Internal medicine
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The effect of clinical pathway (CP) care and early switch from intravenous to oral antibiotics therapy on community-acquired pneumonia (CAP) has been well documented. However, limited studies have evaluated the effects of CP on reducing time taken for attaining clinical stability and duration of antibiotics prescriptions. This study was aimed to investigate the use of a CP and its implication for CAP in a community hospital. ⋯ Implementation of this CP would lead to effective care, may serve to reduce time for attaining clinical stability and reduce the use of unnecessary antibiotics without worsening clinical outcomes in mild and moderate CAP.
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The goal of this study was to evaluate the safety and efficacy of mechanical ventilation (MV), including noninvasive positive pressure ventilation (NPPV) and endotracheal intubation (ETI) in patients with very severe hypoxemia due to refractory heart failure (RHF). ⋯ Both NPPV and ETI are safe and effective modalities for improving hypoxemia and left heart function in patients with RHF. These results suggest that invasive MV should be applied to very severe patients with RHF as quickly as possible when an expected clinical improvement cannot be obtained by NPPV.
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We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients. ⋯ The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.
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An 85-year-old man patient was admitted to the hospital complaining of fever and bilateral leg pain with swelling and erythema. A laboratory investigation revealed leukocytopenia, thus suggesting sepsis. Gram negative rods were detected in the specimen from the affected skin and empiric antibacterial therapy was initiated. ⋯ An autopsy revealed necrotizing fasciitis due to P. aeruginosa. This is a rare case and its clinical presentation was atypical. The clinical diagnosis of this infection may be difficult, and therefore such cases warrant the careful attention of physicians.
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Comparative Study
Smell identification in Japanese Parkinson's disease patients: using the odor stick identification test for Japanese subjects.
The purpose of the present study was to clarify the olfactory functions of Japanese patients with idiopathic Parkinson's disease (IPD) using the odor stick identification test for Japanese (OSIT-J). ⋯ The present study demonstrated that the smell identification ability of Japanese IPD patients was impaired based on the OSIT-J.