Background: Relative bradycardia has been observed in COVID-19 patients, and its potential as a diagnostic tool has been acknowledged. However, its role as an indicator of disease severity remains unclear. Methods: This retrospective cohort study, conducted at a single center, included consecutive COVID-19 patients admitted to an acute care hospital in Japan from April 1, 2020, to July 31, 2021. Data were collected from electronic medical records, and the incidence of relative bradycardia was examined. Logistic regression analyses were employed to evaluate differences in outcomes between patients with and without relative bradycardia. In the primary analysis, the main outcome was the relationship between relative bradycardia during hospital stay and hypoxemia during the same period. In a sub-group analysis, we investigated whether relative bradycardia at admission is predictive of the subsequent development of hypoxemia. Results: Relative bradycardia was strongly correlated with hypoxemia during hospital stay (adjusted odds ratio 7.84;95% confidence interval 3.37-18.24). In the sub-group analysis, relative bradycardia at admission was also strongly correlated with the development of hypoxemia after the second hospital day. Conclusions: This study found that relative bradycardia was correlated with the severity of disease in COVID-19 patients.

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Background: Older individuals often exhibit blunted fever responses, which can complicate diagnosis and increase infection-related morbidity and mortality. Early and accurate diagnosis is crucial for older patients with fever. The aim of this paper is to evaluate the effectiveness of DWIBS for identifying the source of fever of patients with fever or elevated inflammation reaction. Methods: This study was a retrospective evaluation of 43 febrile patients who underwent DWIBS (median age 85 years, 91% over 65 years). Agreement of the DWIBS and conventional imaging modality assessments are expressed by the κ coefficient. Results: In the 43 cases with a final diagnosis, the overall agreement rate between DWIBS and conventional imaging modalities was 88%, with a κ value of 0.4794 (p=0.00157), indicating good agreement. For infectious diseases, the agreement rate was 80.6% with a κ value of 0.448 (p=0.012), while for non-infectious diseases, it was 100%.DWIBS showed high detection rates for several conditions, for example, urinary tract infections, abscess in various organs, osteomyelitis, enteric infection, cellulitis, and collagen diseases. Conclusions: DWIBS was shown to be highly compatible not only with non-infectious diseases such as malignancies but also with infectious diseases, thus it may be particularly compatible for use with older patients.

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Background: In emergency departments (ED), patients who are transported for non-specific complaints, without initial suspicion of infectious diseases, are often ultimately diagnosed with coronavirus disease 2019 (COVID-19). This situation presents significant challenges for infection control in hospital settings. Methods: We conducted a retrospective study on patients diagnosed with COVID-19 who were transported to our ED between January 2022 and June 2024. Data for this study were extracted from electronic medical records, focusing on chief complaints at the time of emergency transport. Patients transferred from other hospitals with a prior COVID-19 diagnosis were excluded. Results: This study included a total of 278 patients, with a significant proportion showing non-specific symptoms, such as weakness and trouble in movement, especially elderly people. Older patients also tended to have lower body temperatures upon arrival, than younger patients. Symptom severity varied, and elderly patients were more likely to experience moderate to severe illnesses. Conclusions: The findings of this study emphasize the challenge of diagnosing COVID-19 in elderly patients owing to the frequent absence of typical symptoms. ED should maintain a high level of suspicion for COVID-19 among elderly patients to prevent nosocomial transmission.

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Objective: To estimate the basal insulin dose required to maintain glycemic stability in hospitalized Japanese patients with type 2 diabetes mellitus (T2DM). Methods: A retrospective, observational study was conducted on patients with T2DM admitted to the JA Toride General Medical Center who received basal insulin injection between April 2020 and October 2024. Patients with a serum creatinine level ›3 mg/dL or type 1 diabetes mellitus were excluded. The basal insulin dose was recorded for patients with morning fasting blood glucose levels in the range of 100-150 mg/dL for three consecutive days. These patients were classified into three body mass index (BMI) categories: underweight (BMI ‹18.5), normal weight (BMI 18.5-25), and overweight (BMI ›25). Results: The data of 110 patients (underweight, 16; normal weight, 65; overweight, 29) was available for inclusion in the study. The median basal insulin dose (interquartile range) for underweight patients was 0.096 (0.054-0.109) units/kg/day, 0.115 (0.086-0.145) units/kg/day for normal-weight patients, and 0.157 (0.107-0.191) units/kg/day for overweight patients; significantly different among the BMI categories, between underweight and overweight, and between normal weight and overweight (P = 0.002). Conclusion: BMI was useful for stratifying the basal insulin dose to ensure glycemic stability in hospitalized Japanese patients with T2DM.

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Objective: This study aimed to evaluate the immunogenicity of the BNT162b2 mRNA vaccine up to 180 days after the third dose in Japanese healthcare workers. Methods: From April 2021 to July 2022, 100 participants (median age: 39 years; interquartile range: 30-48) received at least two doses of the BNT162b2 vaccine, with 90 participants having a third dose. Baseline blood samples were collected before the first-dose and up to 180 days after the final dose. Anti-S-IgG antibody levels were measured using the Abbott and Fujirebio assays. Results: Of all participants, 76 who had no SARS-CoV-2 infection, were not on immunosuppressants, and provided timely blood samples after receiving their third dose were included in the primary analysis. The S-IgG level exhibited bimodal peaks at 14 days after the second and third doses, followed by a steady decline. Antibody titers at 90 and 180 days after the third dose were higher than those at 90 and 180 days after the initial dose. Conclusions: The third dose of the BNT162b2 vaccine was associated with an increase in anti-S-IgG antibody levels up to 180 days post-vaccination, suggesting the value of multiple booster doses of COVID-19 vaccines.

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Introduction: Although fever management is a fundamental skill for general physicians, the COVID-19 pandemic has significantly impacted clinical training worldwide. Junior residents may have had fewer opportunities to manage febrile patients due to infection control measures, telemedicine expansion, and changes in healthcare priorities. This study aimed to assess the experiences and confidence levels of junior residents in Japan regarding fever management during the pandemic. Methods: We conducted two online surveys targeting first- and second-year residents and attending physicians. Residents were asked about their involvement in fever management, perceived sufficiency of experience, and availability of non-COVID-19 fever management lectures. Attending physicians were surveyed to evaluate their perspectives on residents’ training adequacy. Results: Among 1,914 junior residents, 91.7% reported active involvement in fever management, but 31.7% felt their experience was insufficient. In contrast, 45.9% of 122 attending physicians believed residents’ training in fever management was inadequate. Additionally, only 17.8% of residents and 19.7% of attending physicians reported sufficient non-COVID-19 fever management lectures. Discussion: Our findings highlight a discrepancy between residents’ self-assessment and attending physicians’ perceptions. The results suggest a need for an enhanced educational frameworks to provide comprehensive fever management training beyond COVID-19 contexts, ensuring clinical competency for future practice.

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Hematemesis is a rare complication of influenza infection. Here, we report a pediatric case of hematemesis after influenza infection. A 7-year-old boy was brought to our hospital by ambulance because of sudden hematemesis the day after the onset of fever. He vomited 300 mL of blood twice and experienced abdominal pain. A rapid antigen test was positive for influenza A. Endoscopy revealed an acute gastric mucosal lesion without a peptic ulcer or perforation. Therefore, the patient was treated with a hemostatic agent and a proton pump inhibitor. The fever rapidly improved with peramivir hydrate treatment. Blood testing showed anemia, but a blood transfusion was not required. To date, only 21 cases of hematemesis due to influenza have been reported: The age at onset ranged from 1 to 14 y, 8 patients underwent surgery, 2 patients died of hypovolemic shock, and six patients improved with medical therapy. The frequency of peptic ulcers may be underestimated in children with influenza infection because few facilities can perform endoscopic studies in children and close examinations tend to be performed only after serious illnesses. Influenza infections complicated by hematemesis may require surgery; therefore, gastrointestinal endoscopy is important in the treatment of pediatric patients with hematemesis due to influenza.

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Even herbal medicines traditionally considered to have no specific side effects and that meet the relevant guidelines can cause drug induced pneumonia. Here we report a case of interstitial pneumonia that improved after discontinuing EviprostatⓇ prescribed for benign prostatic hyperplasia. Physicians should recognize this risk and consider drug induced pneumonia as a differential diagnosis for unexplained pneumonia.

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Medical education requires a gradual transition from lecture-based learning to active engagement in patient care through a clinical clerkship. This report highlights the academic benefits of involving medical students in the development of clinical pictorials, delivering oral presentations at academic conferences, and publishing them in peerreviewed journals. A cohort of two medical students at Showa Medical University School of Medicine participated in clinical training at Koto Toyosu Hospital Children’s Center, where they created quiz-style clinical pictorials based on instructor-provided cases. The primary objective of this study was to share case studies and enhance the intrinsic motivation of the students without imposing excessive academic pressure. Both medical students successfully presented their cases at national conferences and published their findings, demonstrating the effectiveness of this multifaceted active learning approach. After their achievements, they made positive comments about their future careers. The initiative enhanced their clinical knowledge and presentation skills and fostered autonomy and self-evaluation. These findings indicate that motivated medical students can achieve notable academic milestones before graduation, highlighting the importance of fostering self-driven learning in medical education. This approach may serve as a model for integrating scholarly activities with clinical training, thereby enriching the educational experiences of future healthcare professionals.

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