Predictive Factors for the Necessity of Hospitalization of Patients With Acute Alcohol Intoxication.

Background: The aim of the study was to identify factors related to the need for hospitalization due to acute alcohol intoxication. Methods: The data of 42 patients with acute alcohol intoxication who visited our hospital from April 1, 2014 to September 30, 2015 were available for analysis. Factors related to outcome included hospitalization or release to home, Glasgow coma scale (GCS), temperature, pulse rate, blood pressure, oxygen saturation of the peripheral artery (SpO2), and respiratory rate. A retrospective survey was done that included estimated blood alcohol concentration, osmotic pressure, and serum lactate level. The following formula was used to estimate blood alcohol concentration: (measured osmotic pressure - estimated osmotic pressure × 4.6 mg/dL). Univariate analysis of each variable was done for the two outcome groups, hospital admission or release to home, then statistically significant items were subjected to multivariate analysis. Results: Of the 42 patients (average age 22.8 ± 8.6 years, 33 men, six women), 29 were admitted and 13 were released to home. There was a weak correlation between estimated blood alcohol concentration and GCS. There was no significant difference in alcohol concentration or GCS between the hospitalized and released to home groups. In multivariate analysis using the outcome as the objective variable, a serum lactate level of 26 mg/dL or higher was associated with the need for hospitalization (odds ratio: 6.7). Conclusion: A serum lactate level of 26 mg/dL would be useful for deciding if hospitalization is necessary for patients with acute alcohol intoxication.

A case of transient global amnesia with hippocampal infarction due to infective endocarditis.

Transient global amnesia (TGA) is an uncommon disease characterized by sudden onset anterograde amnesia that typically improves within 24 hours. A 35-year-old woman presented with complete disruption of memory that had started on the previous day. She had fever and heart murmur and was diagnosed as having infective endocarditis with Staphylococcus lugdunensis, a coagulase-negative staphylococcus. Septic embolizations were found in the spleen and kidney on CT scan. The patient underwent aortic valve replacement. MRI susceptibility-weighted imaging showed a dotted low intensity area in the right hippocampus. Recently, etiology of TGA is reported to be related to hippocampal disorder. We report a rare case of TGA with hippocampal infarction due to septic embolism from infective endocarditis.

Maoto, a Traditional Japanese Herbal Medicine, Inhibits Uncoating of Influenza Virus.

We previously reported in randomized controlled trials that maoto, a traditional herbal medicine, showed clinical and virological efficacy for seasonal influenza. In this study, a culturing system for influenza was used to test the effect of maoto. A549 cells in the culture were infected with influenza virus A (PR8) and followed after treatment with maoto; the virus titers in the culture supernatant, intracellular viral proteins, and viral RNA were determined. When infected cells were cultured with maoto for 24 hr, the virus titer and protein were significantly reduced compared with medium only. Other subtypes, A/H3N2, H1N1pdm, and B, were also inhibited by maoto. Proliferation of viral RNA in a 6 hr culture was inhibited by maoto in the early phase, especially in the first 30 min. Focusing on the entry step of the influenza virus, we found that endosomal pH, regulated by vacuolar-type H+ ATPase (V-ATPase) located in the membrane, was increased when treated with maoto. We also found that uncoating of influenza viruses was also inhibited by maoto, resulting in the increase of the number of virus particles in endosomes. These results strongly suggest that the inhibition of endosomal acidification by maoto results in blocking influenza virus entry to cytoplasm, probably through the inhibition of V-ATPase. The present study provides evidence that supports the clinical use of maoto for the treatment of influenza.

A randomized, controlled trial comparing traditional herbal medicine and neuraminidase inhibitors in the treatment of seasonal influenza.

The herbal medicine, maoto, has been traditionally prescribed to patients with influenza in Japan. To better understand the efficacy of maoto for the treatment of influenza, a randomized trial was conducted for comparison with oseltamivir or zanamivir. Adult patients with influenza symptoms, including fever, positive for quick diagnostic kit for influenza within 48 h of fever onset were assessed for enrollment. The data of 28 patients randomly assigned to maoto (n = 10), oseltamivir (n = 8), or zanamivir (n = 10) were analyzed for the duration of fever (>37.5°C) and total symptom score from symptom cards recorded by the patient. Viral isolation and serum cytokine measurements were also done on days 1, 3, and 5. Maoto granules, a commercial medical dosage form, are made from four plants: Ephedra Herb, Apricot Kernel, Cinnamon Bark, and Glycyrrhiza Root. Median durations of fever of patients assigned maoto, oseltamivir, or zanamivir were 29, 46, or 27 h, respectively, significantly different for maoto and oseltamivir. No significant between-group differences were found in total symptom score among three groups. Viral persistent rates and serum cytokine levels (IFN-α, IL-6, IL-8, IL-10, and TNF-α) during the study period showed no differences among three groups. The administration of oral maoto granules to healthy adults with seasonal influenza was well tolerated and associated with equivalent clinical and virological efficacy to neuraminidase inhibitors.