Internal Medicine最新文献

Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons. Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered. Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.

Digital health, which encompasses digital medicine and therapy, integrates advanced technologies across healthcare. Central to this transformation is 'digitization,' which converts continuous analog data into a discrete digital form. However, this process is challenging. First, digitization inherently has the potential to introduce information loss, thereby diminishing the richness and complexity of data. Second, "digit bias," a cognitive distortion, emerges in the interpretation phase, where individuals' perceptions of and reactions to digital data are intrinsically skewed. There exist two major cognitive biases during digitization process: "digit preferences," where healthcare providers prioritize specific numbers, and "left digit bias" where continuous variables are disproportionately estimated by focusing on the leftmost digit. Although information loss and cognitive biases can cause significant distortions in healthcare, the effects of this "digitization" process have not been adequately quantified, and the accumulation of further evidence in this field is anticipated.

Gallbladder abscess is extremely rare. Aseptic abscesses are sometimes observed in patients with active ulcerative colitis (UC) with no history of colectomy; however, it is rare for an aseptic abscess in the gallbladder to develop after surgery for UC. We treated a 56-year-old man with UC and severe pouchitis who had undergone subtotal colorectal resection. A gallbladder lesion was noted during treatment for pouchitis, which increased in size. Therefore, the patient underwent cholecystectomy for suspected gallbladder cancer. A pathological examination revealed an aseptic abscess. This clinical report describes a rare case of an aseptic abscess in the gallbladder after surgery for UC.

We herein report a 68-year-old man with advanced non-small-cell lung cancer treated with tepotinib who showed marked general edema, hypoalbuminemia, and an elevated serum creatinine level. Although tepotinib-induced kidney injury due to creatinine transporter inhibition has been reported, renal biopsy findings suggested tubulointerstitial injury due to decreased renal blood flow, likely secondary to refractory fluid retention. This case highlights the potential for true kidney injury during tepotinib therapy and underscores the importance of careful monitoring and management of adverse renal effects.

We herein report a 69-year-old man with acute kidney injury who required dialysis after receiving a combination of three drug-induced lymphocyte stimulation test-positive drugs. A kidney biopsy showed tubulointerstitial nephritis with severe eosinophilic infiltration and numerous granuloma formations. Acute eosinophilic granulomatous tubulointerstitial nephritis was diagnosed. Eosinophilic granulomatosis with polyangiitis was ruled out because there was no evidence of vasculitis or serum antineutrophilic cytoplasmic antibody and no history of allergy. No clinical findings were suggestive of sarcoidosis. Based on the above findings, the disease was considered to be induced by these three drugs. The renal function was normalized with glucocorticoid treatment.

Background Despite the controversy regarding its clinical utility, the PaO₂/FIO₂ ratio has been used to define the severity of acute respiratory distress syndrome (ARDS). This systematic review and meta-analysis (SRMA) details summary estimates of the predictive performance of PaO₂/FIO₂ ratio in predicting mortality in patients with ARDS. Methods To clarify the integrated diagnostic accuracy, we included studies in which the study population comprised patients with ARDS in any clinical setting, included adult patients (≥18 years old), and evaluated mortality. The MEDLINE and Cochrane Central Registry of Controlled Trials databases were searched for articles in English. We performed SRMA on the accuracy of the diagnostic prognostic tests using the Quality Assessment of Diagnostic Accuracy Studies-2 tool to evaluate the risk of bias. We obtained summary point estimates of sensitivity and specificity and calculated the area under the receiver operating characteristic (AUROC) curve of the summary receiver operating characteristic curve with 95% confidence intervals (CIs). Results Twenty-eight trials with 38270 patients were included in the quality assessment. Most of the studies were conducted in intensive-care units. Overall, the risk of bias is high. For PaO_2/FIO₂ of 100 and 200 the pooled sensitivity, specificity, and AUROC were 44.8% (95% CI, 38.1%-51.7%), 70.6% (95% CI, 65.9%-74.9%), 0.60 (0.58-0.64) and 83.9% (95% CI, 78.9%-87.8%), 26.1% (95% CI, 20.8%-32.1%), 0.64 (0.60-0.69), respectively. Conclusion The PaO₂/FIO₂ ratio alone did not have impressive prediction accuracy for mortality in patients with ARDS and might not be able to be used solely as a clinical prognostic tool.

A 72-year-old man was admitted to our hospital with a complaint of breathlessness. Computed tomography revealed a tumor with intense early enhancement and pleural effusion. Although the pleural effusion was not bloody, the tumor showed a hypervascular area on angiography. Left thyrocervical artery embolization was performed to prevent bleeding during the operation. After embolization, chest radiography revealed decreased pleural effusion. The tumor was resected and pathologically diagnosed as a mediastinal cavernous hemangioma. To our knowledge, mediastinal hemangiomas with pleural effusion are extremely rare; thus, this is the first report of reduced pleural effusion in mediastinal hemangiomas after artery embolization.