A 44-year-old man with COVID-19 and nephrotic syndrome relapse was admitted to our intensive-care unit for respiratory failure. Despite receiving mechanical ventilation and immunomodulators, the ...patient experienced refractory hypoxemia, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy. Due to a worsening renal function, continuous hemodiafiltration was initiated. After 11 days, his respiratory status gradually improved, and VV-ECMO was withdrawn. The kidney function and proteinuria improved, and hemodialysis was subsequently discontinued. The patient was discharged 64 days after admission. This case highlights the potential benefit of early ECMO application in dramatically promoting recovery in severe COVID-19 cases.
Current perspectives of viral hepatitis Usuda, Daisuke; Kaneoka, Yuki; Ono, Rikuo ...
World journal of gastroenterology : WJG,
2024-May-14, 2024-5-14, 20240514, Volume:
30, Issue:
18
Journal Article
Open access
Viral hepatitis represents a major danger to public health, and is a globally leading cause of death. The five liver-specific viruses: Hepatitis A virus, hepatitis B virus, hepatitis C virus, ...hepatitis D virus, and hepatitis E virus, each have their own unique epidemiology, structural biology, transmission, endemic patterns, risk of liver complications, and response to antiviral therapies. There remain few options for treatment, in spite of the increasing prevalence of viral-hepatitis-caused liver disease. Furthermore, chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality, even though effective treatments are available that could reduce or prevent most patients' complications. In 2016, the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030, along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis. Today, treatment is sufficiently able to prevent the disease from reaching advanced phases. However, future therapies must be extremely safe, and should ideally limit the period of treatment necessary. A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis. This review aims to summarize the current state of knowledge on each type of viral hepatitis, together with major innovations.
Objective To identify pulmonary thromboembolism (PTE) using the thrombus attenuation value on unenhanced computed tomography (CT).Design Single-center retrospective study (January 2015-Marcg ...2020).Methods Patients who underwent both unenhanced and enhanced CT for suspected PTE were enrolled. Patients with a hyperdense lumen on unenhanced CT and thrombi in the peripheral pulmonary artery (PA) were excluded. Patients were classified into two groups: thrombi (thrombi detected in PA by enhanced CT) and non-thrombi (attenuations of the main PA evaluated as thrombi). Mean CT attenuation values of the thrombi, main PA, and pulmonary trunk (blood pool) were measured. The attenuation values of the thrombus (T) and the thrombus to blood-pool (T/P), thrombus to hemoglobin (T/Hb), and thrombus to hematocrit (T/Ht) ratios were evaluated. The cut-off attenuation value of the thrombus was calculated by a receiver operating characteristic curve and its accuracy in detecting PTE was determined.Results Of the 260 patients enrolled, 40 were included, of whom 24 had confirmed PTE. The mean T was 27.25 Hounsfield units(HU) and 36.66HU (p<0.001), and the T/P ratio was 0.74 and 0.99 (p=0.004) in the PTE and non-PTE groups, respectively. The thrombus cut-off value for PTE diagnosis was 30.85 HU. The sensitivity and specificity were 79. 9% and 87.5%.Conclusions Measuring and evaluating the attenuation value for the central PA and T/P ratio on unenhanced CT improves the diagnostic ability of central PTE in patients suspected to have PTE but cannot tolerate contrast medium.
Whether temporal differences alter the clinical outcomes of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. Furthermore, the relationship between time of day and ...resuscitation efforts is unknown.
We studied adult OHCA patients in the Survey of Survivors after Out-of-Hospital Cardiac Arrest in the Kanto Region (SOS-KANTO) 2012 study from January 2012 to March 2013 in Japan. The primary variable was 1-month survival. The secondary outcome variables were prehospital and in-hospital resuscitation efforts by bystanders, emergency medical services personnel, and in-hospital healthcare providers. Daytime was defined as 0701 to 1500 h, evening was defined as 1501 to 2300 h, and night was defined as 2301 to 0700 h.
During the study period, 13,780 patients were included in the analysis. The patients with night OHCA had significantly lower 1-month survival compared to the patients with daytime OHCA (night vs. daytime, adjusted odds ratio (OR) 1.66; 95 % confidence interval (CI), 1.34-2.07; P < 0.0001). The nighttime OHCA patients had significantly shorter call-response intervals, bystander CPR, in-hospital intubation, and in-hospital blood gas analyses compared to the daytime and evening OHCA patients (call-response interval: OR 0.95 and 95 % CI 0.93-0.96; bystander CPR: OR 0.85 and 95 % CI 0.78-0.93; in-hospital intubation: OR 0.85 and 95 % CI 0.74-0.97; and in-hospital blood gas analysis: OR 0.86 and 95 % CI 0.75-0.98).
There was a significant temporal difference in 1-month survival after OHCA. The nighttime OHCA patients had significantly decreased resuscitation efforts by bystanders and in-hospital healthcare providers compared to those with evening and daytime OHCA.
Cases of severe disopyramide poisoning are rare and few have been reported. We report a case in which activated-charcoal column hemoperfusion was dramatically effective for life-threatening ...disopyramide poisoning.
A teenage girl who had overdosed on disopyramide (total dose, 4950 mg) was brought to our hospital. She was resuscitated from short period cardiopulmonary arrest and subsequently showed severe cardiogenic shock and ventricular arrhythmia.
Disopyramide poisoning (self-evident).
As hemodynamics remained unstable after providing percutaneous cardiopulmonary support and intra-aortic balloon pumping, we attempted direct hemoperfusion using a coated activated-charcoal hemoperfusion column.
Hemodynamics including electrocardiography and serum disopyramide concentration were dramatically improved, and the patient was ambulatory by hospital day 14.
Because disopyramide has low molecular weight and a small distribution volume, blood purification is considered to be the most effective therapy. We selected direct hemoperfusion for relatively high protein-binding rate. In fact, clinical status was dramatically improved, and the calculated half-life of the direct hemoperfusion phase was the shortest of all phases. In cases of severe or life-threatening disopyramide poisoning, blood purification therapy including direct hemoperfusion using a coated activated-charcoal column should be performed.
Abstract Background Little is known about recent changes in pre- and in-hospital treatments and outcomes for elderly patients with out-of-hospital cardiac arrest (OHCA). Methods We compared data ...collected for the SOS-KANTO study in 2002 and 2012. We included patients aged ≥65 years who experienced OHCA of cardiac aetiology. The primary endpoint was favourable neurological outcomes 1 month after cardiac arrest. Results A total of 8,964 (2002 vs. 2012: 3,544 vs. 5,420) patients were eligible for the current analysis. The proportion of pre-hospital return of spontaneous circulation (ROSC) increased significantly (3.8 vs. 5.6%, p < 0.001). Among patients achieving ROSC, the proportion of advanced in-hospital treatments (i.e. extracorporeal membrane oxygenation, therapeutic hypothermia, and/or percutaneous coronary angiogram/intervention) provided increased significantly in 2012 (1.2 vs. 5.5%, p < 0.001; 2.6 vs. 15.1%, p < 0.001; 4.9 vs. 16.5%, p < 0.001; respectively). The proportion of favourable neurological outcomes at 1 month increased significantly in 2012 (1.6 vs. 2.7%, p = 0.001). A logistic regression analysis that did not consider advanced in-hospital treatments showed a significantly higher rate of favourable neurological outcomes in the 2012 group than that in the 2002 group (OR, 2.2; 95% CI, 1.4–3.5). However, this difference was no longer observed in the second regression model that accounted for advanced in-hospital treatments (OR, 1.6; 95% CI, 0.9–2.9). Conclusion There was an increased proportion of aggressive treatment, both pre- and in-hospital, for elderly patients with cardiogenic OHCA in the Kanto area, Japan. Favourable neurological outcomes improved significantly over 10 years.
Abstract
Background
Reverse transcription-polymerase chain reaction (RT-PCR) is used for the diagnosis of COVID-19, caused by SARS-CoV-2. RT-PCR is a method that detects the virus by amplifying two ...regions of the target viral genome, namely the nuclear (N) and envelope (E) encoding sequences. However, no reports have shown a relationship between the symptoms and the gene expression patterns, especially in asymptomatic patients. Herein, we validated the characteristics of E and N gene expression patterns using RT-PCR on samples obtained from asymptomatic COVID-19-positive patients.
Methods
In this retrospective cohort study, conducted at Juntendo University Nerima Hospital, Tokyo, Japan, SARS-Cov-2 RT-PCR positive patients whose specimens had been obtained and analyzed by our laboratory technicians from September 1, 2020 to December 31, 2020 were enrolled. For RT-PCR, the LightMix Modular SARS-CoV-2 reagent (TIB MOLBIOL company) was used. After excluding patients who had symptoms, background, demographic, laboratory, and gene expression pattern data were collected from RT-PCR-positive asymptomatic patients. We also investigated patients who met the release criteria of the Center for Disease Control and prevention. Continuous and categorical variables were analyzed, with p< 0.05 set as statistical significance using the student-t test, chi-square test, or Fisher’s exact test, respectively.
Results
Of 92 RT-PCR-positive asymptomatic patients, 57 comprised the expression E only group (Group E) and 35 comprised the E+N group (Group E+N). Significantly more patients in Group E met the release criteria compared to those in Group E+N 41 (71%) vs 10 (28%), p< 0.001. Among patients who met the release criteria, those in Group E+N had significantly more immunosuppression 7 (70%) vs 8 (30%), p=0.004.
Moreover, among the patients who underwent RT-PCR screening, no patients in Group E developed symptoms 0 vs 6 (42%), p=0.02.
Conclusion
The results of this study suggest that RT-PCR-positive asymptomatic patients can be divided into three patterns: pre-symptomatic, gene E+N-positive patients; post-symptomatic covid-19-recovered patients, regardless of gene E and N expression patterns; and false positive, gene E-positive patients.
Disclosures
All Authors: No reported disclosures
The 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation recommend Basic Life Support (BLS) and Advanced Life Support (ALS) rules for termination of resuscitation (TOR). ...However, it is unclear whether the TOR rules are valid for out-of-hospital cardiac arrests (OHCAs) of both cardiac and non-cardiac etiologies. In this study, we validated the TOR rules for OHCA resulting from both etiologies.
This was a prospective multicenter observational study of OHCA patients transported to 67 emergency hospitals between January 2012 and March 2013 in the Kanto region of Japan. We calculated the specificity and positive predictive value (PPV) for neurologically unfavorable outcomes at one month in patients with OHCA of cardiac and non-cardiac etiologies.
Of 11,505 eligible cases, 6,138 and 5,367 cases were of cardiac and non-cardiac etiology, respectively. BLS was performed on 2,818 and 2,606 patients with OHCA of cardiac and non-cardiac etiology, respectively. ALS was performed on 3,320 and 2,761 patients with OHCA of cardiac and non-cardiac etiology, respectively. The diagnostic accuracy of the TOR rules for predicting unfavorable outcomes in patients with OHCA of cardiac etiology who received BLS included a specificity of 0.985 (95% confidence interval CI: 0.956-0.997) and a PPV of 0.999 (95% CI: 0.996-1.000). In patients with OHCA from cardiac etiologies who received ALS, the TOR rules had a specificity of 0.963 (95% CI: 0.896-0.992) and a PPV of 0.997 (95% CI: 0.991-0.999). In patients with OHCA from non-cardiac etiologies who received BLS, the specificity was 0.915 (95% CI: 0.796-0.976) and PPV was 0.998 (95% CI: 0.995-0.999). For patients with OHCA from non-cardiac etiologies who received ALS, the specificity was 0.833 (95% CI: 0.586-0.964) and PPV was 0.996 (95% CI: 0.988-0.999).
Both TOR rules have high specificity and PPV in patients with OHCA from cardiac etiologies. For patients with OHCA from non-cardiac etiologies, the rules had a high PPV, but relatively low specificity. Therefore, TOR rules are useful in patients with OHCA from cardiac etiologies, but should be applied with caution to patients with OHCA from non-cardiac etiologies.
A 67-year-old male patient was referred to our department for fecal occult blood in March 2019. In April, lower intestinal endoscopic examination revealed a 25-mm pedunculated polyp in the sigmoid ...colon. Endoscopic mucosal resection was then performed. The pathological diagnosis was tub1-tub2 with an invasion depth of pT1b 3,000 μm, and ly0 and v1 vascular invasion. The tumor marker levels were normal, with CEA of 1.1 ng/mL and CA19-9 of 13.9 U/mL. An additional laparoscopic low anterior resection and D2 dissection were performed in June. After the endoscopic mucosal resection, pathologic examination revealed densely hyperplastic spindle cells arranged in bundles at the proper muscular layer of the scar site. There was no lymph node metastasis. On immunostaining, the lesion tested positive for c-kit, CD34, and DOG1, but negative for desmin, SMA, and S-100, with a MIB-1 index of 2%. The patient was diagnosed with very low risk gastrointestinal stromal tumor(GIST). We encountered a rare case of early sigmoid colon cancer, complicated by sigmoid colon GIST.
Exophiala dermatitidis Usuda, Daisuke; Higashikawa, Toshihiro; Hotchi, Yuta ...
World journal of clinical cases,
09/2021, Volume:
9, Issue:
27
Journal Article
Open access
Exophiala
is a genus comprising several species of opportunistic black yeasts, which belongs to Ascomycotina. It is a rare cause of fungal infections. However, infections are often chronic and ...recalcitrant, and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people, detailed knowledge remains scarce regarding infection mechanisms, virulence factors, specific predisposing factors, risk factors, and host response. The most common manifestations of
Exophiala
infection are skin infections, and the most frequent type of deep infection is pulmonary infection due to inhalation. The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs. The final identification of the causative organism should be achieved through a combination of several methods, including the newly introduced diagnostic analysis, matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry, together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi, and histological and culture findings. Regarding treatment, because anti-infective agents and natural compounds exhibited poor antibiofilm activity, few treatments have ultimately been found to be effective for specific antifungal therapy, so the optimal antifungal therapy and duration of therapy for these infections remain unknown. Therefore, most forms of disease caused by
Exophiala dermatitidis
require aggressive combination therapies: Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.
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