Successful Endoscopic Management of Fish Bone Embedded into the Bladder Wall

We report a case of a pyogenous vesical abscess resulting from an ingested fish bone embedded in the bladder wall that was treated endoscopically in an asymptomatic man. Computed tomography of the abdomen showed a linear radiopaque structure in the thickened left anterolateral wall of the bladder. Cystoscopy revealed a protruding mass, covered with normal-appearing mucosa, with outflow of pus from a shallow recess. Histopathological findings indicated that the transurethrally removed linear structure, located in the submucosa, was compatible with fish bone. A high index of suspicion should be maintained for the correct diagnosis to be made

Association between gefitinib and hemorrhagic cystitis and severely contracted bladder: a case report

<p>Abstract</p> <p>Background</p> <p>Gefitinib remains an excellent treatment option for patients with a variety of cancers, including non small cell lung cancer (NSCLC). However, clinicians must be aware of the potential of gefitinib to cause an inflammatory reaction in the skin, lungs and bladder.</p> <p>Case Presentation</p> <p>We present a case on hemorrhagic cystitis and severaly contracted bladder in a patient with NSCLC on gefitinib.</p> <p>Conclusions</p> <p>Further studies are needed to substantiate the association of gefitinib therapy with hemorrhagic cystitis and contracted bladder.</p

A県内の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連

目的：A県の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連を明らかにする． 方法：A県の高齢者向け住まい（463か所）に勤務する管理者等を対象とし，入居者の状況，サービス提供体制等の自記式質問紙調査を実施した．サービス提供体制と医療的ケア及び看取りの受け入れ意向の有無との関連について，χ2検定又はFisherの直接確率検定を行った． 結果：有効回答は130施設（有効回答率28.1％）であった．医療的ケアの受け入れ意向では，「施設に看護師が常駐」「夜間ケアを提供する職員の配置」等の11項目，看取りの受け入れ意向では，「施設に常勤の介護職員」「施設に常勤の看護師」「協力医療機関の24時間緊急往診要請への対応」「看取りのマニュアルの整備」等の14項目に関連があった． 結論：高齢者向け住まいにおける医療的ケア及び看取りの受け入れには，看護職員・介護職員の配置及び医療機関等との連携の必要性が示唆された．Objectives: To clarify the relationship between the service provision system of housing for the elderly in A prefecture and the intention to accept medical care and end-of-life care. Method: A self-administered questionnaire survey was conducted on residents’ status and components of the service provision system for managers working in residences for senior citizens in A Prefecture (463 facilities). The χ2 test or Fisher’s exact test was performed on the relationship between the service provision system and the intention to accept medical care and end-of-life care. Results: 130 valid responses were returned (effective response rate 28.1%). For the intention to accept medical care, 11 items were extracted, including “nurse resident in facility” and “allocation of staff providing night care”. For the intention to accept end-of-life care, 14 items were extracted, including“ full-time caregiver at facility”,“ full-time nurse at facility”,“ responding to 24-hour emergency visit requests with cooperating medical institutions” and“ maintenance manual”. Conclusion: It was suggested that the placement of nursing staff and cooperation with medical institutions are necessary for the acceptance of medical care and end-of-life care for the elderly.報

Clusters of Coronavirus Disease in Communities, Japan, January-April 2020

We analyzed 3, 184 cases of coronavirus disease in Japan and identified 61 case-clusters in healthcare and other care facilities, restaurants and bars, workplaces, and music events. We also identified 22 probable primary case-patients for the clusters; most were 20-39 years of age and presymptomatic or asymptomatic at virus transmission

ATPの31P核磁気共鳴によるMg++の定量

Mg++の濃度測定のための検量線がATP(アデノシン三リン酸)の31Pのフーリエ変換核磁気共鳴(FT-NMR)に基づくケミカルシフト(δαβ)およびカップリング定数(Jαβ)から求められた.ATPの31PのケミカルシフトはMg++の濃度が0～5.0mMの範囲で濃度依存性を示し,使用可能なほぼ直線的な検量線を与えた.αPのカップリング定数は1.0～5.0mMの範囲で濃度依存性を示したが1.0mM以下では不定であり有効な検量線が描けなかった.Mg++とCa++が共存する場合,Jは全く不規則な値を示して一定せず,検量線作製に無効であったが,δαβは一定の関数になり,一方の濃度あるいは全イオン量が明らかな場合使用可能であった.Determination curves were obtained for the measurement of Mg++ concentration based on chemical shift (δαβ) and the coupling constant (Jαβ) of FT-nuclear-magnetic resonance (FT-NMR). The chemical shift of 31P in ATP was dependent on the Mg++ concentration and showed a nearly straight line for Mg++ determination in the range of 0～5.0mM concentration. The coupling constant of 31P was dependent on Mg++ concentrations in the range of 1.0～5.0mM, but did not show any dependency at concentrations under 0.5mM. When Mg++ and Ca++ coexisted the determination curve founded on the chemical shift could not be used for Mg++ determination unless the concentration of one of the ions or amount of total ions in the solution was known. In addition, the coupling constant was not useful for the preparation of the determination curve because of its irregular value

Transmission dynamics of seasonal influenza in a remote island population.

Seasonal influenza outbreaks remain an important public health concern, causing large numbers of hospitalizations and deaths among high-risk groups. Understanding the dynamics of individual transmission is crucial to design effective control measures and ultimately reduce the burden caused by influenza outbreaks. In this study, we analyzed surveillance data from Kamigoto Island, Japan, a semi-isolated island population, to identify the drivers of influenza transmission during outbreaks. We used rapid influenza diagnostic test (RDT)-confirmed surveillance data from Kamigoto island, Japan and estimated age-specific influenza relative illness ratios (RIRs) over eight epidemic seasons (2010/11 to 2017/18). We reconstructed the probabilistic transmission trees (i.e., a network of who-infected-whom) using Bayesian inference with Markov-chain Monte Carlo method and then performed a negative binomial regression on the inferred transmission trees to identify the factors associated with onwards transmission risk. Pre-school and school-aged children were most at risk of getting infected with influenza, with RIRs values consistently above one. The maximal RIR values were 5.99 (95% CI 5.23, 6.78) in the 7-12 aged-group and 5.68 (95%CI 4.59, 6.99) in the 4-6 aged-group in 2011/12. The transmission tree reconstruction suggested that the number of imported cases were consistently higher in the most populated and busy districts (Tainoura-go and Arikawa-go) ranged from 10-20 to 30-36 imported cases per season. The number of secondary cases generated by each case were also higher in these districts, which had the highest individual reproduction number (Reff: 1.2-1.7) across the seasons. Across all inferred transmission trees, the regression analysis showed that cases reported in districts with lower local vaccination coverage (incidence rate ratio IRR = 1.45 (95% CI 1.02, 2.05)) or higher number of inhabitants (IRR = 2.00 (95% CI 1.89, 2.12)) caused more secondary transmissions. Being younger than 18 years old (IRR = 1.38 (95%CI 1.21, 1.57) among 4-6 years old and 1.45 (95% CI 1.33, 1.59) 7-12 years old) and infection with influenza type A (type B IRR = 0.83 (95% CI 0.77, 0.90)) were also associated with higher numbers of onwards transmissions. However, conditional on being infected, we did not find any association between individual vaccination status and onwards transmissibility. Our study showed the importance of focusing public health efforts on achieving high vaccine coverage throughout the island, especially in more populated districts. The strong association between local vaccine coverage (including neighboring regions), and the risk of transmission indicate the importance of achieving homogeneously high vaccine coverage. The individual vaccine status may not prevent onwards transmission, though it may reduce the severity of infection

Building prognostic models for adverse outcomes in a prospective cohort of hospitalised patients with acute leptospirosis infection in the Philippines

Leptospirosis is endemic to the Philippines. Ten per cent of cases will develop severe or fatal disease. Predicting progression to severity is difficult. Risk factors have been suggested, but few attempts have been made to create predictive models to guide clinical decisions. We present two models to predict the risk of mortality and progression to severe disease. Data was used from a prospective cohort study conducted between 2011 and 2013 in San Lazaro Hospital, Manila. Predictive factors were identified from a literature review. A strategy utilizing backwards stepwise-elimination and multivariate fractional polynomials identified key predictive factors. A total of 203 patients met the inclusion criteria. The overall mortality rate was 6.84%. Multivariable logistic regression revealed that neutrophil counts [OR 1.38, 95% CI 1.15–1.67] and platelet counts [OR 0.99, 95% CI 0.97–0.99] were predictive for risk of mortality. Multivariable logistic regression revealed that male sex (OR 3.29, 95% CI 1.22–12.57) and number of days between symptom onset and antibiotic use (OR 1.28, 95% CI 1.08–1.53) were predictive for risk of progression to severe disease. The multivariable prognostic models for the risks of mortality and progression to severe disease developed could be useful in guiding clinical management by the early identification of patients at risk of adverse outcomes