Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.
Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.
Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.
Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.

View full abstract

Background: In Japan, although many new pharmacy graduates are keen to find work, the number of new job openings for hospital pharmacists is limited. In this survey, we explored the attitudes toward work among hospital pharmacists working in large group hospitals in order to help pharmacy students make informed career decisions.
Methods: A cross-sectional, self-administered survey of 614 hospital pharmacists working in 66 institutions of the Tokushukai Hospital Group across Japan was conducted.
Results: The proportion of usable data from surveyed pharmacists was 71.7%. Approximately 80% of the respondents desired to commit to careers in the healthcare field and were keen to gain opportunities for personal development. Personal development was the key item among reasons given for decisions about workplace and turnover. About 95% of the pharmacists surveyed were satisfied with their jobs. Compared to the job satisfaction level of other workers, that of pharmacists was considerably higher, although only 5.5% of pharmacists saw themselves staying in their current job until retirement. Job satisfaction data demonstrated significant differences among cohorts of age and years employed, although some specific items associated with job satisfaction could not be identified. Future work plans were influenced by age and job satisfaction.
Conclusion: This study suggests that pharmacists working in group hospitals nurture positive expectations for their careers. Management needs to make greater efforts to understand the professional characteristics of hospital pharmacists in order to better utilize their professional abilities and skills for patient care and for the benefit of other healthcare professionals.

View full abstract

Objective: With the recent aging trend in the Japanese population, dysphagia appears to be increasing. However, few epidemiologic surveys have been conducted to determine the prevalence of dysphagia in local inhabitants. Ohkuma et al. prepared a highly reliable questionnaire using a simple test and safe examination method. We investigated the presence/absence of symptoms of dysphagia in local inhabitants, evaluated their association with subjective symptoms, and examined whether the inhabitants were following a particular diet, which is the most important factor in management of dysphagia.
Methods: A cross-sectional study involving 743 inhabitants (age: over 20) of an isolated island was performed. Each subject was asked basic questions (awareness about the presence/absence of dysphagia and dietary habits), and the data was analyzed by chi-square test. Based on their responses, dysphagia incidence was determined and rated on a 3-category scale (severe, mild, and no dysphagia).
Results: Responses were recollected from 368 subjects (response rate, 49.5%). The percentage of subjects aware of dysphagia in the severe, mild, and no dysphagia groups was 13.8%, 3.2%, and 0%, respectively and the percentage of subjects who changed their dietary habits was 17.2%, 2.6%, and 0%. These percentages were significantly higher in the severe group than in the mild and no dysphagia groups, though the value was less than 20% in the 3 groups.
Conclusion: Most subjects in the present study were unaware of dysphagia, suggesting that patients with dysphagia tend to be unaware of the key symptoms of dysphagia.

View full abstract

Background: Gastric and colorectal cancers are the leading cause of cancer-related deaths in Japan. In an attempt to control such cancer-related deaths, gastric and colorectal cancer screenings (GCSs) are readily available in Japan. Despite this, the rate of participation has been lower than expected. Previous studies have reported that some intervention tools can improve participation in cancer screenings and others cannot. Such studies conducted in rural areas are quite rare.
Methods: The subjects were residents of Kozu Island. All subjects were aged 40 and over. In the clinical setting, primary care physicians (PCPs) handed their patients a screening invitation, in an attempt to improve participation in GCSs. We examined participation trends before and after this intervention. In addition, we administered questionnaires to examine subjects' reasons for attendance and relevant characteristics of the subjects.
Results: Following the intervention, participation in GCSs did not significantly improve in the short term. In 2011, the number of participants in gastric cancer screening was 173 (22.1%) and was not significantly different from the 2010 results (P=0.80). Furthermore, the number of participants from year to year (2005-2011) was not significantly different (P=0.07). In addition, the number of participants in colorectal cancer screening was 145 (16.5%) and was not significantly different from the 2010 results (P=0.65). Moreover, the number of participants from year to year (2005-2011) was not significantly different (P=0.17). 172 out of 211 (82%) participants submitted the questionnaire. Results taken from the questionnaires showed that our screening invitation influenced non-elderly people (49.5±3.9 vs. 56.4±6.5, P=0.04) and first-attendance people showed a significant tendency for more gastrointestinal symptoms (4 vs. 2, P=0.03).
Conclusion: On the whole, the screening of invitations from PCPs did not improve participation rates in GCSs in the short term. However, we believe that screening invitations can influence non-elderly people, and this intervention can be effective in increasing the numbers of gastrointestinal-symptomatic people attending for the first time (first-attendance people).

View full abstract

Background: Female hormones may influence the oral environments of pregnant women. Appropriate oral care by pregnant women promotes oral health, contributing to caries prevention in children from the perspective of cariogenic bacteria transmission. The purpose of this study was to evaluate the oral environment of pregnant women and clarify factors associated with the presence of Streptococcus mutans.
Methods: A saliva test (volume, pH, Streptococcus mutans count, Lactobacillus count, and total oral Streptococcus count) and questionnaire survey regarding subject characteristics, oral symptoms, and oral health behavior were conducted with 264 pregnant women. We examined the association between the saliva volume/pH and caries-associated bacteria, and compared oral environments related to differences in the subject characteristics, oral symptoms, and oral health behavior. Binomial logistic regression analysis was also conducted to clarify factors associated with the presence of Streptococcus mutans.
Results: Oral cleanliness was maintained in the subjects who participated in this study. However, in 22.0% of these women, the Streptococcus mutans accounted for 1% or more of the total oral Streptococcus count. Eight items that reduced the proportion of Streptococcus mutans in the total Streptococcus count were confirmed and included the following: “tooth-brushing time of 5 minutes or more” ; “absence of tooth pain” ; “absence of stimulation related to sweets” ; “saliva pH of 6.8 or higher” ; “having a dental checkup for pregnant women” ; “consciously brushing teeth” ; “confidence in brushing” ; and, “employment (housework and full-time work) ”.
Conclusion: The results of this study contribute to health education during pregnancy, in which health behavior may change as childbirth approaches, and may be useful for guiding appropriate oral health behavior.

View full abstract

We report the case of a 63-year-old male with diabetes who was diagnosed with staphylococcal bacteremia. Paralysis of the extremities (right upper, left lower) and bladder and bowel dysfunction developed 5 days after treatment initiation. Spinal magnetic resonance imaging revealed a spinal epidural abscess at the L4/5 level. Despite right upper extremity palsy, there was no visible cervical spine abscess. Emergency surgery was undertaken, which resulted in complete neurological recovery. General physicians must be aware that damage to the spinal cord can be caused not only by direct compression of an epidural abscess but also by impaired blood circulation or inflammation.

View full abstract

We present a case of a 34-year-old woman with tophaceous gout and a history of anorexia nervosa from the age of 17. She presented with recurrent finger pain, which was initially treated as cellulitis. However, multiple subcutaneous nodules developed a year later, and tophaceous gout was diagnosed. Although gout is uncommon in young women, anorexic states carry a risk of hyperuricemia. In addition, the practice of habitual self-induced vomiting and an overuse of laxatives may precipitate gout.

View full abstract

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

View full abstract

Metformin is widely prescribed for patients with type 2 diabetes mellitus (DM). Its use for patients with type 1 has been considered a contraindication because of possible adverse effects such as lactic acidosis. However, metformin has been recently used with insulin therapy to reduce insulin-dose requirements in Type 1 DM.
An 81-year-old Japanese woman with type 1 DM was treated with insulin and metformin. She was admitted to our hospital due to altered mental state and hypotensive shock via a referral from her primary care physician. The patient had severe lactic acidosis and acute kidney injury with hyperkalemia with the suspected cause being the use of metformin. She was treated successfully with hemodialysis (HD).
Although the independent predictive factor of mortality due to metformin-associated lactic acidosis is a prothrombin time (PT) activity of less than 50% in 24 hours, we recommend that HD should be performed for a patient with severe lactic acidosis even if the initial PT activity is normal.

View full abstract