Internal medicine
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A 36-year-old man was diagnosed with multiple gastric polyps by esophagogastroduodenoscopy. Subsequent colonoscopy identified two tubular adenomas, and computed tomography revealed subcutaneous tumors. ⋯ A genetic analysis demonstrated that he had a frameshift variant at codon 1928 of APC, suggesting AFAP. In this era of less Helicobacter pylori infection and frequent use of proton pump inhibitors, diagnoses of AFAP and GAPPS should be considered in patients with prominent gastric fundic gland polyposis.
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Objective Understanding the clinical factors associated with the severity of coronavirus disease 2019 (COVID-19) is very important for the effective use of limited medical resources, including the appropriate evaluation of the need for hospitalization and discharge. Methods Patients hospitalized with a diagnosis of COVID-19 from March 2021 to October 2022 were included in the study. Patients admitted to our facility were classified into four waves: 4th (April to June 2021), 5th (July to October 2021), 6th (January to June 2022), and 7th waves (July to October 2022). ⋯ Further comparisons between the respiratory failure group (n=75) and the nonrespiratory failure group (n=471) revealed significant differences in the age, sex, vaccination history, and biomarker values between the two groups. Conclusion In this study, elderly men were found to be more likely to develop severe disease than others, and biomarkers of COVID-19, such as C-reactive protein and lactate dehydrogenase, were useful for predicting severity. This study also suggested that vaccination may have contributed to a reduced disease severity.
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An 89-year-old woman with a giant hiatal hernia complained of persistent chest pain. An electrocardiogram (ECG) showed hyperacute T waves, suggesting the early phase of ST-elevation myocardial infarction. After endoscopic drainage for hiatal hernia, the chest pain disappeared, and the ECG abnormalities resolved. The present case illustrates that compression of the heart by a giant hiatal hernia can induce T wave elevation mimicking acute coronary syndrome.
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Objective During the coronavirus disease 2019 (COVID-19) pandemic period, an extended total activity time (TAT) in emergency cases has been reported, especially in febrile patients. A brief selection time (ST) regarding the transport of patients to designated hospitals is vital to achieving a good outcome. However, to our knowledge, no studies have reported the impact of the COVID-19 pandemic on the ST. ⋯ The difference-in-differences analyses showed that the mean ST increased by 2.52 minutes (p<0.001), the mean ART by 3.10 minutes (p<0.001), and the mean TAT by 7.27 minutes (p<0.001) for patients with a fever during the COVID-19 period. Conclusion This study showed that febrile patients had a longer ST, ART, and TAT during the 2020 COVID-19 period. Considering the COVID-19 pandemic and the threat of future pandemics, regional infection control and information-sharing should be conducted to reduce the EMS activity time.