Naoto Ishimaru

Rapid effects of Kikyo-to on sore throat pain associated with acute upper respiratory tract infection.

Abstract Background: Kikyo-to is used empirically for relieving sore throat pain associated with acute upper respiratory tract infection (URTI) in Japan. However, few studies have demonstrated its clinical effect. This study was conducted to investigate the efficacy of Kikyo-to on sore throat pain associated with acute URTI. Methods: Patients with sore throat pain who were diagnosed with URTI in General Medicine Department Office, Tsukuba Medical Center Hospital from January to March 2012 were enrolled. Patients received 2.5 g of Kikyo-to diluted in a cup of hot water. The primary outcome was the change in sore throat score on the visual analog scale (VAS) 10 min after Kikyo-to administration. Secondary outcomes were change in sore throat score on VAS after 30 min and impact of sore throat pain on daily life (none, mild, moderate, and severe) after 10 and 30min. Results: Forty patients were eligible. Mean VAS score was 48.2±18.2 before treatment and reduced significantly to 35.4±18.1 after 10 min and 30.7±19.3 after 30 min (p<0.001 in both periods). The proportion of patients with moderate or more impact of sore throat pain on daily life was 67.5% and was reduced significantly to 37.5% after 10 min and 30% after 30 min (p<0.001 in both periods). The patients reported no side effects. Conclusions: Kikyo-to relieves sore throat pain associated with acute URTI.

The impact of an early_exposure program on medical students' interest in and knowledge of rural medical practices: a questionnaire survey

BackgroundMany medical students in Japan were brought up in urban areas, thus rural medical practice is often unfamiliar to them. The University of Tsukuba created a one-day early_exposure program to provide freshman students with experience in rural practices. This study was designed to clarify how this one-day early_exposure program affected medical students’ attitudes toward and knowledge of rural practices.FindingsFirst-year medical students (n = 103) were assigned to one of seven rural clinics in which they experienced rural practice for one day. A pre- and post-program questionnaire, rated on a 5-point Likert scale, was administered to assess students’ interest in and knowledge of rural medical practice, with higher scores indicating greater interest and knowledge. Respondents who gave answers of 4 or 5 were defined as having high interest and knowledge. One hundred and one (98.1%) responses were received from students. After the program, the percentage of students interested in rural medical practices was increased (pre- and post-program: 39.0% and 61.0%, respectively; P < .001), as was the number of students who wanted to become physicians in a rural medical practice (pre- and post-program: 53.0% and 73.0%, respectively; P < .01).ConclusionsOur one-day early_exposure program demonstrated a positive impact on medical students’ interest in and knowledge of rural medical practice. Further follow-up surveys are needed to clarify whether these effects are sustained long-term.

Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion in an Adult Patient with Influenza

We herein report the case of a 31-year-old Japanese woman who developed adult-onset clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and presented with consciousness disorder and olfactory disturbance secondary to influenza A infection. The patients neurological symptoms and the lesion in the splenium resolved within 14 days without therapy. Magnetic resonance images and the clinical course were consistent with a diagnosis of MERS; however, mental changes following the influenza infection always present a diagnostic dilemma for physicians. We considered various diagnoses, including viral encephalitis, medication-related encephalopathy, and MERS. A comprehensive assessment may be required to diagnose MERS, since it may mimic other neurological diseases, such as viral encephalitis and medication-related encephalopathy.

The sensitivities and prognostic values of the Wells and revised Geneva scores in diagnosis of pulmonary embolism in the Japanese population

OBJECTIVE To assess the sensitivities of the Wells score (WS) and the revised Geneva score (RGS) and their prognostic values in the diagnosis of pulmonary embolism (PE) in the Japanese population. METHODS We conducted a retrospective chart review of patients with PE aged 16 years or older who were assessed between December 2008 and August 2014. Patients were divided into the PE unlikely and PE likely groups according to the WS and PE unlikely and PE likely groups according to the RGS. We also described the characteristics and three-month mortality of the patients. Univariate predictors with p < 0.05 were included in the multiple regression model. Fisher׳s exact test and Student׳s t-test were used for categorical and continuous variables, respectively. RESULTS PE was confirmed in 53 patients, and seven (13%) patients died within 3 months. The mean age was 66.0 ± 14.4 years. There were 32 female patients (60.4%). The RGS had a higher sensitivity than the WS (20.8% vs. 15.1%, P <0.01), although both scores had low yields. Mortality rate was significantly higher in patients with syncope than in those without (33.3% vs. 7.3%, respectively; P = 0.039). After age and sex adjustments, the presence of syncope showed a statistically significant association with mortality. The mortality rate did not significantly differ between the two groups categorized according to the WS (17.4% vs. 0%; P = 0.58) and RGS (21.7% vs. 14.3%; P = 1.00). CONCLUSION WS and RGS had low sensitivity in the diagnosis of PE and had limited prognostic values in a Japanese community hospital setting. Promoting awareness about the risk of mortality in patients with PE, especially those with syncope, is necessary.

Microscopic polyangiitis presented with biopsy-confirmed pleuritis

We describe a case of microscopic polyangiitis manifested as pleuritis confirmed by thoracoscopic biopsy. An 80-year-old man presented with a three-day history of shortness of breath and cough. Chest radiography revealed patchy opacities in the lower fields of the bilateral lung and right-sided pleural effusion. Thoracentesis revealed lymphocytic pleural exudates. Thoracoscopic biopsy specimens were compatible with fibrotic pleuritis. He developed rapidly progressive glomerulonephritis with elevated myeloperoxidase anti-neutrophil cytoplasmic antibody titer in blood and pleural effusion. Although the patient was resistant to two weekly courses of pulse steroid therapy, he was successfully treated with a five-day course of intravenous immunoglobulin.