Journal of rural medicine : JRM最新文献

Objective: Although gastrointestinal symptoms are common immediate reactions to food allergies (FA), the relationship between acute pancreatitis (AP) and FA remains unclear.

Patient: A 3-year-old boy developed vomiting, dyspnea, and urticaria 30 min after eating a cashew nut (CN) and was diagnosed with anaphylaxis.

Results: The patient was diagnosed with AP based on markedly elevated serum pancreatic amylase activity (1,847 IU/L) and mild pancreatic enlargement on abdominal ultrasonography, despite the absence of abdominal pain. All symptoms resolved immediately after intramuscular adrenaline injection, and serum pancreatic amylase activity normalized after 3 days. CN allergy was diagnosed based on blood tests showing elevated serum levels of CN- and Ana o 3-specific immunoglobulin E.

Conclusions: This is the first reported case of AP associated with anaphylaxis due to a CN allergy. AP should be considered in patients with FA who present with gastrointestinal symptoms, even if vomiting is the only symptom and abdominal pain is absent. AP associated with anaphylaxis may resolve rapidly with appropriate treatment.

Objective: Following the novel coronavirus disease 2019 (COVID-19) outbreak that began in 2020, contact between hospitalized patients and their families was significantly restricted to prevent infection. In May 2023, COVID-19 was classified as a Class 5 infectious disease by the Japanese Ministry of Health, Labour and Welfare. Although restrictions have gradually been lifted in some areas, at the time of writing this report, our hospital has not lifted all visit restrictions. Understandably, patients in this situation experience mental distress due to a lack of support from family, friends, or partners. Although remote visits have been introduced as an alternative to in-person visits, their effectiveness remains unclear. In this study, we report three cases in which we examine the impact of remote visits via electronic devices on patients who were unable to receive in-person visits.

Patients: Among the inpatients referred to our hospital's palliative care team from April 2022 to March 2023, three who requested remote visits due to psychological distress caused by the inability to see their families were enrolled in this study.

Results: The degree of psychological distress in all cases reduced after conducting remote visits. However, cancer-related pain (in two patients) and postoperative wound pain (in one patient) showed no significant differences in severity. In one patient, anxiety was evoked following a remote visit. This was attributed to the patient's realization of their isolation from their family.

Conclusion: For patients whose family members are unable to conduct in-person visits due to visit restrictions for various reasons, remote visits may help alleviate psychological distress. Since remote visits can cause adverse emotional reactions in some cases, monitoring the mental status during and after remote visits is necessary.

Objective: Recent treatment advancements have improved the survival rates of patients with hematological malignancies, making hematopoietic stem cell transplantation (HSCT) a key curative option. However, despite ongoing awareness efforts, the number of bone marrow donor registrations has not significantly increased over time, possibly because of the impact of recent infectious disease outbreaks. This may affect patients requiring allogeneic HSCT. This study explored the experiences of adolescent and young adult (AYA) bone marrow donors.

Patient and methods: Using a qualitative descriptive research design, we conducted semi-structured interviews with six AYA individuals who had experience as bone marrow donors. The study was approved by the institutional ethics committee (022-03), and no conflicts of interest were disclosed.

Results: Seven categories and 23 subcategories were identified in this analysis. Participants reported a strong sense of duty as donors, but faced challenges such as family opposition, lack of understanding from employers, and concerns about the impact on work and family life. Despite these difficulties, donors often experienced personal growth and fulfillment through donation.

Conclusion: Nurses should recognize AYA bone marrow donors as a population that requires support, and consider strategies to increase the understanding and registration among this crucial demographic group.

Objective: We present a case of small intestinal perforation within an inguinal hernia following low-energy indirect trauma.

Patient: A 55-year-old man with a known right inguinal hernia which had no prior indication for surgery developed acute right groin pain after sudden braking caused his scooter handlebar to strike his right thigh.

Results: Physical examination and computed tomography (CT) scan of the abdomen and pelvis revealed multiple pockets of extraluminal air within the hernia sac, as well as gas bubbles in the surrounding intestinal contents. Based on these findings, we made a diagnosis of small intestinal perforation within the inguinal hernia.

Conclusion: Small intestinal perforation within an inguinal hernia is an uncommon but potentially life-threatening complication requiring emergent surgical intervention. Delays in diagnosis and management can lead to peritonitis, abscess formation, sepsis, and prolonged hospitalization. Therefore, clinicians should maintain a high index of suspicion for intestinal perforation in patients with inguinal hernias, even in the absence of direct trauma or subsequent low-energy injuries.

Objective: Fabry disease is rarely reported in South Asian countries, except India. Here, we report a case of Fabry disease incidentally discovered in a Bangladeshi male.

Case report: A 31-year-old Bangladeshi male presented to our hospital in Japan for the evaluation of potential male infertility, during which hypospermia and asthenozoospermia were identified. No structural or endocrine abnormalities were observed; however, mulberry bodies were incidentally detected during urine microscopy. Reduced α-galactosidase activity and a known genetic mutation confirmed the diagnosis of Fabry disease. The patient was provided with information regarding Japan's subsidy program for rare diseases, through which he could access enzyme replacement therapy.

Conclusion: Fabry disease is likely to be underdiagnosed in developing countries because of limited medical resources and awareness. Although early detection has improved in developed countries, high treatment costs remain a challenge. This case highlights the need to balance equitable access to treatment for rare disorders, such as Fabry disease, with the maintenance of a sustainable healthcare system, regardless of the patient's nationality or socioeconomic status.

Objective: The purpose of this study was to clarify the meaning of the use of type-B continuous employment support facilities by individuals with mental disabilities and to examine the factors that make their transition to general employment difficult based on previous studies. This study sought to obtain insight into the role of nurses in employment-related disability welfare services.

Materials and methods: A literature search was conducted using the web version of the Igaku Chuo Zasshi (Index Medicus of Japan) and Medical Online search system. Sentences describing the meaning of Type B continuous employment support facilities were extracted, and the resulting data were collected and categorized. Factors that made the transition to regular employment difficult were summarized descriptively based on the extracted data.

Results: The use of type-B continuous employment support facilities by those with mental disabilities meant the following: [awareness as a member of society], [increased sense of self-efficacy], [attempts to stabilize psychiatric symptoms], and [independence in daily living]. The following factors complicated the transition of individuals with mental disabilities to regular employment: they found illness management challenging because of their psychiatric symptoms, which caused difficulties in continuing to work. They also perceived their workplace environment negatively, complaining that their coworkers did not understand their psychiatric symptoms.

Conclusions: Individuals with mental disabilities found meaning in utilizing B-type continuous employment support facilities beyond simply aiming for a transition to general employment. However, numerous factors complicate the transition to full employment. One is that individuals with mental disabilities find it challenging to manage their psychiatric symptoms. Hence, our findings suggest an increasing need for collaboration with nursing professionals and for providing high-level nursing care.

Severe fever thrombocytopenia syndrome (SFTS) is a tick-borne viral hemorrhagic fever prevalent throughout Asia. In 2024, our hospital in eastern Shizuoka reported three consecutive cases of SFTS, the first such cluster identified in this region. Since April 2013, the confirmed area of infection has expanded from Kyushu to Shizuoka, which currently marks the easternmost limit. As global warming progresses, the spread of SFTS is projected to increase.

Objective: This study aimed to determine the prevalence and risk factors of intimate partner violence during pregnancy in rural Tanzania.

Method: An analytical cross-sectional study was conducted among 360 randomly selected postnatal mothers in rural Tanzania between March and April 2024 to determine the prevalence and risk factors of intimate partner violence during pregnancy. Data were collected using a pre-tested, semi-structured questionnaire. Bivariate and multivariable logistic regression analyses were performed using Statistical Package for Social Sciences (SPSS) version 25 to identify risk factors. Statistical significance was assessed at a 95% confidence interval (CI), with associations reported as Adjusted Odds Ratios (AOR).

Results: During pregnancy, 70.3% of women experienced at least one form of violence, with 45.6% suffering from two or more forms. Overall, 112 postnatal mothers (31.1%, 95% CI=26.4%-36.2%) experienced intimate partner violence during pregnancy. Significant factors included the health facility attended; Kondoa (AOR=0.262, P=0.017), Mpwapwa (AOR=0.197, P=0.001), Manyoni (AOR=0.086, P<0.001), and Sokoine (AOR=0.122, P<0.001) compared to Makole Health Center; rural residence (AOR=3.653, P=0.001), woman's autonomy in choosing partner (AOR=2.757, P=0.046); dowry payment (AOR=2.809, P=0.013); male partner's alcohol use (AOR=2.125, P=0.025), and a history of abortion (AOR=2.910, P=0.005).

Conclusion: A high proportion of women experienced intimate partner violence during pregnancy. Residing in rural areas, autonomy in partner selection, bride price payment, male partner alcohol use, prior experience of abortion exacerbated the prevalence. The study advocates for widespread educational campaigns to raise awareness about the detrimental impact of intimate partner violence, especially during the vulnerable period of pregnancy.

Objective: This report describes a rare case of a dural arteriovenous fistula of the falcine sinus associated with a flow-related aneurysm.

Patient and methods: A 68-year-old man presented with severe headache secondary to an intracranial hemorrhage. The bleeding was caused by a dural arteriovenous fistula (dAVF) of the falcine sinus with a flow-related aneurysm of the dural branch of the right posterior cerebral artery.

Results: Trans arterial obliteration of the aneurysm and its feeder using glue and trans venous embolization of the draining portions using a coil were successfully performed.

Conclusion: The unusual coexistence of a flow-related aneurysm on the feeder of the dAVF resulted in a unique hemorrhage.

Objective: Standard treatment modalities, including surgery, are desirable, even in older adults with breast cancer. However, frailty and comorbidities may limit surgery. This study aimed to evaluate whether endocrine therapy (ET) is associated with a lower survival rate than a standard surgical regimen.

Patients and methods: In this retrospective observational study, older adults (aged ≥75 years) diagnosed with nonmetastatic hormone receptor-positive, HER2-negative, primary breast cancer who were treated between 2006 and 2022 were evaluated in the ET (n=33) and surgery (n=95) groups. Survival status and cause of death were analyzed by estimating the overall survival (OS) and breast cancer-specific survival (BCSS) rates. Univariate and multivariate analyses were performed to identify survival-associated factors. Propensity score matching (PSM) was used to reduce the effect of selection bias.

Results: The median ages of the ET and surgery groups were 84.6 and 80.4 years, respectively, and their mortality rates were 12.5% and 17.2%, respectively. OS and BCSS were significantly higher in the surgery group than in the ET group (hazard ratio [HR] 0.27, P=0.0014 and HR 0.66, P=0.029, respectively). Age, performance status, and treatment regimen proved to have a significant effect on OS and BCSS in univariate analysis. Only age and treatment affected OS; however, no factors were shown to affect BCSS in multivariate analysis. After PSM, the OS rates were higher in the surgery group than in the ET group (HR 0.23, P<0.001); however, no differences in BCSS rates were found.

Conclusion: ET may be an appropriate treatment option for older adults with breast cancer without sufficient life expectancies.