of concentration. Also, lowered effectiveness in cognitive function (AFI) and significant disturbances in mood state (POMS) were observed. Overall, a greater number of symptoms was associated with lowered cognitive function (r = -0.47; p < 0.01) and greater mood disturbance (r = 0.65; p < 0.01). Younger women younger than 55 years of age (n = 25) reported significantly (p = 0.02) greater overall symptom distress (SDS) than older women (n = 49). Interestingly, severity of distress did not differ in groups anticipating breast-conserving surgery (n = 35) instead of mastectomy (n = 39). The findings showed a discernible pattern of symptom distress before any treatment in women newly diagnosed with breast cancer, indicating a need for early intervention to promote the initial process of adjustment.

Stability of positive and negative symptoms in schizophrenic patients: a 3-year follow-up study

The course of negative and positive symptoms was studied in neuroleptic-treated patients over a 3-year period, in consideration also of the initial phase of illness (post-acute or chronic). This study was carried out in a broadly defined schizophrenic sample, in order not to give preference to one diagnostic subgroup over another. Forty-six patients were evaluated every year for 3 years, 23 in the post-acute group and 23 in the chronic group. Aggravations of the Clinical Global Impression (CGI) and of the SANS total score were observed, regardless of the group (chronic or post-acute). This global aggravation confirmed Kraepelin's concept of dementia praecox; moreover, this aggravation was not due to an increase in the number of patients relapsing, or to an aggravation of akinesia. Three types of negative and positive symptom courses were observed: i) the mean sub-scores of positive symptoms, such as hallucinations, delusions, positive formal thought disorders, and of negative symptoms such as flattening affect, avolition/apathy and attentional impairment, did not vary significantly over time in either group; ii) the mean sub-scores of bizarre behavior and alogia fluctuated over time (p < 0.05) and only poverty of speech was perfectly stable among the items constituting alogia; iii) the mean subscores of anhedonia/asociality worsened significantly over time irrespective of the groups (p < 0.05), and among the items constituting anhedonia, recreational interest-activities and intimacy-closeness abilities worsened (p < 0.05 and p < 0.01, respectively). This aggravation was neither due to an increase in neuroleptic doses nor to the duration and chronicity of illness. However, negative symptoms, except anhedonia, can be reversible in some patients. The very strong stability of anhedonia, whatever the group, emphasize the importance of taking anhedonia into account in future diagnostic classifications.

Attentional fatigue following breast cancer surgery.

Attentional fatigue usually follows intense use of mental effort and is manifested as a decreased capacity to concentrate, that is, to direct attention. The purpose of this study was to examine the capacity to direct attention in persons with cancer during the initial phase of illness. The sample consisted of 32 women without cognitive or affective disorders who underwent surgery for localized (Stage I or II) breast cancer. Subjects manifested attentional deficits of varying intensity on a battery of tests of directed attention on the day before discharge from the hospital, which was a mean of 3 days following mastectomy or breast conservation surgery. Unexpectedly, the two surgical groups did not differ significantly in attentional capacity and functioning. Attentional test scores were not significantly correlated with narcotic pain medication interval, mood state, or self-ratings of attentional functioning. However, as number of days postsurgery increased, attentional performance decreased. The theoretical basis for further examination of attentional fatigue in people with cancer or other life-threatening illnesses is discussed.

Suppression of the night increase in serum TSH during development of ketosis in diabetic patients.

The alterations in metabolic parameters, circulating iodothyronines and serum TSH were studied during a 21 h period of insulin withdrawal in 6 young patients with juvenile type diabetes mellitus. Concomitant with the derangement of metabolic state a significant fall in serum T3 (in average 27%), serum free T3 (28%), and T4 (12%) was observed. SErum free T4 remained unchanged. Before and after the period of ketosis the normal diurnal pattern of high serum TSH at night and low levels during the daytime period was observed. During the period of ketosis the night level of serum TSH was significantly depressed (46 +/- 9% lower at 23.00 h, p less than 0.01) while no significant alterations occurred in daytime TSH. Both the variations in T3, reverse T3 (rT3) and night TSH were correlated to the increase in blood-3-hydroxybutyrate. The depression of the night surge in serum TSH may be of importance for the fall in circulating levels of active iodothyronines during the initial phase of illness, together with the well known inhibition of T4 deiodination to T3 in peripheral tissues occurring in acute illness.