[Introduction] Peripheral insertion of a central venous catheter (PICC) is included in “Tokuteikoui” and is a mandated practice in nurse training. This study aimed to evaluate the safety of on-the-job training (OJT) for PICC placement by nurse trainees. [Methods] All patients who underwent PICC placement from April 2021 to March 2022 were included. In OJT cases, a nurse trainee performed PICC placement under the direct supervision of a physician or a nurse practitioner with expertise in PICC placement. We compared the outcomes of OJT cases (O group) and cases involving PICC placement by experts (I group). [Results] A total of 636 cases were analyzed, with 88 in the O group and 548 in the I group. On the day of PICC placement, no significant difference was noted in the frequency of catheter-related bloodstream infection or lumen occlusion. The procedure time was significantly longer in the O group than in the I group (37.2 ± 9.4 vs. 23.9 ± 7.6 minutes; p< 0.001). Trainees had more instances of difficult PICC placement than the experts [53 cases (60.2%) vs. 101 cases (18.4%) (p< 0.001)]. [Conclusions] Trainees took longer to perform PICC placement and had procedural difficulties more frequently than did the experts. However, no significant difference was observed in usability or complication rate.

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We retrospectively examined the thyroid function of 32 infants born to pregnant women taking levothyroxine (LT4) for hypothyroidism. The TSH and FT4 values at birth (cord blood) and at the age of four days were extracted from medical records. Maternal LT4 dosages ranged from 25-125 μg/day. At birth, the median TSH and FT4 levels in cord blood were 6.114 μIU/mL and 0.99 ng/dL, respectively. At the age of four days, the median TSH and FT4 levels were 2.929 μIU/mL and 1.83 ng/dL, respectively. Nineteen infants (59%) had abnormal thyroid function at birth and 13 (41%) had abnormalities at the age of four days. Of those 13 infants, 11 completed follow-up and their thyroid function was normalized by 51 days without treatment. In infants born to hypothyroid mothers treated with LT4, abnormal thyroid function may be transient and may normalize without treatment.

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An 81-year-old previously healthy man developed generalized fatigue, severe anorexia, and abnormal sensations throughout his body, along with paroxysmal hypertension, following an episode of constipation　and difficulty in　passing stools. A colonoscopy was performed, leading to a diagnosis of rectal mucosal　prolapse syndrome and colonic diverticulosis. The search for the cause of the paroxysmal hypertension　was negative for　pheochromocytoma. The patient’s recurrent symptoms were attributed to panic attacks　related to memories of difficult　bowel movements due to constipation. Supportive psychotherapy was　initiated. Four months later, he was hospitalized for diverticulitis. Interestingly, his panic attacks and　paroxysmal hypertension resolved after he was able to understand our explanation that his abdominal pain　was related to diverticulitis. This case highlights how a common symptom like constipation can　significantly impact mental health and overall well-being. This case also underscores the importance of　recognizing that frequent symptoms, such as constipation, can have a　substantial influence on both mental　health and physical functioning.

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For patients with tracheostomy who require continuous mechanical ventilation, establishment of communication is a critical issue in treatment. Above cuff vocalization (ACV) was first reported in 1967 and has been favorably reevaluated worldwide in the past few years as a communication tool for patients with tracheostomy. While mechanical ventilation is continued, oxygen or air is retrogradely delivered at approximately 5 L/min through the port above the cuff of the tracheostomy tube. This process generates airflow to the vocal cord and enables patients to vocalize. Recently, we implemented ACV in two patients, and they were able to vocalize for the first time in several months. Both the patients and their families were greatly satisfied. The complications observed were leakage of insufflated air from the tracheostomy stoma and pharyngeal discomfort. For wide implementation of ACV, further research and studies on aspects such as standardization of the procedure and establishment of safety will be necessary.

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Cytomegalovirus (CMV) is a double-stranded DNA virus of the Herpesviridae family that causes various forms of infection in humans. We herein report the case of a healthy middle-aged adult who developed CMV-associated infectious mononucleosis-like syndrome (CMV-IM) complicated with splenic infarction and gastroenteritis. The patient, a 44-year-old Japanese woman, underwent a thorough examination because of a fever that had lasted three weeks. Our laboratory detected atypical lymphocytes and an elevated transaminase level. Contrast-enhanced computed tomography scan revealed a splenic infarction. Serum CMV antigen was positive and CMV IgM showed an increasing trend after the onset, leading to the diagnosis of primary CMV infection. Moreover, endoscopy revealed multiple ulcers in the gastric antrum and the terminal ileum, and pathological findings showed nuclear inclusion bodies, indicating the development of CMV gastroenteritis. The patient’ s fever subsided with two weeks of valganciclovir, and the laboratory abnormalities recovered. CMV-IM usually resolves spontaneously in immunocompetent individuals, and antiviral treatment is not recommended. Little evidence is available regarding the necessity of antiviral or anticoagulant therapies for patients with CMV-IM complicated with thrombosis and gastroenteritis. Future study will be need to clarify the treatment indications after comprehensive evaluation of such patients.

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A 52-year-old man was admitted to our hospital due to a right foot ulcer and fever. Four years prior, he underwent amputation of a toe on the same foot due to a diabetic foot condition. Because insulin therapy had been interrupted for 3 years, his serum glycosylated hemoglobin level was 11.7 %. A diagnosis of an infected diabetic foot ulcer (DFU) was made. Culture studies from both the foot ulcer and the blood revealed the presence of methicillin-sensitive Staphylococcus aureus (MSSA) and Streptococcus dysgalactiae, a group G streptococcus. Transesophageal echocardiography identified a verruca on the aortic valve, confirming infective endocarditis (IE). Successful treatment was achieved through standard intra-venous ceftriaxone therapy for IE following confirmation via antibiotic sensitivity testing .Hyperglycemia increases the risk of musculoskeletal infection and IE, where DFU can serve as a portal of systemic infection. Although group G streptococcal infections have been growing due to super-aging and multi-morbidity, IE with group G streptococci may remain undiagnosed. Early closure of DFU wounds, effective blood-glucose control, and appropriate microbiological and imaging studies are essential for preventing and treating systemic infections related DFU.

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A 50-year-old man positive for HIV who developed coronavirus disease 2019 (COVID-19) pneumonia was admitted in our hospital in August 2021 during the fifth wave in Japan of the COVID-19 pandemic caused by a delta variant of severe acute respiratory syndrome coronavirus 2. His white blood cell count and serum C-reactive protein levels were 3,100/μL and 9.0 mg/dL, respectively. His chest X-ray revealed a bilateral ground-glass opacity. Although he was treated with antibiotics and antiviral agents, he needed 118 days of mechanical ventilation. His respiratory management was challenging because he developed pneumomediastinum twice. Because the antibiotics and antiviral agents had limited effect, we administered corticosteroid under the diagnosis of organizing pneumonia. He was discharged after 187 days following improvement of the pneumonia. During the fifth wave of the COVID-19 pandemic in Japan, the Japanese medical system was burdened by an overwhelming patient load. Because our hospital only had two pulmonary specialists, a diabetologist team took responsibility for this case. Despite the case overwhelming the non-specialists and medical staff, all physicians played their roles efficiently, successfully using their general medicine skills and knowledge.

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