Internal medicine
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Both 1,3-beta-D-glucan (BDG) and galactomannan (GM) are polysaccharide components of the fungal cell wall. Although elevated levels of serum BDG and Aspergillus GM suggest invasive fungal infection or Pneumocystis pneumonia and aspergillosis, respectively, it is also necessary to consider the possibility of false-positives. ⋯ The false-positive serum BDG and GM findings may have been due to his aspiration of food containing them. It is important to take a detailed history of aspiration in addition to making a conventional differential diagnosis in patients with pneumonia with elevated serum BDG and GM levels.
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A 38-year-old man with renal cell carcinoma was referred to our hospital because of a productive cough. He had received radiotherapy for lung metastasis and been treated with axitinib. ⋯ Although radiotherapy in combination with axitinib carries a risk of causing airway toxicity, MRSA necrotizing bronchitis has not been reported. Physicians should consider the possibility of infectious necrotizing bronchitis if irradiated patients show prolonged respiratory symptoms.
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A 44-year-old woman was admitted due to gross hematuria and progressive renal dysfunction. Poststreptococcal acute glomerulonephritis (PSAGN) was suspected due to her elevated anti-streptolysin O and anti-streptokinase titers and hypocomplementemia. A renal biopsy showed crescent formation and endocapillary hypercellularity with neutrophil infiltrate. ⋯ However, myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA) was positive, and peritubular capillaritis was observed. Furthermore, citrullinated histone H3-positive neutrophils were detected as markers for neutrophil extracellular trap formation. Therefore, she was diagnosed with ANCA-associated vasculitis superimposed on PSAGN that was the main contributor to her progressive renal injury.
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Objective Whether or not combined lifestyle factors are associated with similar decreases in risks of incident hypertension and diabetes among individuals with and without chronic kidney disease (CKD) remains unclear. Methods This population-based prospective cohort study included participants 40-74 years old who were free from heart disease, stroke, renal failure, hypertension, diabetes, and hypercholesterolemia at baseline (n =60,234). Healthy lifestyle scores (HLSs) were calculated by adding the total number of 5 healthy lifestyle factors (non-smoking, body mass index <25 kg/m2, regular exercise, healthy eating habits, and moderate or less alcohol consumption). ⋯ Compared with adhering to 0, 1, or 2 components, adherence to all 5 HLS components was associated with a nearly one-half reduction in the risk of hypertension [hazard ratio (HR) =0.52; 95% confidence interval (CI), 0.45-0.60] and diabetes (HR=0.51; 95% CI, 0.32-0.81) in fully adjusted models. CKD did not have a modifying effect on associations between the HLS and incident hypertension (Pinteraction=0.6) or diabetes (Pinteraction=0.3). Conclusion Adherence to HLS components was associated with reduced risks of incident hypertension and diabetes, regardless of CKD status.
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Objective The incidence and clinical importance of delirium in coronavirus disease 2019 (COVID-19) have not yet been fully investigated. The present study reported the prevalence of delirium in patients with COVID-19 and identified the factors associated with delirium and mortality. Methods We performed an observational, retrospective study of patients diagnosed with COVID-19 at the Kinki-Chuo Chest Medical Center. ⋯ Delirium was associated with an increased mortality. Conclusion Delirium in patients with COVID-19 is prevalent and associated with poor clinical outcomes in Japan. Despite difficulties with COVID-19 patient care during the pandemic, physicians should be aware of the risk of delirium and be trained in its optimal management.