Internal Medicine最新文献

Objective Patients undergoing maintenance dialysis are at a higher risk of morbidity and mortality due to severe coronavirus disease 2019 (COVID-19) than the general population. However, longitudinal data regarding this subpopulation of patients are lacking. We therefore examined the prognosis of patients with COVID-19 undergoing maintenance dialysis between 2020 and 2023. In addition, we explored the factors correlated with COVID-19 severity, focusing on the transition thereof throughout the observational period. Methods The primary outcome was the progression to severe or fatal COVID-19. We evaluated the correlation between the primary outcome and baseline demographic and clinical characteristics of patients. Patients undergoing maintenance dialysis who were hospitalized for mild-to-moderate COVID-19 between February 2020 and April 2023 were enrolled at four institutions in Kanagawa, Japan. Results Of the 173 patients, 7 (4.0%) developed severe COVID-19, and 12 (6.9%) died. The severe/death cohort was significantly older, with a higher percentage of unvaccinated patients than the non-severe cohort (58.2% and 25.0%, respectively; p=0.016). Thymus and activation-regulated chemokine levels on admission were lower in the severe/death cohort than in the non-severe cohort, albeit not to a statistically significant degree (148±84 mg/dL and 342±657 pg/mL, respectively; p=0.082). A multivariate logistic regression analysis revealed that the odds ratio for severe morbidity or death was 0.23 (95% confidence interval: 0.07-0.75) for vaccinated patients. Conclusion In patients undergoing maintenance dialysis, the severity rate of COVID-19 is approximately 10%. Vaccination was correlated with a reduced risk of severe COVID-19.

The year 2023 marked a significant change for Internal Medicine, as the number of submissions related to the novel coronavirus infection (COVID-19) declined significantly and interest shifted to other disease fields and research areas. Our journal published its first articles on artificial intelligence (AI) and machine learning (ML), and these articles have shown that AI may be useful for the early detection of potential cardiac diseases, while ML can be used to predict the risk of serious illness in patients hospitalized with COVID-19, providing new possibilities for diagnoses and treatment. In addition to touching on the above, the present article also highlights the status of submissions to the journal (including the number of submissions and acceptance rate) in 2023.

We herein report three patients with Fontan-associated liver disease (FALD) who developed hepatocellular carcinoma (HCC). All three patients had very high serum alpha-fetoprotein (AFP) concentrations, and their HCCs were located in the peripheral areas of the liver. To identify the characteristics of FALD-HCC, we reviewed previously published case reports that included descriptions of imaging. This review revealed that FALD-HCC is generally located in the peripheral areas of the liver and AFP concentrations are usually high. Thus, it is important that follow-up of patients with FALD include repeated AFP concentrations and abdominal imaging.

Objective To determine the clinical background factors of patients with type 2 diabetes who showed deterioration of defecation status after hospitalization. Methods The defecation status of 128 patients with type 2 diabetes who were admitted to our department for diabetes education was evaluated for 7 days after hospitalization. New-onset constipation was diagnosed when patients without constipation before hospitalization met the criteria for constipation after hospitalization. Worsening constipation was diagnosed when patients with constipation required a larger laxative dose than that before hospitalization. New-onset constipation and worsening constipation were defined as the deterioration of defecation status. The major outcome was the incidence of deterioration of defecation status after hospitalization. Results After hospitalization, 23 of 99 patients who had no constipation before hospitalization developed new-onset constipation. Among the 29 patients with constipation before hospitalization, 9 showed worsening constipation. Overall, 52 patients (41% of all subjects) had constipation, and 32 (25% of all subjects) were diagnosed with deterioration in defecation status. In univariate logistic regression analyses, patient age, albuminuria, diabetic peripheral neuropathy, AST, eGFR, HbA1c, and baPWV were significantly associated with deterioration in defecation status. In the multivariate logistic regression analyses, albuminuria was the only factor that showed a significant association with the deterioration of defecation status after hospitalization. Conclusion Constipation is highly prevalent among hospitalized patients with type 2 diabetes. Paying attention to albuminuria is useful for facilitating an appropriate response to the deterioration of defecation status in patients with type 2 diabetes after hospitalization.

We herein report a 48-year-old man with neurosyphilis manifesting as limbic encephalitis, initially suspected to be autoimmune limbic encephalitis. The patient exhibited rapid behavioral changes, and magnetic resonance imaging showed high-intensity lesions in both medial temporal lobes. The diagnosis was based on symptoms, cerebrospinal fluid abnormalities, and positive serum tests for syphilis. Notably, the cerebrospinal fluid immunoglobulin G index was markedly elevated (4.91). This case highlights the diagnostic challenges in differentiating neurosyphilis from autoimmune limbic encephalitis, given the increasing atypical presentation. A markedly elevated immunoglobulin G index may serve as a valuable diagnostic indicator for neurosyphilis in such cases.

Erdheim-Chester disease (ECD) is a rare type of non-Langerhans cell histiocytosis, characterized by the infiltration of disease-specific foamy histiocytes, polymorphic granulomas, and fibrosis. Although cardiovascular involvement is observed radiologically in approximately half of ECD patients, only a few reports have described its pathological features. We herein report the autopsy of an ECD patient with pulmonary, cardiovascular, and retroperitoneal involvement that may have caused his death. Autopsy revealed the pathological association of coronary and renal arterial stenosis with the BRAF^V600E gene mutation. BRAF mutations should be considered in patients with ECD, especially in those with arterial lesions.

A 61-year-old man who underwent allogeneic bone marrow transplantation presented to our hospital with severe abdominal pain and no significant rash. Computed tomography revealed periarterial fat stranding around the celiac and superior mesenteric arteries. Skin and gastric biopsies revealed varicella-zoster virus (VZV) infection, leading to the diagnosis of VZV infection. Symptoms of VZV infection are severe and potentially fatal, making early intervention important. The characteristic findings of periarterial fat stranding around the celiac and superior mesenteric arteries on CT may play an important role in the early diagnosis of VZV infection.

Anti-GM1 antibodies are associated with Guillain-Barré syndrome (GBS), primarily peripheral neuropathy. However, there are cases of anti-GM1 IgG antibody-positive GBS with upper motor neuron (UMN) signs. We herein report a case of gastrointestinal infection followed by subacute gait disturbance with predominant signs of UMN on a neurological examination. The serum and cerebrospinal fluid tests were positive for anti-GM1 and anti-asialo-GM1 IgG antibodies. An electrophysiological evaluation revealed normal nerve conduction and prolonged central motor conduction times. No MRI abnormalities were observed. The symptoms improved with treatment, which was accompanied by decreased antibody titers. This case highlights the fact that anti-GM1 IgG-associated disorders may present with predominant UMN involvement.