Pub Date : 2022-06-07DOI: 10.2169/internalmedicine.9291-21
Naoto Kuroda, Anna Suzuki, Kai Ozawa, Nobuhiro Nagai, Yurika Okuyama, Kana Koshiishi, Masafumi Yamada, Yoshihiko Raita, Y. Kakisaka, N. Nakasato, M. Kikukawa
Objective This cross-sectional national study determined which educational approaches are associated with the effectiveness of online clerkship for medical students. Method A survey was conducted for medical students at 78 medical schools in Japan from May 29 to June 14, 2020. It comprised the following aspects: (a) participants' profiles, (b) number of opportunities to learn from each educational approach (lecture, medical quiz, assignment, oral presentation, observation of a physician's practice, clinical skill practice, participation in interprofessional meetings, and interactive discussions with physicians) in online clerkship, (c) frequency of technical problems, and (d) educational outcome measurement (satisfaction, motivation, knowledge acquisition, skill acquisition, change in self-study time, and understanding of the importance of medical care team). Results Of the 2,640 respondents, 2,594 (98.3%) agreed to cooperate. Ultimately, 1,711 matched our inclusion criteria. All educational approaches but assignments were positively associated with satisfaction and motivation. All educational approaches excluding assignment submission and interprofessional meeting were positively associated with knowledge acquisition. Observation, practice, and interprofessional meeting were positively associated with skill acquisition. Only assignment submission was positively associated with the change in self-study time. Educational approaches excluding medical quizzes were positively associated with understanding the importance of the medical care team. Technical problems were negatively associated with motivation, knowledge acquisition, and skill acquisition. Conclusions Educators should implement various educational approaches, especially observation and practice, even in online clinical clerkship. They also need to minimize the technical problems associated with the Internet, as they reduce the effectiveness of online clerkship.
{"title":"Educational Approaches That Enhance Online Clinical Clerkship during the COVID-19 Pandemic","authors":"Naoto Kuroda, Anna Suzuki, Kai Ozawa, Nobuhiro Nagai, Yurika Okuyama, Kana Koshiishi, Masafumi Yamada, Yoshihiko Raita, Y. Kakisaka, N. Nakasato, M. Kikukawa","doi":"10.2169/internalmedicine.9291-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.9291-21","url":null,"abstract":"Objective This cross-sectional national study determined which educational approaches are associated with the effectiveness of online clerkship for medical students. Method A survey was conducted for medical students at 78 medical schools in Japan from May 29 to June 14, 2020. It comprised the following aspects: (a) participants' profiles, (b) number of opportunities to learn from each educational approach (lecture, medical quiz, assignment, oral presentation, observation of a physician's practice, clinical skill practice, participation in interprofessional meetings, and interactive discussions with physicians) in online clerkship, (c) frequency of technical problems, and (d) educational outcome measurement (satisfaction, motivation, knowledge acquisition, skill acquisition, change in self-study time, and understanding of the importance of medical care team). Results Of the 2,640 respondents, 2,594 (98.3%) agreed to cooperate. Ultimately, 1,711 matched our inclusion criteria. All educational approaches but assignments were positively associated with satisfaction and motivation. All educational approaches excluding assignment submission and interprofessional meeting were positively associated with knowledge acquisition. Observation, practice, and interprofessional meeting were positively associated with skill acquisition. Only assignment submission was positively associated with the change in self-study time. Educational approaches excluding medical quizzes were positively associated with understanding the importance of the medical care team. Technical problems were negatively associated with motivation, knowledge acquisition, and skill acquisition. Conclusions Educators should implement various educational approaches, especially observation and practice, even in online clinical clerkship. They also need to minimize the technical problems associated with the Internet, as they reduce the effectiveness of online clerkship.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"2431 - 2440"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42899059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We herein report a 71-year-old woman presented with a fever, arthralgia, general malaise and leg muscle stiffness following administration of the COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech). Laboratory findings showed an elevated C-reactive protein level and erythrocyte sedimentation rate. In addition, Gallium-67 scintigraphy demonstrated an increased uptake in multiple joints. Typing of human leukocyte antigen (HLA) revealed the presence of the DRB1*0404/*0803 allele. These findings met the diagnostic criteria for polymyalgia rheumatica (PMR), and when we started steroid treatment, her symptoms improved rapidly. This patient developed PMR after receiving a COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech). This case is considered to be valuable, as the HLA-DRB1 allele was also confirmed.
{"title":"Polymyalgia Rheumatica Following COVID-19 Vaccination.","authors":"Akira Yokote, Shinsuke Fujioka, Nobutaka Takahashi, Takayasu Mishima, Yoshio Tsuboi","doi":"10.2169/internalmedicine.8934-21","DOIUrl":"10.2169/internalmedicine.8934-21","url":null,"abstract":"<p><p>We herein report a 71-year-old woman presented with a fever, arthralgia, general malaise and leg muscle stiffness following administration of the COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech). Laboratory findings showed an elevated C-reactive protein level and erythrocyte sedimentation rate. In addition, Gallium-67 scintigraphy demonstrated an increased uptake in multiple joints. Typing of human leukocyte antigen (HLA) revealed the presence of the DRB1*0404/*0803 allele. These findings met the diagnostic criteria for polymyalgia rheumatica (PMR), and when we started steroid treatment, her symptoms improved rapidly. This patient developed PMR after receiving a COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech). This case is considered to be valuable, as the HLA-DRB1 allele was also confirmed.</p>","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1775-1777"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49330075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.2169/internalmedicine.7018-21
Shota Okutsu, Makito Futami, Tadaaki Arimura, Kosuke Ohki, Tetsuya Hiyoshi, E. Sakihara, Y. Kato, Yoko Ueda, Masaya Yano, M. Takeshita, H. Ishikura, Tadaki Suzuki, Seiya Kato, S. Miura, S. Nabeshima
A 67-year-old man, hospitalized with fever and pancytopenia, experienced cardiogenic shock on the 3rd day of hospitalization. He complained of chest pain and exhibited cardiac dysfunction, upregulated serum troponin levels, and an ST elevation on electrocardiogram. Severe fever with thrombocytopenia syndrome (SFTS) was suspected based on the symptom course after a tick bite and was definitively diagnosed using the serum polymerase chain reaction (PCR) test. An endomyocardial biopsy performed in the convalescent phase revealed a sign of myocardial inflammation with increases in CD3- and CD68-positive cells. We herein report the first case of acute myocarditis complicated with SFTS.
{"title":"Acute Myocarditis with Severe Fever and Thrombocytopenia Syndrome","authors":"Shota Okutsu, Makito Futami, Tadaaki Arimura, Kosuke Ohki, Tetsuya Hiyoshi, E. Sakihara, Y. Kato, Yoko Ueda, Masaya Yano, M. Takeshita, H. Ishikura, Tadaki Suzuki, Seiya Kato, S. Miura, S. Nabeshima","doi":"10.2169/internalmedicine.7018-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.7018-21","url":null,"abstract":"A 67-year-old man, hospitalized with fever and pancytopenia, experienced cardiogenic shock on the 3rd day of hospitalization. He complained of chest pain and exhibited cardiac dysfunction, upregulated serum troponin levels, and an ST elevation on electrocardiogram. Severe fever with thrombocytopenia syndrome (SFTS) was suspected based on the symptom course after a tick bite and was definitively diagnosed using the serum polymerase chain reaction (PCR) test. An endomyocardial biopsy performed in the convalescent phase revealed a sign of myocardial inflammation with increases in CD3- and CD68-positive cells. We herein report the first case of acute myocarditis complicated with SFTS.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1779 - 1784"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41624496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.2169/internalmedicine.8136-21
S. Tani, K. Imatake, Yasuyuki Suzuki, Tsukasa Yagi, A. Takahashi, N. Matsumoto, Yasuo Okumura
Objective We investigated the relationship between the amount and frequency of fish intake, and the white blood cell (WBC) count and aerobic exercise habits. Methods We conducted a cross-sectional study between April 2019 and March 2020 at the Health Planning Center of Nihon University Hospital on a cohort of 8,981 male subjects. Results The average amount and frequency of fish intake were 134±85 g/week and 2.14±1.28 days/week, respectively. The WBC count decreased significantly as the amount of fish intake increased (p<0.0001). According to a multivariate regression analysis, a high fish intake amount (β=-0.082, p<0.0001) and regular aerobic exercise (β=-0.083, p<0.0001) were independent determinants of a low WBC count. The proportion of subjects engaged in regular aerobic exercise increased with an increase in the amount of fish intake (p<0.0001). Furthermore, the amount and frequency of fish intake significantly correlated with the amount of n-3 polyunsaturated fatty acid intake determined using the Japan's National Nutrition Survey results (both r=0.962 and 0.958). Therefore, the amount of fish intake could be substituted by the average number of days of fish intake per week. Conclusion A high fish intake was an independent determinant of a low WBC count and engagement in regular aerobic exercise, regardless of whether the fish intake was defined by the amount or frequency of fish intake. However, since fish intake frequency can be measured more easily, this may be used to measure the fish intake.
{"title":"The Frequency and Amount of Fish Intake Are Correlated with the White Blood Cell Count and Aerobic Exercise Habit: A Cross-sectional Study","authors":"S. Tani, K. Imatake, Yasuyuki Suzuki, Tsukasa Yagi, A. Takahashi, N. Matsumoto, Yasuo Okumura","doi":"10.2169/internalmedicine.8136-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.8136-21","url":null,"abstract":"Objective We investigated the relationship between the amount and frequency of fish intake, and the white blood cell (WBC) count and aerobic exercise habits. Methods We conducted a cross-sectional study between April 2019 and March 2020 at the Health Planning Center of Nihon University Hospital on a cohort of 8,981 male subjects. Results The average amount and frequency of fish intake were 134±85 g/week and 2.14±1.28 days/week, respectively. The WBC count decreased significantly as the amount of fish intake increased (p<0.0001). According to a multivariate regression analysis, a high fish intake amount (β=-0.082, p<0.0001) and regular aerobic exercise (β=-0.083, p<0.0001) were independent determinants of a low WBC count. The proportion of subjects engaged in regular aerobic exercise increased with an increase in the amount of fish intake (p<0.0001). Furthermore, the amount and frequency of fish intake significantly correlated with the amount of n-3 polyunsaturated fatty acid intake determined using the Japan's National Nutrition Survey results (both r=0.962 and 0.958). Therefore, the amount of fish intake could be substituted by the average number of days of fish intake per week. Conclusion A high fish intake was an independent determinant of a low WBC count and engagement in regular aerobic exercise, regardless of whether the fish intake was defined by the amount or frequency of fish intake. However, since fish intake frequency can be measured more easily, this may be used to measure the fish intake.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1633 - 1643"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48692054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.2169/internalmedicine.9598-22
Mizuki Asako, H. Matsunaga, K. Oka, S. Ueda
An 86-year-old Japanese woman was referred for an examination of leukocytosis and diagnosed with Waldenström macroglobulinemia. She was asymptomatic and remained stable during follow-up without treatment. The day after receiving her first COVID-19 vaccination (Pfizer-BioNTech), she developed urticarial exanthema on her limbs. Although the rash improved with topical steroids, it worsened the day after she received the second vaccination; bone pain, general fatigue, and leukocytosis (white blood cell count: 11,600/ μL) also developed. A skin biopsy showed perivascular and interstitial neutrophil infiltrate with leukocytoclasia (Picture A, B), and definite Schnitzler syndrome was diagnosed according to the Strasbourg criteria (1). She rapidly responded to low-dose prednisolone (10 mg/day), and the skin rash and systemic symptoms resolved. Schnitzler syndrome is autoinflammatory and characterized by urticarial rash and immunoglobulin M monoclonal gammopathy. Lymphoproliferative disorders feature immune dysregulation that often results in autoimmune disease (2). In patients with lymphoproliferative disorders, physicians should pay careful attention to immune complications after COVID-19 vaccination.
{"title":"Schnitzler Syndrome after COVID-19 Vaccination","authors":"Mizuki Asako, H. Matsunaga, K. Oka, S. Ueda","doi":"10.2169/internalmedicine.9598-22","DOIUrl":"https://doi.org/10.2169/internalmedicine.9598-22","url":null,"abstract":"An 86-year-old Japanese woman was referred for an examination of leukocytosis and diagnosed with Waldenström macroglobulinemia. She was asymptomatic and remained stable during follow-up without treatment. The day after receiving her first COVID-19 vaccination (Pfizer-BioNTech), she developed urticarial exanthema on her limbs. Although the rash improved with topical steroids, it worsened the day after she received the second vaccination; bone pain, general fatigue, and leukocytosis (white blood cell count: 11,600/ μL) also developed. A skin biopsy showed perivascular and interstitial neutrophil infiltrate with leukocytoclasia (Picture A, B), and definite Schnitzler syndrome was diagnosed according to the Strasbourg criteria (1). She rapidly responded to low-dose prednisolone (10 mg/day), and the skin rash and systemic symptoms resolved. Schnitzler syndrome is autoinflammatory and characterized by urticarial rash and immunoglobulin M monoclonal gammopathy. Lymphoproliferative disorders feature immune dysregulation that often results in autoimmune disease (2). In patients with lymphoproliferative disorders, physicians should pay careful attention to immune complications after COVID-19 vaccination.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"46 3","pages":"2397 - 2397"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41307665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.2169/internalmedicine.8306-21
Sie-Hiong Tan, Sheng-Chieh Chen, Long-Wei Lin, Lu-Ting Kuo
We herein report a case of an extremely rare spinal cord endodermal sinus tumor (EST). A nine-year-old boy presented with progressive paraparesis, hypesthesia, and urinary retention. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed multiple intradural enhancing lesions at T1 to T9 without evidence of intracranial tumors. He underwent partial resection of the lesions, and histology revealed an EST. He received chemotherapy, but 12 months after surgery, rapid tumor progression and intracranial metastases with obstructive hydrocephalus were detected. Following external ventricular drainage, the patient's condition rapidly deteriorated, and he ultimately died. EST should be considered when confronting a homogenously enhancing intradural tumor of the spine on post-contrast MRI.
{"title":"Intracranial Seeding Following Surgery and Chemotherapy in a Child with a Spinal Cord Endodermal Sinus Tumor: A Case Report.","authors":"Sie-Hiong Tan, Sheng-Chieh Chen, Long-Wei Lin, Lu-Ting Kuo","doi":"10.2169/internalmedicine.8306-21","DOIUrl":"10.2169/internalmedicine.8306-21","url":null,"abstract":"<p><p>We herein report a case of an extremely rare spinal cord endodermal sinus tumor (EST). A nine-year-old boy presented with progressive paraparesis, hypesthesia, and urinary retention. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed multiple intradural enhancing lesions at T1 to T9 without evidence of intracranial tumors. He underwent partial resection of the lesions, and histology revealed an EST. He received chemotherapy, but 12 months after surgery, rapid tumor progression and intracranial metastases with obstructive hydrocephalus were detected. Following external ventricular drainage, the patient's condition rapidly deteriorated, and he ultimately died. EST should be considered when confronting a homogenously enhancing intradural tumor of the spine on post-contrast MRI.</p>","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41448339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.2169/internalmedicine.9136-21
Y. Ueda, S. Asakura, S. Wada, Takashi Saito, T. Yano
A patient with follicular lymphoma treated with obinutuzumab and bendamustine experienced prolonged coronavirus disease-2019 (COVID-19). One month after the symptoms transiently improved, the patient experienced exacerbated COVID-19 symptoms. The patient recovered from COVID-19 with remdesivir and dexamethasone and was discharged 77 days after the disease onset. The patient completed a primary series of SARS-CoV-2 vaccinations on day 176, but the anti-spike protein IgG was not detected later. A careful observation to detect any subsequent relapse of COVID-19 symptoms is necessary in immunocompromised patients. Chemotherapy should be based on the disease status and type of lymphoma.
{"title":"Prolonged COVID-19 in an Immunocompromised Patient Treated with Obinutuzumab and Bendamustine for Follicular Lymphoma","authors":"Y. Ueda, S. Asakura, S. Wada, Takashi Saito, T. Yano","doi":"10.2169/internalmedicine.9136-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.9136-21","url":null,"abstract":"A patient with follicular lymphoma treated with obinutuzumab and bendamustine experienced prolonged coronavirus disease-2019 (COVID-19). One month after the symptoms transiently improved, the patient experienced exacerbated COVID-19 symptoms. The patient recovered from COVID-19 with remdesivir and dexamethasone and was discharged 77 days after the disease onset. The patient completed a primary series of SARS-CoV-2 vaccinations on day 176, but the anti-spike protein IgG was not detected later. A careful observation to detect any subsequent relapse of COVID-19 symptoms is necessary in immunocompromised patients. Chemotherapy should be based on the disease status and type of lymphoma.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"2523 - 2526"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47656848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.2169/internalmedicine.9534-22
H. Kobe, A. Ito, Yosuke Nakanishi, A. Kuriyama, H. Tachibana, T. Ishida
Objective The coronavirus disease 2019 (COVID-19) pandemic continues to spread across the world, and the utility of many drugs for treatment has been suggested. However, few studies have examined the efficacy and safety of treatment with baricitinib, remdesivir, and dexamethasone. Methods A retrospective, cohort study of patients who were admitted to Kurashiki Central Hospital in Japan between April 6 and June 29, 2021, was conducted. Differences in patients' background characteristics, clinical outcomes, and safety were investigated in the groups with and without baricitinib treatment. The primary outcome was the bacterial infection rate, and the secondary outcome was the 28-day mortality rate. An inverse probability of treatment weighting (IPTW) analysis, including 12 covariates, was used as a propensity score analysis to reduce biases. Results In total, there were 96 patients, including 43 in the baricitinib-containing therapy (BCT) group and 53 in the non-baricitinib-containing therapy (non-BCT) group. In the BCT group, the ordinal scale on admission was 2.3% with 4, 51.1% with 5, 23.3% with 6, and 23.3% with 7. In the non-BCT group, the ordinal scale was 1.9% with 3, 18.9% with 4, 58.5% with 5, 13.2% with 6, and 7.5% with 7. After adjusting by the IPTW analysis, the BCT group did not have an increased bacterial infection rate [odds ratio (OR), 1.1; 95% confidence interval (CI), 0.36-3.38; p=0.87] or 28-day mortality rate (OR, 0.31; 95% CI, 0.07-1.3; p=0.11) compared with the non-BCT group. Conclusion BCT can be administered without increasing the infection risk compared with non-BCT.
目的2019冠状病毒病(COVID-19)大流行在全球范围内持续蔓延，并建议使用多种药物进行治疗。然而，很少有研究考察巴比替尼、瑞德西韦和地塞米松治疗的有效性和安全性。方法对2021年4月6日至6月29日在日本仓市中心医院(Kurashiki Central Hospital)住院的患者进行回顾性队列研究。在接受和未接受巴西替尼治疗的组中，研究了患者背景特征、临床结果和安全性的差异。主要转归是细菌感染率，次要转归是28天死亡率。采用治疗加权逆概率(IPTW)分析，包括12个协变量，作为倾向评分分析以减少偏倚。结果96例患者，含巴比替尼治疗组(BCT) 43例，不含巴比替尼治疗组(non-BCT) 53例。BCT组入院时的平均评分为:2.3%(4)、51.1%(5)、23.3%(6)、23.3%(7)。非bct组依次为3组1.9%，4组18.9%，5组58.5%，6组13.2%，7组7.5%。经IPTW分析调整后，BCT组细菌感染率没有增加[优势比(OR)， 1.1;95%置信区间(CI)， 0.36-3.38;p=0.87]或28天死亡率(or, 0.31;95% ci, 0.07-1.3;p=0.11)。结论与未行BCT相比，行BCT治疗不增加感染风险。
{"title":"Addition of Baricitinib to COVID-19 Treatment Does Not Increase Bacterial Infection Compared to Standard Therapy: A Single-center Retrospective Study","authors":"H. Kobe, A. Ito, Yosuke Nakanishi, A. Kuriyama, H. Tachibana, T. Ishida","doi":"10.2169/internalmedicine.9534-22","DOIUrl":"https://doi.org/10.2169/internalmedicine.9534-22","url":null,"abstract":"Objective The coronavirus disease 2019 (COVID-19) pandemic continues to spread across the world, and the utility of many drugs for treatment has been suggested. However, few studies have examined the efficacy and safety of treatment with baricitinib, remdesivir, and dexamethasone. Methods A retrospective, cohort study of patients who were admitted to Kurashiki Central Hospital in Japan between April 6 and June 29, 2021, was conducted. Differences in patients' background characteristics, clinical outcomes, and safety were investigated in the groups with and without baricitinib treatment. The primary outcome was the bacterial infection rate, and the secondary outcome was the 28-day mortality rate. An inverse probability of treatment weighting (IPTW) analysis, including 12 covariates, was used as a propensity score analysis to reduce biases. Results In total, there were 96 patients, including 43 in the baricitinib-containing therapy (BCT) group and 53 in the non-baricitinib-containing therapy (non-BCT) group. In the BCT group, the ordinal scale on admission was 2.3% with 4, 51.1% with 5, 23.3% with 6, and 23.3% with 7. In the non-BCT group, the ordinal scale was 1.9% with 3, 18.9% with 4, 58.5% with 5, 13.2% with 6, and 7.5% with 7. After adjusting by the IPTW analysis, the BCT group did not have an increased bacterial infection rate [odds ratio (OR), 1.1; 95% confidence interval (CI), 0.36-3.38; p=0.87] or 28-day mortality rate (OR, 0.31; 95% CI, 0.07-1.3; p=0.11) compared with the non-BCT group. Conclusion BCT can be administered without increasing the infection risk compared with non-BCT.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"2273 - 2279"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46452696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.2169/internalmedicine.9800-22
H. Kawano, Tetsufumi Motokawa, H. Kurohama, Shinji Okano, Ryohei Akashi, T. Yonekura, S. Ikeda, K. Izumikawa, K. Maemura
A 60-year-old Japanese woman was hospitalized for cardiogenic shock 24 days after receiving the second dose of the coronavirus disease 2019 BNT162b2 vaccine. Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were immediately initiated along with inotropic support and steroid pulse therapy, as an endomyocardial biopsy specimen showed myocarditis. Three weeks later, her cardiac function had recovered, and she was discharged. An immune response associated with the presence of spike protein in cardiac myocytes may be related to myocarditis in the present case because of positive immunostaining for severe acute respiratory syndrome coronavirus 2 spike protein and C4d in the myocardium.
{"title":"Fulminant Myocarditis 24 Days after Coronavirus Disease Messenger Ribonucleic Acid Vaccination","authors":"H. Kawano, Tetsufumi Motokawa, H. Kurohama, Shinji Okano, Ryohei Akashi, T. Yonekura, S. Ikeda, K. Izumikawa, K. Maemura","doi":"10.2169/internalmedicine.9800-22","DOIUrl":"https://doi.org/10.2169/internalmedicine.9800-22","url":null,"abstract":"A 60-year-old Japanese woman was hospitalized for cardiogenic shock 24 days after receiving the second dose of the coronavirus disease 2019 BNT162b2 vaccine. Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were immediately initiated along with inotropic support and steroid pulse therapy, as an endomyocardial biopsy specimen showed myocarditis. Three weeks later, her cardiac function had recovered, and she was discharged. An immune response associated with the presence of spike protein in cardiac myocytes may be related to myocarditis in the present case because of positive immunostaining for severe acute respiratory syndrome coronavirus 2 spike protein and C4d in the myocardium.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"2319 - 2325"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45772562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.2169/internalmedicine.9321-22
Naoto Kuroda, Prasannakumar Gajera, Hon-Ru Yu, T. Kubota
Objective To investigate seizure control in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic. Method A systematic review and meta-analysis was conducted, and the MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies that reported seizure control in patients with epilepsy during the COVID-19 pandemic were included. Pooled proportions with 95% confidence intervals (CIs) of patients with epilepsy who experienced seizure worsening during the COVID-19 pandemic were assessed using a random-effects model. The quality of the assessment for each study, heterogeneity between the studies, and publication bias were also evaluated. Subgroup analyses were performed, excluding studies with reports of seizures worsening from caregivers. Results A total of 24 studies with 6,492 patients/caregivers were included in the meta-analysis. The pooled proportion of seizure worsening was 18.5% (95% CI: 13.9-23.6; I2=96%; p<0.01). The pooled proportion of seizure worsening in the subgroup analysis was 18.9% (95% CI: 13.5-25.0; I2=96%; p<0.01). Conclusion Although the heterogeneity was high, our results showed a relatively high incidence of seizure worsening during the COVID-19 pandemic. During the COVID-19 pandemic, physicians should be aware of the likelihood of worsening seizures in patients with epilepsy.
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