Journal of General and Family Medicine最新文献

Kawasaki disease (KD) is an acute systemic vasculitis managed mainly through intravenous immunoglobulin (IVIG), aspirin, and steroids. Although gastrointestinal symptoms are common, gastrointestinal bleeding is rare. We present the case of an 11-month-old girl with incomplete KD who developed severe gastrointestinal bleeding due to multiple gastric ulcers, despite prophylactic H2-receptor antagonist therapy, requiring blood transfusion therapy. This case illustrates that gastrointestinal bleeding can occur as a direct consequence of KD and from the combined effects of corticosteroids and nonsteroidal anti-inflammatory drugs. It emphasizes the need for vigilant monitoring and further research to efficiently prevent gastrointestinal bleeding in patients with KD.

We read with great interest the recent article by Fujikawa et al., “Family physicians have greater ambiguity tolerance in the clinical context: a nationwide cross-sectional study”.¹ The authors' contribution is timely and valuable, particularly for those of us involved in postgraduate training and professional development in family medicine.

Their findings reinforce what we often observe in our own practice and in the mentoring of new physicians: that tolerance for clinical ambiguity is an essential characteristic in primary care. This is especially true when facing diagnostic uncertainty, multimorbidity, and limited access to immediate investigations—hallmarks of both rural and urban family practice. The use of the J-TAMSAD scale represents a validated and appropriate method for evaluating this cognitive-emotional construct.²

While the cross-sectional methodology effectively highlights differences in tolerance levels between physicians, it also opens doors to several future inquiries. First, a longitudinal design could clarify how ambiguity tolerance evolves over time, from undergraduate training to clinical maturity.³ Second, qualitative inquiry may help explore how physicians conceptualize and respond to ambiguity in culturally distinct ways. In our Latin American context, ambiguity is not only a clinical challenge but also a sociopolitical and systemic reality. Family physicians often manage patients with complex needs, in under-resourced environments, without clear protocols or referral pathways.⁴

Moreover, we wish to underline the importance of ambiguity tolerance as a teachable and assessable competency. It is closely related to emotional resilience, clinical reasoning, and professional identity formation. Curricular models that integrate case-based learning, reflection, and feedback on uncertainty management may help future physicians to not only tolerate but also effectively navigate ambiguity.⁵ This is of particular importance in global family medicine, where adaptability to diverse contexts is essential for equitable care.

Fujikawa et al. provide critical evidence to support a broader, competency-based approach to medical education and ongoing professional development. Their article should stimulate further research and international dialogue, especially among educators and clinicians working in complex, variable, and resource-constrained settings like those frequently found across Latin America.

Manuel Millán-Hernández: Conceptualization; methodology; investigation; supervision; writing – review and editing. Daniela F. Albarrán-Pérez: Conceptualization; investigation; formal analysis; writing – original draft.

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Idiosyncratic drug-induced agranulocytosis is a rare but life-threatening condition that requires immediate medical intervention. Although sulbactam/ampicillin (SBT/ABPC) is a widely used antibiotic, no prior case reports of its associated agranulocytosis were identified in our narrative literature review. We present a case of an 85-year-old man who developed agranulocytosis following SBT/ABPC treatment for pressure ulcer infection and aspiration pneumonia, accompanied by a narrative literature review. Awareness of this condition, prompt discontinuation of the suspected agent, and close monitoring of total white blood cell counts are essential for early detection and management of this life-threatening complication.