A man in his 60s was ultimately diagnosed with a secondary lung abscess caused by an esophagorespiratory fistula. On admission, however, he had initially been diagnosed with a primary lung abscess because of aspiration, given his history of alcohol use. Secondary lung abscesses can result from various underlying conditions. Among these, esophagorespiratory fistulas are significant causes and are often associated with esophageal cancers. An intriguing aspect of this case is that secondary lung abscesses originating from esophageal cancer can occur under similar conditions as aspiration-related pulmonary suppuration. Given the difficulty in distinguishing between the two based solely on imaging, physicians should exercise caution when encountering patients with a history of heavy alcohol consumption.
Atopic dermatitis is a chronic inflammatory skin condition treated with topical corticosteroids as first-line therapy. The Finger-Tip Unit (FTU) serves as an objective indicator for determining appropriate amounts of topical corticosteroids. However, the amount of topical corticosteroids prescribed and the amount actually applied by patients based on the FTU method in clinical practice and its efficiency remain unclear.
We conducted a cross-sectional study at 36 community pharmacies in Japan. Atopic dermatitis patients aged ≥16 years prescribed topical corticosteroids were surveyed. The primary outcome was FTU-based prescription insufficiency, defined as an insufficient amount of prescription compared to the required application amount based on the FTU method. Secondary outcomes included FTU-based application insufficiency, defined as an insufficient amount of application compared to the required application amount based on the FTU method, and patient-reported prescription insufficiency. We also explored factors associated with FTU-based application insufficiency.
Among 116 participants, FTU-based prescription insufficiency was observed in 35.7% of patients. FTU-based application insufficiency and patient-reported prescription insufficiency were observed in 39.8% and 17.4% of patients, respectively. Moreover, FTU-based prescription insufficiency was associated with FTU-based application insufficiency (adjusted OR: 4.12, 95%CI: 1.72–9.87, p = 0.001).
In patients with atopic dermatitis, about one-third or more had insufficient corticosteroid prescriptions and applications based on FTUs. All healthcare providers, including primary care physicians, dermatologists, and pharmacists, may ensure prescription amounts and provide guidance on application doses that align with FTU methods.
A 68-year-old man was emergently transported to the hospital due to a sudden onset of motor paralysis and sensory impairment in the left upper and lower limbs. He arrived 90 minutes after symptom onset. He reported no headache, chest pain, or back pain. His vital signs on admission were as follows: body temperature, 36.0°C; blood pressure, 130/102 mmHg; heart rate, 98 beats per minute (regular); respiratory rate, 20 breaths per minute; and peripheral saturation in oxygen, 95% on room air. His consciousness was clear, with no conjugate gaze deviation or dysarthria. On physical examination, he had muscle weakness (Medical Research Council grade 4) and decreased superficial sensation in the left upper and lower limbs. The National Institutes of Health Stroke Scale score was 3. Carotid ultrasound revealed good-color Doppler signals in both carotid arteries, with no evidence of arterial dissection. There were no apparent stroke findings on head computed tomography (CT) and magnetic resonance imaging.
Laboratory tests revealed a markedly elevated D-dimer level (33.0 μg/mL). Additionally, supine chest radiography showed mild mediastinal widening (9 cm in the upper mediastinum). The pulses in the left radial and dorsalis pedis arteries were not palpable. Contrast-enhanced CT demonstrated extensive aortic dissection extending from the ascending aorta to the level of the common iliac arteries, with pericardial effusion. Blood flow beyond the left subclavian artery and left common iliac artery was completely occluded (Figure 1), but the dissection did not extend into the carotid or intracranial arteries. The patient was diagnosed with Stanford type A acute aortic dissection (AAD). He was transferred to a higher-level medical facility but developed cardiac arrest because of cardiac tamponade during transport. Despite resuscitative efforts and intensive care, he did not survive.
In Stanford type A AAD, aortic dissection frequently extends beyond the carotid arteries, leading to cerebral infarction and subsequent unilateral upper and lower limb neurological deficits.1 However, cases in which unilateral upper and lower limb paralysis and sensory impairment mimic stroke because of simultaneous dissection-related arterial occlusion are exceedingly rare. There have been reports of AAD causing unilateral lower limb paresthesia and pain2, 3 and of acute limb ischemia presenting as unilateral upper and lower limb paresthesia.4 These findings underscore the importance of differentiating ischemia from neurological disorders in cases of acute unilateral symptoms. In our case, the absence of pain made differentiation from stroke even more challenging. When urgent evaluation is required to administer intravenous thrombolysis (t-PA) for acute ischemic stroke, carotid ultrasound is often useful in ruling out AAD.5 However, as demonstrated in this case, carotid ultr
Chronic kidney disease (CKD) is a growing public health concern globally, with primary care physicians (PCPs) playing a pivotal role in its early detection and management. This review explores the epidemiology, risk factors, screening strategies, and clinical manifestations of CKD within primary care settings. PCPs are integral in recognizing at-risk populations, initiating timely screening through eGFR and albuminuria tests, and managing modifiable risk factors like hypertension and diabetes. The article discusses current guideline-recommended pharmacologic therapies—including RAAS inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and non-steroidal MRAs—that slow disease progression. Lifestyle modifications and dietary interventions are emphasized as essential components of care. Additionally, the review outlines key indications for nephrology referral and the management of common CKD complications, such as anemia and mineral-bone disorder. By embracing a proactive and multidisciplinary approach, PCPs can significantly influence CKD outcomes, reduce progression to end-stage renal disease, and improve overall patient prognosis.
We report an 80 year old man in the terminal stage of cancer receiving home care. On the 18th day after starting home care, he experienced a sudden onset of impaired consciousness, unsteadiness of gait, and ophthalmoplegia. Based on the clinical symptoms and a prolonged loss of appetite, Wernicke encephalopathy (WE) was suspected. Thiamine 100 mg was administered intravenously, and 20 minutes later, the patient responded to verbal stimuli. After 1 h, he was able to engage in conversation. When impaired consciousness occurs in cancer patients receiving home care, it is important to consider WE as a differential diagnosis.
This study aimed to clarify the status of disease management during home visits for patients with heart failure (HF).
In this cross-sectional study, questionnaire surveys were conducted with health-care professionals employed by home-visit nursing stations in Kochi Prefecture. Data were collected by postal mail between May and June 2019. A 13-item questionnaire was created based on the disease management items in the “2017 Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure.” The Chi-square test and logistic regression analysis were used for the statistical analyses.
The analysis set comprised data collected from 144 nurses and therapists. Regarding disease management for patients with HF, 99.1% of the nurses examined the “status of blood pressure measurement” during home visits. Regarding therapists, 100% confirmed the “status of blood pressure measurement” as well as “signs and symptoms of heart failure.” The items “status of medication use,” “body weight measurement and changes,” “infection prevention and vaccination,” “psychiatric symptoms (anxiety and depression),” and “cognitive function” were confirmed significantly more frequently by nurses than by therapists. After adjusting for confounders, compared with therapists, “body weight measurement and changes” (adjusted odds ratio [aOR]: 4.58; 95% confidence interval [CI]: 1.11–18.87) and “psychiatric symptoms (depression and anxiety)” (aOR: 7.25; 95% CI: 1.39–37.70) were confirmed significantly more frequently by nurses than by therapists.
The present findings suggest that, compared with therapists, nurses attempt to gain a greater overall understanding of the status of patients with HF in disease management.
Although selected patients with community-acquired pneumonia (CAP) can be treated in outpatient settings, some exhibit an insufficient response to initial outpatient treatment resulting in subsequent hospitalizations. Laboratory and animal studies have demonstrated that makyokansekito, a Japanese herbal kampo medicine, can alleviate lung damage and inflammation. However, its clinical effectiveness in adult patients with CAP has not been evaluated.
Using the commercially available JMDC health insurance claims database (Tokyo, Japan), we identified outpatients with CAP between April 2012 and April 2022. Patients were classified into those who received or did not receive makyokansekito on the day of diagnosis. The primary outcome was hospitalization within 30 days. The secondary outcomes included antibiotic treatment duration and total medical costs. Multivariate regression analyses were used to compare the outcomes between the two groups.
Among 76,177 eligible patients, 273 and 75,904 were classified into the makyokansekito and non-makyokansekito groups, respectively. After adjustment, the proportions of hospitalized patients in the makyokansekito and non-makyokansekito groups were 3.0 and 3.4%, respectively, with a difference of −0.4% (95% confidence interval [CI], −2.5% to 1.8%; p = 0.705). The adjusted mean antibiotic treatment durations were 6.3 and 6.5 days, respectively, with a difference of −0.2 days (95% CI, −0.6% to 0.1%; p = 0.155). Adjusted total medical costs were 53,455 and 52,000 Japanese yen (JPY), respectively, with a difference of 1452 JPY (95% CI, −10,988 to 18,525 JPY; p = 0.852).
The use of makyokansekito in outpatients with CAP was not associated with a reduction in hospitalization.
The incidence of hypertension is increasing worldwide. Recent studies have suggested that smaller thighs are a disadvantage for health and survival, but the association of body mass index (BMI) adjusted for thigh circumference (BMI-to-thigh ratio) and hypertension remains uncertain.
This study included 788 men (mean age 69 ± 10 years) and 975 women (mean age 69 ± 10 years) from a rural village. The relationship between BMI-to-thigh ratio and hypertension was examined using both cross-sectional (baseline, N = 1763) and cohort data (follow-up, N = 433). Logistic regression models were used to evaluate the BMI-to-thigh ratio as a significant predictor of hypertension.
Both the cross-sectional and cohort data demonstrated that higher BMI-to-thigh ratios were associated with an increased prevalence and incidence of hypertension. In the cohort data, participants in the fourth quartile (odds ratios [OR]: 2.58, 95% confidence interval [CI]: 1.15–5.80) and third quartile (OR: 2.54, 95% CI: 1.24–5.20) of the BMI-to-thigh ratio had significantly higher ORs compared with the first quartile. In the cross-sectional data, the optimal BMI-to-thigh ratios cutoff values for predicting hypertension were 51 (sensitivity: 71.1%; specificity: 54.3%) for men and 51 (sensitivity: 65.0%; specificity: 70.6%) for women. In the cohort data, the optimal BMI-to-thigh ratios were 50 (sensitivity: 73.2%; specificity: 52.3%) for men and 47 (sensitivity: 70.9%; specificity: 51.2%) for women.
The findings suggest that the BMI-to-thigh ratio is a useful screening tool for incident hypertension.
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