There have been a substantial number of gross hematuria cases reported after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in adults, and many of these patients have immunoglobulin A nephropathy (IgAN) as their primary disease. Since pediatric cases remain few, we analyzed the clinical characteristics of 14 pediatric IgAN cases presenting with gross hematuria following SARS-CoV-2 vaccination. This cohort comprised 3 cases from our hospitals and 11 cases under the age of 18 retrieved from a PubMed search. We also compared the clinical characteristics of the 14 pediatric cases with previously reported adult cases with gross hematuria after SARS-CoV-2 vaccinations. Most children (12/14) developed gross hematuria the day after the second dose. Among the 7 cases with microscopic hematuria at the vaccination, three patients developed kidney dysfunction. Conversely, no patient (0/3) who was in urinary remission at the time of vaccination developed kidney dysfunction. Similarly, among 9 patients who had not diagnosed with IgAN at the vaccination, five developed kidney dysfunctions, while among 4 patients who had diagnosed IgAN and was under/post treatment, only 1 patient developed kidney dysfunction. A higher rate of kidney dysfunction was observed in pediatric cases than in adult cases (42.9% vs. 0%, 28.6%). IgAN cases in children with gross hematuria after SARS-CoV-2 vaccinations had different clinical characteristics compared to adult cases.

Hypertrophic pachymeningitis is a rare disease associated with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. We recently treated a 20-year-old female who exhibited hypertrophic pachymeningitis accompanied by recurrent temporal swelling. Physical examination only revealed severe pain in the left temporal head with subcutaneous swelling; however, when we performed a lumbar puncture, we noticed that she also had tenderness in the right sacroiliac joint. Bone scintigraphy revealed the bull’s head pattern, the typical findings of SAPHO syndrome. Moreover, it was noted the C-reactive protein, erythrocyte sedimentation rate, and interleukin-6, but not interleukin-4, were elevated during clinical worsening, which was compatible with the diagnosis of SAPHO syndrome. The controversial complication of immunoglobulin G subclass 4 (IgG4) syndrome has been debated due to the increased serum IgG4 at onset, which has been considered not contradictory to the diagnosis of SAPHO syndrome according to literature reviews. Considering the patient’s recurrent course and specific radiological findings, we avoided the need for a biopsy to diagnose SAPHO syndrome and prioritized specific treatments such as anti-tumor necrosis factor antibody, resulted in stable condition. When hypertrophic pachymeningitis is encountered, a careful whole-body examination, in addition to biomarkers including IgG4, should be performed in order to differentiate it from SAPHO syndrome.

A 70-year-old male presented with intermittent vertigo, dizziness, and left facial spasms. Otoscopic examination and temporal bone computed tomography revealed extensive cholesteatoma with lateral semicircular canal erosion and a vestibular fistula. Preoperative audiometry demonstrated severe mixed hearing loss with partial preservation of bone conduction thresholds. The patient underwent canal wall-down tympanomastoidectomy using the underwater technique, which involved continuous saline irrigation to stabilize the inner ear environment and minimize perilymph leakage. The fistula site was sealed with soft tissue, bone fragments, and bone pate. Postoperative pure-tone audiometry showed preserved bone conduction thresholds, and stabilometry analysis demonstrated temporary vestibular dysfunction, followed by gradual recovery. One-year postoperative CT confirmed successful closure of the fistula without recurrence. This case highlights the potential of the underwater surgical technique in cholesteatoma-associated vestibular fistulas. By maintaining a stable hydraulic environment and reducing mechanical trauma, this method may contribute to the preservation of cochleovestibular function.

The COVID-19 pandemic significantly impacted healthcare delivery systems worldwide, with medical institutions facing the dual challenge of COVID-19 care and maintaining regular services. However, the relationship between institutional characteristics and changes in clinical practice during the pandemic remains unclear. This study evaluated how hospital characteristics affected percutaneous coronary intervention (PCI) implementation during the pandemic by analyzing Diagnosis Procedure Combination (DPC) data from April 2018 to December 2021. We stratified 634 hospitals by PCI volume (High/Middle/Low) and COVID-19 response level (High/Middle/Low) and employed autoregressive integrated moving average models with exogenous variables to quantify changes during state of emergency periods. Results revealed differential impacts based on institutional characteristics. In PCI volume stratification, high and middle-volume facilities showed significant reductions in both emergency PCIs (5.0% and 5.1%, respectively) and elective PCIs (9.6% and 10.8%, respectively). In COVID-19 response stratification, high-response facilities demonstrated the largest decreases in elective PCIs (17.7%), compared to medium-response (8.5%) and low-response facilities (6.4%). High COVID-19 response facilities had a greater proportion of public hospitals (62.1%) and fewer advanced treatment hospitals (4.9%) compared to low-response facilities (43.0% and 21.2%, respectively). These findings suggest that functional differentiation among medical institutions during the pandemic resulted from complex interactions between historical roles, management constraints, and institutional priorities. Our study provides important implications for medical service delivery system planning for future infectious disease outbreaks, emphasizing the need for planned role allocation and appropriate management support systems.

The coronavirus disease 2019 (COVID-19) pandemic has significantly changed many aspects of our lifestyles. This study aimed to investigate health and lifestyle changes one year after the onset of the COVID-19 pandemic, particularly focusing on the impact of telework. This was a web-based questionnaire study conducted between 27 April and 10 May 2021. Participants were randomly selected adults, aged 20 years or above, living in six urban areas of Japan from members of a Japanese market research company. We evaluated the results of responses to the following questions: telework experience, changes in body weight, exercise, food intake, sleep quality, insomnia, and stress since approximately one year after the first outbreak of the COVID-19 pandemic. Of the total 3,022 respondents, 1,751 (57.9%) were male and 1,271 (42.1%) were female, and 1,918 (63.5%) were in the 40-59 age group. Additionally, 2,503 (82.8%) were employed and 519 (17.2%) were unemployed. Of those employed, 1,553 (62.0%) had experienced telework since the COVID-19 pandemic. Among those employed, those with telework experience had a higher proportion of weight change (39.7% gained and 17.5% lost) than those without it (31.4% gained and 13.5% lost). And those with telework experience had a higher proportion of improved sleep quality (7.1%) and reduced anxiety about current life (21.7%) than those without it. Our study indicates that lifestyle changes due to the COVID-19 pandemic have affected various aspects of people’s health, including weight, exercise, food intake, sleep quality, and anxiety. Particularly, these changes were more pronounced among employed individuals with telework experience compared to those without it.