While the restrictions on visitation as a countermeasure against the COVID-19 pandemic have contributed to infection prevention and control, they also impose a medical and psychological burden on patients, their families, and healthcare workers. To clarify the impact of visitor restrictions and to develop an improvement plan, we interviewed 11 medical staff members and 10 patients or their family members. The restrictions on visitation were generally accepted by both groups and there were no major complaints. Although medical explanation became more difficult because phone calls were primarily used, flexible measures were taken such as face-to-face explanations at outpatient wards when needed or making frequent contact with a patient’s family. However, there were some cases in which difficulty was encountered in the coordination of discharge support because family members could not see the patient’s condition and therefore could not imagine the patient’s lifestyle after discharge. Virtual visits using tablets were problematic in that communicating with elderly patients with hearing loss was difficult and because there was an extra burden on healthcare professionals of having to coordinate the time of contact. To solve the above problems and utilize the medical resources effectively, a review of visitation policy and consideration of alternative methods is a pressing issue.

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Our hospital is mainly responsible for inpatient care for patients infected with COVID-19 in the Kuji medical area on the northern coast of Iwate Prefecture.There were 24 hospitalizations in 2020 and 142 in 2021, but there were no in-hospital clusters or deaths of COVID-19 positive patients. However, in 2022, amid the seventh wave that started in July, clusters occurred in the hospital and there were 8 deaths of COVID-19 positive patients during the isolation period. In November of 2022, there were already 157 hospitalizations. Since the first cluster outbreak, the hospital has had five clusters, but they occurred in only two of the four wards in our hospital. We measured the CO2 concentration in the rooms and toilets of the two wards, and there were no places where the CO2 concentration exceeded 1000ppm, which leads us to believe that the cluster outbreaks in our hospital had little to do with poor ventilation. We must further investigate the cause of the clusters.

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An increase in aspiration pneumonia cases can be observed in rapidly aging societies like Japan. In particular, many patients with cerebrovascular disorder have some type of dysphagia. In this case report, a patient with a history of cerebral infarction experienced recurrent aspiration pneumonia. During readmission, a pharyngeal tumor was detected via oral examination that may have been an etiological factor for aspiration. Etiological factors for dysphagia include organic factors related to passage obstruction of the pharynx/esophagus and functional factors related to transport disorders of nerves and muscles. Even if a functional factor is suspected as the etiology of aspiration pneumonia, the presence of organic factors should be ruled out.

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We herein describe a 57-year-old man with a history of foot amputation due to right foot necrosis as a complication of type 2 diabetes. The patient was admitted with fever and difficulty moving. Pyogenic spondylitis was suspected due to heat sensation and tenderness near the 5th lumbar vertebra and a high inflammatory response. The patient was first administered tazobactam/piperacillin. On the 4th day, a combination of vancomycin and meropenem was administered. A blood culture was positive for methicillin-resistant Staphylococcus aureus (MRSA), and the trough level was within the recommended range. The patient was diagnosed with acute renal failure based on edema, oliguria, and increased serum Cron day 10, and vancomycin was discontinued. Although treatment was changed to Sulfamethoxazole Trimethoprim (ST) compound, it was discontinued due to the development of a high fever and neutropenia. Linezolid was subsequently initiated. The patient was hospitalized for a long time and continued treatment in the medical care ward. After stopping linezolid, minomycin and rifampicin were co- administered. With strict blood sugar control, a complete cure was achieved after 105 days. This patient developed purulent spondylitis at a difficult-to-operate site and, thus, was not indicated for surgery and transferal to another hospital was not possible.

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Fatigue, anorexia, and weight loss are common symptoms of patients presenting at general internal medicine departments. Their commonality requires physicians to consider a wide range of　differential diagnoses. Amyotrophic lateral sclerosis (ALS) is a progressive, fatal, paralytic disorder characterized by upper and lower motor neuron deficits. We present a case of ALS who developed unexpected CO2 narcosis during a colonoscopy done without sedation. Patients not yet diagnosed with ALS may present to a physician with nonspecific symptoms such as fatigue, loss of appetite, and weight loss. Furthermore, in some cases of ALS, acute respiratory failure develops due to respiratory muscle palsy, even though there is still muscle activity in their limbs. ALS should be included in the differential diagnosis of patients who complain of fatigue or weight loss, and it should be noted that they could develop hypoventilation and acute respiratory failure.

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A 57-year-old male patient with diabetes and obesity was admitted to our hospital with complaints of fever in April 2020. His white blood cell count and C-reactive protein were 10500/μL and 17.4 mg/dL, respectively. His chest X-ray revealed a bilateral ground-glass opacity. The patient’s SARS-CoV-2 PCR test was positive;. hence, he was diagnosed with COVID-19. He needed 62 days of mechanical ventilation. Furthermore, he was administered numerous medications, including Favipiravir, Nafamostat Mesylate, methylprednisolone and antibiotics. He was discharged on day 82. Subsequently, he presented with the following clinical features;taste/olfactory disorders, joint pain, myalgia, and dyspnea. However, no clinical examination could explain those symptoms. When the initial COVID-19 wave shook Japan in April 2020, the TamaNanbu Chiiki Hospital had only one pulmonary specialist and no infectious disease expert. At that time, the availability of information and medical resources on COVID-19 was insufficient. A COVID-19 team including physicians primarily not from the department of respiratory medicine was assembled by our hospital. In this team, all physicians played their roles efficiently by using their general medicine skills. This case was epoch-making for showing the importance of physicians with general medicine skills during the COVID-19 crisis, which caused widespread problems for the Japanese medical system.

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Sodium glucose cotransporter 2 inhibitor is an anti-diabetic drug that is reported to be effective for elderly patients with chronic heart failure under reduced cardiac ejection fraction (HFrEF). We experienced the case of a 72-year old man with HFrEF whose cardiac function represented by serum BNP value and Ejection Fraction by echocardiography was improved after oral administration of Dapagliflozin 10mg after acute phase therapy. The precise mechanism of the effectiveness of Dapagliflozin for cardiac function is speculated to be improvement of cardiac energic metabolism by the increased use of ketone body, cardiac protection by inhibition of sympathetic nerve function, and improvement of cardiac remodeling represented by cardiac mass weight. Dapagliflozin was effective in the treatment of this elderly patient with chronic heart failure (HFrEF).

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A 75-year-old man was referred to our hospital due to shortness of breath on exertion. Laboratory findings showed mild anemia and mild elevation of serum amylase. Chest X-ray revealed right, massive, bloody, pleural effusion. Contrast-enhanced computed tomography (CECT) revealed pancreatic pseudocysts but did not show extravasation. Local anesthetic thoracoscopy could not show the tumor or the active bleeding in the pleural space. After this procedure, CECT showed a pancreatic pseudocyst containing air. This finding suggest that this cyst was communicated to the thoracic cavity via the mediastinum. His pleural fluid amylase level was very high (17,710 IU/L). This patient was finally diagnosed with chronic alcoholic pancreatitis and a rupture of a mediastinal pancreatic pseudocyst with right intrathoracic bleeding. Conservative treatment of his acute pancreatitis resulted in clinical improvement. A mediastinal pancreatic pseudocyst with pleural effusion or intrathoracic bleeding is a rare but important complication associated with chronic pancreatitis.

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Hemolytic anemia is not a common presentation in infective endocarditis and has been reported in few case reports. We report a case of patient who had hemolytic anemia and mitral regurgitation with infective endocarditis due to Streptococcus mitis. The hemolytic anemia was dramatically improved after antibiotic and surgical treatment.

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We report the case of a 2-month-old boy who was hospitalized due to fever after a single administration of the 13-valent pneumococcal conjugate vaccine (PCV13) and subsequently diagnosed with invasive pneumococcal disease (IPD). Blood culture identified Streptococcus pneumoniae serotype 10A, a non-PCV13 serotype. Despite a significant decline in the number of children with IPD after the introduction of PCV13, the rate of IPD due to non-PCV13 serotypes has increased. Pneumococcal vaccination cannot completely prevent IPD, and IPD due to non-vaccine serotypes should be considered in children with fever.

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[in Japanese]

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[in Japanese]

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