Jejunal Intussusception Caused by a Nasointestinal Ileus Tube

A 79-year-old man was admitted to our hospital due to pleural empyema. After 4 weeks of antimicrobial therapy and pleural drainage, he recovered but complained of new-onset abdominal pain. Abdominal computed tomography revealed adhesive small bowel obstruction and a nasointestinal ileus tube with intermittent suction was inserted. This procedure initially decreased his abdominal pain, but severe abdominal pain and vomiting developed 3 days later. Repeat abdominal computed tomography revealed jejuno-jejunal intussusception due to the nasointestinal ileus tube. Our patient was initially treated conservatively. However, he underwent surgical reduction due to clinical deterioration 1 day after diagnosis and died from a surgical complication 19 days later. Intussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube in the small intestine. Because urgent operative reduction is needed to avoid intestinal resection in most cases, early diagnosis and surgical reduction of intussusception are critical

Feasibility of methotrexate discontinuation following tocilizumab and methotrexate combination therapy in patients with long-standing and advanced rheumatoid arthritis: a 3-year observational cohort study

Objectives: Methotrexate (MTX) is associated with extensive side effects, including myelosuppression, interstitial pneumonia, and infection. It is, therefore, critical to establish whether its administration is required after achieving remission with tocilizumab (TCZ) and MTX combination therapy in patients with rheumatoid arthritis (RA). Therefore, the aim of this multicenter, observational, cohort study was to evaluate the feasibility of MTX discontinuation for the safety of these patients. Methods: Patients with RA were administered TCZ, with or without MTX, for 3 years; those who received TCZ+MTX combination therapy were selected. After remission was achieved, MTX was discontinued without flare development in one group (discontinued [DISC] group, n = 33) and continued without flare development in another group (maintain [MAIN] group, n = 37). The clinical efficacy of TCZ+MTX therapy, patient background characteristics, and adverse events were compared between groups. Results: The disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) at 3, 6, and 9 months was significantly lower in the DISC group (P < .05, P < .01, and P < .01, respectively). Further, the DAS28-ESR remission rate at 6 and 9 months and Boolean remission rate at 6 months were significantly higher in the DISC group (P < .01 for all). Disease duration was significantly longer in the DISC group (P < .05). Furthermore, the number of patients with stage 4 RA was significantly higher in the DISC group (P < .01). Conclusions: Once remission was achieved, MTX was discontinued in patients who responded favorably to TCZ+MTX therapy, despite the prolonged disease duration and stage progression

The efficacy of high-dose penicillin G for pneumococcal pneumonia diagnosed based on initial comprehensive assessment at admission: an observational study

Abstract Objectives High-dose penicillin therapy is effective in approximately 90% of pneumococcal pneumonia cases diagnosed based on urinary pneumococcal antigen tests or Gram staining at admission. The efficacy of high-dose penicillin therapy for pneumococcal pneumonia diagnosed based on an initial comprehensive assessment comprising a syndromic approach, Gram staining of sputum and urinary pneumococcal antigen testing was investigated. Results Seventy adult patients diagnosed with pneumococcal pneumonia based on an initial comprehensive assessment and treated with high-dose penicillin G at admission were included. The median patient age was 76.5 years, and 37.1% of the patients were women. The urinary pneumococcal antigen test was positive in 67.1% of all patients, and Gram staining of sputum showed that gram-positive cocci were dominant in 58.6% of the patients. The primary outcome was treatment success based on vital signs until day 6. Treatment with high-dose penicillin G was effective in 87.1% of the patients (95% CI 79.1–95.2%), and the proportion of patients who received other antibiotics because of treatment failure with penicillin G was only 5.7%. The efficacy of high-dose penicillin G treatment for pneumococcal pneumonia diagnosed based on a comprehensive assessment at admission may be comparable to that in previous reports

Characteristics of the use of cold combination products among older ambulatory patients at the National Hospital Organization Tochigi Medical Center in Japan: a retrospective single-center observational study

Abstract Objective This study aimed to determine the frequency and characteristics of prescriptions of cold combination products among older ambulatory patients. A retrospective observational study was conducted using electronic medical records. All patients aged 65 years or older who continued visiting internal medicine physicians for at least 1 year were included. The primary outcome was the prescription of cold combination products by any physicians in National Hospital Organization Tochigi Medical Center during a 1-year follow-up. Results Seven hundred fifty-six patients were included. The mean age was 75.4 years, 392 (51.9%) were men, the mean Charlson Comorbidity Index was 1.8, and the mean number of medications was 4.9. The proportion of patients who were prescribed cold combination products during the 1-year follow-up was 6.1% (95% confidence interval 4.4–7.8%). The prescription of cold combination products was not significantly associated with age (p = 0.11) or Charlson Comorbidity Index (p = 0.93) but was associated with an increasing number of medications (p < 0.001). A substantial proportion of older ambulatory patients were exposed to cold combination products during a 1-year follow-up

MOESM1 of The efficacy of high-dose penicillin G for pneumococcal pneumonia diagnosed based on initial comprehensive assessment at admission: an observational study

Additional file 1: Table S1. Enforcement and documentation rates of vital signs, microbial testing and imaging at admission. aSputum specimens were judged to be high quality if there were fewer than 10 squamous epithelial cells and greater than 10 polymorphonuclear cells per low-power field. Table S2. Clinical outcomes according to the severity of pneumonia based on CURB-65 and the pneumonia severity index. aClinical success was defined as the condition in which all the following threshold values were achieved for a 24-h period: temperature, ≤ 37.2 °C; heart rate ≤ 100 beats/min; respiratory rate ≤ 24 breaths/min; systolic blood pressure, ≥ 90 mmHg; and oxygen saturation ≥ 90% or arterial oxygen partial pressure ≥ 60 mmHg when the patient was not receiving supplemental oxygen. bComparison of outcomes between subgroups according to severity of pneumonia was performed using the Chi squared test. Table S3. Comparison of primary outcomes between subgroups according to the presumptive etiology of pneumonia based on the final results of microbial investigation. aClinical success was defined as the condition in which all the following threshold values were achieved for a 24-h period: temperature ≤ 37.2 °C; heart rate ≤ 100 beats/min; respiratory rate ≤ 24 breaths/min; systolic blood pressure, ≥ 90 mmHg; and oxygen saturation ≥ 90% or arterial oxygen partial pressure ≥ 60 mmHg when the patient was not receiving supplemental oxygen. bComparison of outcomes between subgroups was performed using the Chi squared test

MOESM2 of The efficacy of high-dose penicillin G for pneumococcal pneumonia diagnosed based on initial comprehensive assessment at admission: an observational study

Additional file 2: Text S1. Definition of terms and outcomes used in this study. Text S2. Four cases in which penicillin G was replaced by other antibiotics because of treatment failure for pneumonia