Re-administration of abatacept for the control of articular symptoms of rheumatoid arthritis during anti-tuberculous therapy

This case report describes the re-administration of abatacept to successfully reduce the articularsymptoms of a patient with rheumatoid arthritisduring the intensive phase of anti-tuberculous therapy. A 75-year-old man developed active pulmonary tuberculosis during the administration of abatacept for rheumatoid arthritis. The patient experienced a paradoxical reaction and exacerbation of rheumatoid arthritis that caused us to discontinue the abatacept. Later re-administration of abatacept along with anti-tuberculosis treatment led to well-controlled rheumatoid arthritis without exacerbation of the tuberculosis. This case shows that re-administration of abatacept may be much safer than TNF inhibitor to treat patients who are infected with mycobacteria during thetreatment of immunological diseases such asrheumatoid arthritiswith biological agents

A Case of Yellow Nail Syndrome with Dramatically Improved Nail Discoloration by Oral Clarithromycin

An 80-year-old woman was admitted to our hospital with pneumonia and exacerbation of sinobronchial syndrome (SBS). She presented with yellow discoloration of the nail beds of all fingers and toes, and her nails were recognized as growing slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and bilateral pleural effusion. We diagnosed her as having yellow nail syndrome (YNS), based on the triad of yellow nails, lymphedema, and lung disease. After treatment with antibiotics [ampicillin/sulbactam and clarithromycin (CAM)] for pneumonia and SBS, her general condition improved, and the yellow nails disappeared in some fingers. When she was previously treated with 200 mg CAM for SBS, her yellow nails had not shown improvement. This time, her yellow nails improved after treatment with 400 mg CAM. The literature reports vitamin E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in the treatment of yellow nails. Two studies have reported treatment for YNS using CAM, though they found a lack of efficacy. Thus, the present case is the first to report improved yellow nails using CAM alone. We conclude that not only SBS and lung disease but also YNS were improved by treatment with 400 mg CAM

The importance of bacterial and viral infections associated with adult asthma exacerbations in clinical practice.

Viral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear.The relation between various infections and adult asthma exacerbations was investigated in clinical practice.The study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis.Asthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients.Viral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation

Pre-implementation awareness and recognition of the content and methods in the new national curriculum guidelines among primary and junior high school teachers in Okinawa Prefecture

First objective of this research is to identify the level of understanding of the new national curriculum guidelines among the teachers in primary and junior high schools in Okinawa Prefecture and collection of foundational data for the future teacher training by comparative verification of the state of recognition of the content and methods in the new national curriculum guidelines, with distinction to school type (primary or junior high school) and area (mainland Okinawa and outlying islands).Second objective is to examine how the difference of being in charge of extracurricular activities or not is affecting the recognition of the content and methods in the new national curriculum guidelines. Questionnaires has been collected from 793 primary and junior high school teachers from all around Okinawa Prefecture (with the response rate of 48.4％)According to the result of the analysis no difference between schools or areas has been observed in the awareness and recognition of the content and methods in the new national curriculum guidelines. However, with respect to the level of understanding of in-school training opportunities and special education, statistically significant gap has been detected between the primary schools and junior high schools. Furthermore, primary school teachers, who are in charge of extracurricular activities had high ratio of “true” answers in the following 2 questions: “I aim to enhance experimental activities” and “I try to organise the curriculum that put emphasis on cooperation with the local area”. Additionally, the level of understanding about inclusive education and reasonable accommodation with regard to special education was statistically significantly higher among teachers from outlying islands rather than those from mainland Okinawa. It is suspected that small size class on the outlying islands might be influential. The foundational data on the comprehension of the new national curriculum guidelines collected at this time, is to be examined comparatively with the outcome of similar survey, which is planned to be conducted after the full implementation of the new national curriculum guidelines

Pathogen detection from asthma exacerbation patients after a common cold.

<p>Pathogen detection from asthma exacerbation patients after a common cold.</p