Acute Medicine & Surgery最新文献

Each patient with a critical illness such as sepsis and severe trauma has a different genetic background, comorbidities, age, and sex. Moreover, pathophysiology changes dynamically over time even in the same patient. Therefore, individualized treatment is necessary to account for heterogeneity in patient backgrounds. Recently, the analysis of comprehensive biomolecular information using clinical specimens has revealed novel molecular pathological classifications called subtypes. In addition, comprehensive biomolecular information using clinical specimens has enabled reverse translational research, which is a data-driven approach to the identification of drug target molecules. The development of these methods is expected to visualize the heterogeneity of patient backgrounds and lead to personalized therapy.

A 74-year-old man presented to the emergency department with acute diplopia and transient left-sided paresthesia of the upper and lower limbs. He reported no headaches, dizziness, or vision loss. Upon presentation, he was alert and oriented. Neurological examination revealed right abducens nerve palsy with diplopia on the right lateral gaze (Figure 1A). His left-sided paresthesia had improved on presentation, and there were no other neurological findings. Brain magnetic resonance imaging (MRI) revealed a small infarct in the right pontine tegmentum (Figure 1B,C). Magnetic resonance angiography revealed no significant stenosis of the cerebral arteries. Dual antiplatelet therapy was started, and his right abducens nerve palsy gradually resolved. He was discharged after a one-week hospital stay.

To our knowledge, this is the second report of medial pontine mid-tegmentum syndrome¹ resulting from damage to the mid-lateral portion of the medial lemniscus of the pons. Because the abducens nerve crosses the medial lemniscus at the pontine level, this syndrome is associated with ipsilateral abducens nerve palsy and contralateral sensory disturbance¹ (Figure 1D). Given the limited sensitivity of MRI for detecting ischemic stroke of the posterior circulation,² recognition of this syndrome as one of the stroke syndromes is critical for prompt intervention.

The authors declare no conflicts of interest.

Approval of the research protocol: N/A.

Informed consent: Informed consent was obtained from the patient.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

We have read with great interest the study by Shirasaki et al.¹ recently published in Acute Medicine and Surgery, where the authors studied the long-term outcomes of psychiatric disorders in families of COVID-19 patients admitted to the intensive care unit (ICU) of a single hospital in Tokyo, Japan. They described that as high as 39% of families suffered from anxiety and/or depression even more than a year after the patient's discharge. Notably, this is a valuable study that presents data on long-term post-intensive care syndrome—family (PICS-F) in Japan.

In the context of the prolonged COVID-19 pandemic, the high transmissibility of SARS-CoV-2 may pose an additional discussion in assessing the long-term psychological outcomes of family members of COVID-19 patients. According to the Japanese Ministry of Health, Labour, and Welfare, the prevalence of SARS-CoV-2 antibodies among Japanese adult population is as high as 56.4%, as of November 2023.² The fact suggests that many family members may have contracted COVID-19 themselves during the epidemic.

A crucial aspect to consider is the prevalence of “long COVID,” a condition characterized by persistent sequelae including psychiatric disorders, in a significant number of COVID-19 survivors.³ Notably, around 30% of COVID-19 patients who required mechanical ventilation in Japan exhibited symptoms of psychiatric disorders after discharge.⁴

Furthermore, while the Hospital Anxiety and Depression Scale (HADS) is a widely recognized tool for assessing anxiety and depression symptoms in PICS-F,⁵ it does not specifically determine whether these symptoms are directly linked to the ICU admission of a family member. As a result, the depressive and anxious symptoms described in this study could be attributed not only to PICS-F but also to the impacts of long COVID or post-intensive care syndrome (PICS) experienced by the patients themselves. Therefore, we feel it is essential to adopt a more nuanced approach to understand the complex effects of these conditions on the mental health of families affected by COVID-19.

Again, we would applaud the authors for performing such an important study, which suggests the need for support for both patient-centered and family-centered care during the remote period after the patient's discharge from the ICU.

The authors declare no conflicts of interest.

Approval of the research protocol: N/A.

Informed consent: N/A.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

A computed tomography (CT) image of the patient's neck after a cricothyroidotomy was performed due to upper airway obstruction. The CT revealed that the tracheostomy tube was inserted into the thyrohyoid membrane, not the cricothyroid ligament.