Internal medicine
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Objective To examine the impact of lifestyle changes caused by the first emergency declaration issued in 2020 on glycemic control and body weight changes in Japanese individuals with type 1 diabetes mellitus. Methods This study included Japanese individuals with type 1 diabetes mellitus who visited Tokyo Women's Medical University Hospital between January 2019 and September 2020 (n=278). Seasonal changes in glycated hemoglobin (HbA1c) levels and the body mass index (BMI) were compared. ⋯ HbA1c levels were significantly lower after the first emergency declaration in individuals with type 1 diabetes mellitus than that before the emergency declaration, even after accounting for seasonal variations. Conclusion Decreased HbA1c levels were associated with a decreased food intake, increased moderate exercise, and increased sleep duration during the state of emergency. The BMI remained relatively unchanged.
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A 64-year-old woman was transported to the emergency room with a headache and fever. She presented with a right ocular protrusion, hyperemia, and tenderness in the neck. Contrast-enhanced MRI of the head showed a high DWI signal in the bilateral sphenoid sinuses and contrast defects along the bilateral internal jugular and superior ophthalmic veins. ⋯ Surgery was performed for Lemierre's syndrome secondary to sphenoid sinusitis. The patient was treated with antibiotics and anticoagulant therapy, but a duodenal ulcer and brain abscess thereafter developed. However, multidisciplinary endoscopic and surgical treatment saved her life.
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Objective Due to the increasing elderly population and number of dementia patients, the current number of psychiatrists and neurologists remains insufficient to treat dementia in Japan. Therefore, a simple method for accurately performing a dementia diagnosis, including that of primary care physicians, is sought in clinical practice. Methods A retrospective study was conducted on patients who made their first visit due to amnesia between October 2020 and October 2022. ⋯ Comparing Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), the difference between the MMSE and CDT scores was significantly greater in patients with DLB. Conclusion To quickly screen for dementia, a combination of CCT and CDT is recommended for the highest sensitivity (78.4%). In addition, the difference between the CDT and MMSE scores is considered to be useful for differentiating DLB from AD.
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Observational Study
Incidence of Arterial Thrombotic and Bleeding Events in Patients Who Develop Cancer After ST-elevation Myocardial Infarction.
Objective Cancers increase the risk of both arterial thrombosis and bleeding. The present study investigated whether or not comorbid new-onset cancers increase arterial thrombosis and bleeding events in patients after ST-elevation myocardial infarction (STEMI). Methods Among 918 consecutive STEMI patients, excluding 300 who used mechanical hemodynamic supportive devices, the 67 with cancer and 851 without cancer were compared with respect to the frequency of thrombotic events, consisting of myocardial infarction (MI) and ischemic stroke, and bleeding events during the trackable observation period in this observational study. ⋯ Bleeding events were observed in 26.9% of patients with cancer and 7.6% of patients without cancer (p<0.01; incidence rates, 4.4 vs. 2.4/100 person-years). The C-statistics for predicting bleeding events in patients with and without cancer were 0.65 vs. 0.71 using the ARC-HBR criteria and 0.67 vs. 0.71 using the PRECISE-DAPT scores, respectively. Conclusion Cancers increase unpredictable bleeding but not arterial thrombotic events in patients after STEMI.