In this study, rapid antigen screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was done before starting work each day in March 2022 for employees who had close contact with SARS-CoV-2-positive individuals. We also conducted a retrospective analysis of the positive and false-positive rates based on reverse transcription-PCR (RT-PCR) test results from March to November 2022. The threshold cycle (Ct) value calculated by real-time RT-PCR was used as an indicator of viral load. The logtransformed antigen quantification value showed an inverse correlation with viral load, whereas no clear correlation was observed between the antigen quantification value and age or sex. The receiver operating characteristic (ROC) analysis results showed a cut-off value of 4.90 and a positive concordance rate of 87%. Our findings indicate that this test method is simple to use, with results available approximately 20 min after specimen detection, making it highly effective when frequent testing is required, such as before employees begin work. However, there are issues such as nonspecific reactions; thus, it is necessary to make comprehensive judgments, such as understanding the characteristics and important points in examinations and establishing appropriate criteria for additional examinations.

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Background: COVID-19 is not only acute but also causes a post COVID-19 condition (PCC). In this study, we investigated trends in PCC. Methods: This was a single-center, retrospective observational study from February 15, 2021 to March 31, 2023 in Okayama in Japan. We summaries the weekly trends and epidemiological aspects of PCC and reported COVID-19 cases. Results: The weekly number of PCC-related visits by the date of COVID-19 onset showed a trend similar to that of COVID-19 cases. Weekly visits to CAC tended to increase several months after each pandemic wave. The incidence rates of PCC in the Omicron-dominant period were one-tenth of those during the Delta-dominant period. Conclusion: This study revealed that the number of PCC-related visits tended to increase a few onths after an increase in COVID-19 cases. The number of patients with PCC is expected to further increase in the near future owing to Omicron variants.

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The patient had developed a right thyroid mass the size of a ping-pong ball 41 years before presentation; however, the size of the mass did not change during this period. Thyroid ultrasound examination and puncture cytology had been performed almost every year for 19 years, but the cytology revealed no malignant findings. Eleven years before presentation, a lesion appeared in the upper lobe of the left lung and was followed up as a suspected hamartoma, and nine years before presentation a similar lesion appeared in the middle lobe of the right lung. Seven years before presentation, cytology of the right thyroid gland was classified as class III and surgery was recommended, but the patient refused. One year before presentation, the thyroid mass had enlarged to 60 × 70 mm, and the patient was hospitalized with dyspnea. Although the symptoms temporarily improved, the patient developed a respiratory tract infection on the 123rd day of hospitalization, experienced pain in the right thyroid mass on day 148, and died of pneumonia on day 195. Consent for an autopsy was obtained, and it was performed on the same day. The tumor size at autopsy was 130 × 90 mm. The patient was diagnosed with follicular and undifferentiated thyroid cancer.

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A 76-year-old woman who was being treated for Mycobacterium avium lung infection discontinued treatment after showing improvement; however, her symptoms and imaging findings worsened thereafter. A diagnosis of a relapse of the Mycobacterium avium lung infection was made and treatment was resumed. However, the symptoms did not improve, and non-Penicillium marneffei species were detected using bronchoscopy samples. A diagnosis of non-Penicillium marneffei penicilliosis was made, and treatment with itraconazole was started, which improved the patient’s condition. The findings from this case suggest that non-Penicillium marneffei penicilliosis should be considered in patients treated for infection with nontuberculous mycobacteria.

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A 97-year-old woman underwent open repair and immobilization of a right femoral metaphyseal fracture at our hospital. Owing to a postoperative cerebral infarction, enteral nutrition via a nasogastric tube was initiated. The patient subsequently developed hyperosmolar hyperglycemic syndrome (HHS) triggered by a urinary tract infection; she was unable to communicate and was referred to our department. In cooperation with a certified diabetes nurse and nutritionist, we adjusted the blood glucose levels and discontinued enteral nutrition. The patient’s level of consciousness improved, and she was able to talk with her family. We received useful advice from the diabetes-certified nurse (insulin dose and how to correct blood electrolyte levels) and nutritionist (when to start enteral feeding and increase caloric intake). Elderly patients often have multiple comorbidities, and the management of our patient was difficult because of the HHS. However, the patient was able to resume normal activities owing to the multidisciplinary collaboration in her treatment.

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The number of elderly patients receiving home medical care is expected to rise in Japan, where the population is aging. This case report highlights the importance of sharing information, communication, and establishing a relationship of trust among the physician, the patient and key persons. This collaboration is crucial for providing appropriate, patient-centered care for elderly patients receiving home medical care. The case involves a patient with extensive use of home care who had experienced a brief stay in a long-term care facility and has a family that fully understands how comprehensive care operates. Due to the patient’s advanced age, the involvement of a key person in the treatment and care planning was necessary. To foster a strong relationship among the three parties the implementation of Shared Decision-Making (SDM)-a process in which both the patient and medical professionals participate in determining the treatment plan-, helped facilitate communication among them and led to a treatment plan that all parties agreed upon. It was suggested that SDM improved the quality of treatment and care of this elderly patient undergoing home medical care by building a new relationship with the key person as the patient aged.

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A cholinergic crisis is a condition characterized by nausea, vomiting, hypotension, bradycardia, diarrhea, diaphoresis,miosis, and salivation caused by acetylcholine receptor overstimulation. Bethanechol-induced cholinergic crisis has been rarely reported. Decreased cholinesterase activity cannot be utilized as a diagnostic criterion, unlike cholinesterase inhibitor-induced cholinergic crisis, and a clinical diagnosis of parasympathetic overactivity is crucial. A 79-year-old male patient with diabetic neuropathy complicated by a urinary tract infection developed a cholinergic crisis following a glycerin enema procedure. He experienced vomiting, hypotension, bradycardia, and increased airway secretions. These symptoms persisted for 6 h and were self-limited. Patient factors, such as constipation, renal insufficiency, diabetic autonomic neuropathy, and complicating infection, in addition to bethanechol administration and a glycerin enema procedure, were considered contributing factors to the stimulation of his parasympathetic nerve, which caused the development of the cholinergic crisis.

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Amyotrophic lateral sclerosis (ALS) is a rare disease with a poor prognosis, and early diagnosis can be challenging. We encountered a case of diffuse panbronchiolitis (DPB), suspected to be due to subclinical aspiration caused by ALS, that was refractory to low-dose macrolide therapy. A 69-year-old man presented to our hospital with complaints of cough and yellowish sputum. He had a history of sinusitis, and based on characteristic chest CT findings, was diagnosed with DPB and started on low-dose clarithromycin (CAM) therapy. His symptoms gradually improved, and the chest shadows resolved. After one year of CAM therapy, the treatment was discontinued. However, six months later, the same symptoms recurred, and CAM was restarted. This time, there was no improvement, and the patient experienced progressive weight loss, which eventually led to muscle weakness in his lower extremities. A brain MRI revealed no central nervous system lesions, and nerve conduction studies were normal, but needle electromyography showed characteristic findings consistent with ALS. We suspected that the recurrence of DPB was due to subclinical aspiration exacerbated by ALS. In cases of DPB with unexplained weight loss or muscle weakness, the possibility of coexisting ALS should be considered.

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Syphilis is a prevalent sexually transmitted infection that can cause various symptoms, including nephrotic syndrome. Nephrotic syndrome due to syphilis can be treated with antibiotics alone. We describe a case of nephrotic syndromecaused by syphilis in a young woman that was successfully treated with amoxicillin.

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In Japan, hospital-based general medicine physicians play a significant role in outpatient care. Outpatient practice demands advanced clinical skills, including the swift recall of differential diagnoses, effective patient communication, and the implementation of comprehensive management plans. Based on these demands, we developed five key themes for enhancing the quality and efficiency of outpatient care. The themes were derived from discussions at the Japan Society of Hospital General Medicine Annual Meeting, where physicians exchanged insights and identified practical approaches to common outpatient challenges. The five themes are: (1) history-taking and physical examination, emphasizing structured, patient-centered methods; (2) fostering patient-physician relationships to build trust and continuity; (3) ensuring continuity of care, particularly for patients with undiagnosed or medically unexplained symptoms; (4) balancing efficiency and quality improvement to manage complex patient cases in both inpatient and outpatient settings; and (5) preventing burnout, promoting resilience, and fostering “joy in patient interactions” for sustainable practice. This framework synthesizes concepts from patient-centered care, narrative medicine, and family medicine and reinterprets them for hospital generalists. By adopting these themes, Japanese hospital-based general medicine physicians can achieve improved patient outcomes and a more fulfilling clinical practice.

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