Internal Medicine最新文献

Objective To assess the association between concomitant use of central nervous system drugs and femoral fracture risk in individuals ≥80 years old in Japan. Methods A case-crossover design was used, defining the case period as 3 days before the fracture diagnosis and the control period as 31-33, 34-36, and 37-39 days prior. The association between the daily intake of central nervous system drugs (Anatomical Therapeutic Chemical codes) and fracture risk was analyzed using conditional logistic regression. Patients Using the Japanese administrative claims database, we examined elderly patients diagnosed with femoral neck fractures between January 1, 2009, and December 31, 2020. Results In 255,875 patients, the concomitant use of central nervous system drugs increased the odds ratios of femoral fracture [3.41 (95% confidence interval: 3.27-3.55), 3.69 (3.46-3.91), 3.76 (3.42-4.13), and 4.34 (3.86-4.86) for an intake of >0-1, >1-2, >2-3, and >3 central nervous system drugs, respectively]. Conclusion The concomitant use of central nervous system drugs is associated with an increased risk of femoral fractures in individuals ≥80 years old in Japan.

Objective In recent years, there has been a growing focus on health risks associated with alcohol consumption. The present study investigated whether or not the genetic variant of aldehyde dehydrogenase 2 (ALDH2) influences the risk of gastric cancer among individuals identified as hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT), which provides a comprehensive assessment of hazardous drinking behavior. Patients We enrolled men with hazardous drinking behavior (AUDIT score ≥8) who had undergone gastric cancer screening (either endoscopy or a barium X-ray examination of the upper gastrointestinal tract) between April 2013 and March 2020 within 1 year from entry and who had subsequently undergone at least one more gastric cancer screening up to March 2021. Functional single-nucleotide polymorphisms of ALDH2 (rs671) were measured using a direct TaqMan polymerase chain reaction method with unprocessed saliva. Results A total of 246 men were enrolled, comprising 193 individuals with active ALDH2 (ALDH2*1/*1) and 53 with less-active ALDH2 (ALDH2*1/*2). The cumulative incidence of gastric cancer in the less-active group was higher than in the active ALDH2 group (p=0.01, hazard ratio: 4.6, 95% confidence interval: 1.2-16.7). Alcohol consumption was lower in the less-active ALDH2 group than in the active ALDH2 group, although no marked difference was observed in the AUDIT score. Conclusion In individuals with hazardous drinking behavior, a heightened risk of gastric cancer was observed among those with less-active ALDH2 variants, even when their alcohol consumption was comparatively lower than in those with active ALDH2 variants.

Histoplasmosis, a fungal infection caused by Histoplasma capsulatum, is endemic in many parts of the world. However, this is not common in Japan. We herein present a unique case of military histoplasmosis in a 45-year-old female with mixed connective tissue disease (MCTD) who was receiving immunosuppressive therapy. The histological findings coupled with molecular confirmation led to final a diagnosis. This case emphasizes the diagnostic challenges associated with histoplasmosis in immunocompromised patients and underscores the importance of considering it in the differential diagnosis of any atypical presentation in rheumatic patients.

Traditionally, the treatment of chronic constipation has focused on lifestyle modification, dietary guidance and therapy, and osmotic and stimulant laxatives. Recently, several drugs with new mechanisms of action have been introduced as treatments for chronic constipation. In Japan, polyethylene glycol and lactulose can now be administered under insurance coverage. The number of treatment options for constipation has increased dramatically. First, lifestyle modifications and dietary therapies must be implemented. If constipation does not improve sufficiently, specialized functional tests are performed to diagnose physiological subgroups. If functional tests are not available, patients are classified as having the "decreased frequency of defecation" type or the "difficult defecation" type based on the patient's symptoms, with treatment applied according to each type. Medical therapy includes osmotic laxatives, secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and Kampo medicines. The temporary use of stimulant laxatives, suppositories, enemas, and digital evacuation is also recommended. The usefulness of biofeedback is yet to be determined.

A 59-year-old woman presented with a rash on the top part of her hands and pain in the wrist joint and was diagnosed with dermatomyositis complicated by interstitial pneumonia positive for anti-melanoma differentiation-associated gene 5 (MDA-5) antibody. However, the patient reported a severe headache following treatment with oral prednisolone and tacrolimus. Posterior reversible encephalopathy syndrome (PRES) was diagnosed based on the brain magnetic resonance imaging findings. Tacrolimus was discontinued, and mycophenolate mofetil was instead administered with a favorable outcome. Mycophenolate mofetil should therefore be considered as an alternative treatment for anti-MDA-5-positive interstitial lung disease in cases where calcineurin inhibitors cannot be used.

IgG4-related disease (IgG4-RD) is a systemic and chronic inflammatory disorder that can affect every part of the body. The formation of tertiary lymphoid tissues (TLT) in the affected organs may be a key phenomenon in understanding the pathogenesis of this disease because T follicular helper (Tfh) 2 cells play an important role in IgG4 class switching within TLT in the affected organs or tissues. TLT formation leads to the formation of masses or swelling of the affected organs. Interleukin (IL)-4 and IL-10 are critical cytokines for IgG4-class switching and are produced in TLT. Other factors, such as CD4-positive (CD4+) cytotoxic T cells, M2 macrophages, and LAG3+ Tfh cells, have been identified as disease-specific contributors to lesion formation. In this review, I describe the current knowledge necessary to understand the pathogenesis of this disease and recent developments in treatment strategies beyond B-cell depletion therapy.

Objective Intravenous fluid therapy, including peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC) can occasionally lead to bloodstream infections (BSIs). PPN may thus be a risk factor for PVC-related BSI (PVC-BSI). However, the risk factors and incidence of PVC-BSI have not been previously reported, and evidence for these conditions remains unclear. Methods We retrospectively collected data from 391 patients who underwent PPN therapy with PVC at the Fukujuji Hospital from August 2022 to November 2023. We compared 20 patients who developed BSI during PPN therapy (BSI group) with 371 who did not develop BSI during PPN therapy (no-infection group). Results The incidence rate of PVC-BSI during PPN therapy was 5.1%. The BSI group had a significantly longer average daily infusion time of PPNs [median 24.0 (range 6.0-24.0) h vs. 6.0 (2.0-24.0) h, p<0.001] and of all intravenous fluids [median 24.0 (range 8.8-24.0) h vs. 10.3 (2.0-24.0) h, p<0.001] than the no infection group. An average daily infusion time of PPNs ≥12.0 h and an average daily infusion time of intravenous fluids ≥18.0 h were identified as predictive risk factors for BSI. When both risk factors were present, the sensitivity, specificity, and odds ratio for the development of BSI were 85.0%, 83.2%, and 27.9, respectively. Conclusion This study identified the incidence of and risk factors for developing BSI, such as a longer average daily infusion time of PPNs and all intravenous fluids, in patients receiving PPN therapy.