Journal of general and family medicine
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A 66-year-old man with a 2-year history of suspected scalp eczema with excessive dandruff developed painful swollen joints in the extremities. Four months after developing polyarthritis and polydactylitis, eczema gradually spread to the face. He was referred to our hospital for intractable scalp and facial eczema and polyarthritis. ⋯ Treatment with apremilast (a phosphodiesterase-4-inhibitor) was initiated, which swiftly alleviated the skin lesions. The joint deformities persisted, but the pain in the joints disappeared. This case implies that psoriatic arthritis should be suspected even if psoriatic skin lesions are localized to the scalp.
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While Okinawa has been facing outbreak of the coronavirus disease 2019 (COVID-19) pandemic, healthcare collapse should be prevented by sufficient supply of ventilators for caring the rapidly growing number of critically ill patients with COVID-19. We estimated the number of invasive and noninvasive ventilators that would be required in Okinawa at the peak of the COVID-19 outbreak based on recent data of COVID-19 cases in Okinawa and data on the proportion of patients with COVID-19 in the ICU requiring ventilation. Based on our results using the current supply of all ventilators, demand for ventilators could be prepared for patients with COVID-19 who would require it and demand for noninvasive ventilators could also be prepared for those with COVID-19 who would require it. The higher supply over the demand would be achieved by flattening the epidemic curve by implementing public health interventions to delay and suppress the epidemic peak in Okinawa.
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A 79-year-old Japanese woman presented with acute and diffuse abdominal pain, which turned out to be an unusual diagnosis. This article highlights a hint in physicians' diagnostic process, thereby avoiding the obstacles in making a correct diagnosis.
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Poor access to a primary care physician may lead to poor control of risk factors for disease. This study investigated whether geographic access to a primary care physician was related to ischemic heart disease and stroke mortality. ⋯ Longer road-distance to a primary care facility may increase the risk of stroke mortality.