Background: The self-developed Saga Fall Injury Risk Model (SFIRM) consists of six items: sex, age, presence of a referral letter, ambulance transportation, history of falls, and Bedriddenness Rank: and demonstrated good discriminative ability in a preliminary study conducted in acute and chronic care hospitals. This study validates the SFIRM for use in chronic care hospitals, where many older patients at high risk of fall-related injuries are admitted. Methods: This multicenter retrospective study targeted patients aged 20 years who were admitted to three chronic care hospitals from April 2018 to March 2021. Data on information and factors related to falls and fall-related injuries were collected from medical records. The primary outcome was the presence or absence of a fall-related injury, and the Area Under the Curve (AUC) of SFIRM was calculated. Results: The data of 1,184 patients (median age = 86 years; men = 45.6%) was available for analysis. Among them, 103 had fall-related injuries that occurred within the hospital. The AUC of the SFIRM was 0.856 (95% CI: 0.820- 0.891, p <0.001). Conclusion: The SFIRM demonstrated good accuracy with data from chronic care hospitals, indicating that it is a simple and helpful model applicable to diverse populations.

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Edwardsiella tarda (E. tarda), a gram-negative bacillus, is frequently detected in aquatic environments. Although it is mainly documented as a fish pathogen, it can also infect humans. Potential routes for human infection encompass contaminated water or seafood ingestion and through an open wound. Patients with immunosuppressed states or specific risk factors are more vulnerable to infections; however, case reports are limited, and no standardized guidelines for diagnosis or treatment currently exist. This study retrospectively reviewed 19 cases of E. tarda infection at Wakkanai City Hospital from 2013 to 2023. Enteritis, cholangitis, liver abscess, and urinary tract infection were the identified infections. Notably, five cases progressed to sepsis. The average age of patients with sepsis was 74.4 years, and four of them had a biliary jejunostomy history. Despite the severity of the infections, the mortality rate was 0%, with all patients discharged alive. Patients with biliary jejunostomy were considered at a higher risk of severe illness. Although previous studies have reported high E. tarda infection-related fatality rates, this study demonstrated improved outcomes with timely diagnosis and appropriate treatment. Rapid identification of the causative pathogen, assessment of risk factors, and prompt antimicrobial therapy initiation are critical in E. tarda infection management.

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In Japan, hospital general medicine has gained attention, yet its professional roles and scope remain unclear. This study aims to clarify hospitalists’ roles, challenges, and levels of job satisfaction. A nationwide survey of JSHGM members yielded 450 responses. Regional analysis showed more members in western Japan, with the proportion of female members significantly correlated with the number of members per population. Findings revealed significant gender disparities in academic achievements, career progression, and income. Male physicians were more likely to hold PhDs, study abroad, and attain academic positions, while female physicians faced greater difficulties balancing research and family duties. Text mining analysis highlighted key concerns, including insufficient research time, heavy clinical workloads, and limited professional growth opportunities. Both genders expressed a strong desire to engage more in research and medical education, underscoring the need for institutional support. Enhancing research frameworks, improving work-life balance, and strengthening training programs are essential for the future of hospital general medicine in Japan. Addressing these issues is crucial to attracting young physicians and ensuring the field’s long-term sustainability.

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Tramadol, a μ-opioid receptor agonist, is widely used to manage chronic pain owing to its effective analgesic properties and lower risk of respiratory depression than other opioids. However, severe adverse effects including seizures and respiratory depression may occur, particularly when combined with other medications. We report the case of a 69-year-old woman with depression and schizophrenia who was on long-term benzodiazepine therapy. She developed altered consciousness and type II respiratory failure after receiving tramadol and celecoxib for lumbar spinal stenosis. Despite the comprehensive testing, no structural or metabolic abnormalities were observed. Benzodiazepines, a part of her psychiatric medication regimen, were deemed unlikely to explain her symptoms, as serum drug levels were within the therapeutic range. Rapid improvement following naloxone administration strongly suggests opioid toxicity, potentially exacerbated by interactions between tramadol and celecoxib. This case highlights the risks of combining opioids with other central nervous system depressants, particularly polypharmacy. It also highlights the challenges in managing opioid toxicity in Japan, where serum tramadol testing is unavailable. Clinicians should be vigilant for adverse effects in patients taking multiple medications and be prepared to initiate empirical treatment, such as opioid antagonists, to mitigate potentially life-threatening complications.

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A 47-year-old male with type 2 diabetes presented to the internal medicine department with nausea. Laboratory findings showed metabolic acidosis on blood gas analysis and ketone bodies on urinary tests; however, serum glucose levels were normal. A review of his drug history showed that semaglutide had been prescribed one week before this episode at a 0.25 mg weekly subcutaneous dose. Semaglutide interruption resulted in eliminating his symptoms and metabolic acidosis on blood gas analysis. The GLP-1 receptor increases insulin secretion, decreases glucagon secretion, and delays gastric emptying, all of which lower blood glucose, resulting in the development of euglycemic ketoacidosis.

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A 77-year-old woman with no history of urinary tract stones, urological disorder, or trauma presented to our hospital with complaints of persistent right flank pain accompanied by nausea. Initial blood tests revealed mildly elevated inflammatory markers but no definitive abnormalities. A contrast-enhanced computed tomography (CT) scan revealed retroperitoneal fluid accumulation, raising suspicion of urine leakage. A follow-up CT scan taken 4 h later confirmed extravasation of contrast medium, establishing the diagnosis of spontaneous ureteric rupture without ureteral obstruction. The patient underwent retrograde pyelography (RP), which identified the rupture site at the ureteropelvic junction. A ureteral stent was placed, and intravenous antibiotics were administered, resulting in full recovery. This case emphasizes the importance of considering ureteric rupture in cases of acute abdomen with unexplained fluid accumulation. Because elderly patients may experience delayed contrast excretion, repeat CT scans at appropriate intervals are recommended for accurate diagnosis. This case also highlights the dual diagnostic and therapeutic value of RP, emphasizing the need for timely urologist referral in emergency settings where specialist access may be limited.

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The evaluation of acute abdominal pain remains diagnostically challenging, particularly in adolescent females, where gynecologic and systemic causes must be considered. Immunoglobulin A vasculitis (IgAV) can initially manifest with isolated gastrointestinal symptoms, making early recognition difficult when the classical triad of purpura, arthritis, and abdominal pain is incomplete. We report a case of IgAV in a 16-year-old girl who presented solely with abdominal pain. Imaging showed terminal ileal thickening, but no definitive etiology. Continued inpatient observation and hypothesis-driven physical examination (HDPE) revealed new-onset purpura and arthritis on hospital day 8. A skin biopsy of the purpuric lesions confirmed the diagnosis, showing leukocytoclastic vasculitis with perivascular neutrophilic and eosinophilic infiltration on histology and IgA deposition on immunofluorescence. This case underscores the importance of HDPE and serial reassessment in diagnostically ambiguous cases of acute abdomen. Importantly, it highlights the diagnostic utility of skin biopsy in confirming vasculitis, particularly when extra-abdominal features appear late in the clinical course. Early discharge could have led to delayed or missed diagnosis. Clinicians should maintain vigilance for evolving systemic signs in similar presentations and be aware that purpura and arthritis may emerge only after a significant delay from the initial gastrointestinal symptoms.

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A 92-year-old male with type 2 diabetes was hospitalized for COVID-19. Treatment with molnupiravir was successful, and he made progress with rehabilitation. However, the patient suddenly developed fever, hypotension, and respiratory failure. Computed tomography (CT) revealed niveau due to gas in the bladder. He was diagnosed with septic shock due to emphysematous cystitis. Treatment with antibiotics, vasopressor drugs, and steroids was administered, but he deteriorated rapidly and passed away. Some patients with emphysematous cystitis do not present any symptoms, leading to delays in diagnosis. Saving the lives of patients depends on early diagnosis and correction of any co-existing risk factors.

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A 56-year-old man was admitted to our hospital with electrolyte abnormalities identified during an examination for leg cramps at a clinic. On arrival, his vital signs were as follows: Glasgow Coma Scale (GCS), E4V5M6; body temperature, 37.8°C; blood pressure, 128/78 mmHg; pulse rate, 87/min; respiratory rate, 16/min; and SpO2, 95% on room air. His medical history included alcoholic liver cirrhosis and alcohol use disorder. Laboratory examinations revealed hypokalemia (1.8 mEq/L), hypomagnesemia (1.1 mg/dL), hypophosphatemia (2.1 mg/dL), hypocalcemia (6.0 mEq/L) and an electrocardiogram (ECG) showed a prolonged QT interval (QTc, 559 ms) due to electrolyte abnormalities. The patient was admitted to our hospital and electrolyte abnormalities were corrected through the use of intravenous infusion therapy administered by our medical team. Laboratory examination on day 4 showed improved electrolyte abnormalities, and an ECG on day 4 showed a normal QT interval (QTc, 437 ms). Clinicians should be aware that alcoholic myopathy and long QT syndrome may develop in individuals with alcohol use disorder.

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A 54-year-old bedridden Japanese man with a history of cerebral infarction and recurrent cholecystitis that required biliary stenting was admitted with fever and vomiting shortly after treatment for aspiration pneumonia. He showed signs of sepsis, and laboratory tests revealed leukocytosis, elevated C-reactive protein, and abnormal liver function. Blood cultures grew Shewanella algae and Enterococcus faecalis. Abdominal CT confirmed a biliary stent without signs of abscess or ileus. ERCP revealed sludge-induced stent obstruction. The stent was replaced, and papillotomy was performed. Bile cultures confirmed the same organisms. Although the patient had had no exposure to seawater, he had consumed a small amount of raw fish approximately one month prior to onset. He improved with meropenem and was discharged in stable condition. This case highlights Shewanella algae as an emerging pathogen in healthcare-associated biliary infections and suggests that even remote dietary exposure may be relevant in such infections.

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General medicine was formally established as a basic specialty in Japan in 2018, and a specialty program for hospital general medicine was later launched in 2022. Fellows of Hospital General Medicine (FHGM) are expected to deliver high-quality care in outpatient clinics, general beds, emergency wards, and intensive care settings while contributing to community healthcare, research, and education. However, the number of FHGMs remains small, with key challenges regarding education and career path clarification. Educational improvement requires clinical supervision by experienced FHGMs and enhanced diagnostic reasoning education through a well articulated teaching regimen.Additionally, presenting clear FHGM career paths is essential, as it requires concrete, diversified career models and network building. Such systems are necessary to continuously train FHGMs to provide standardized, high-quality medical care and to contribute to the dissemination and expansion of the Japanese healthcare system.

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