Exploratory study on glycemic control improvement for patients with diabetes mellitus by appropriate re-education on insulin self-injection technique during COVID-19 pandemic.

AIMS: To conduct a study on glycemic control improvement by appropriate re-education on the self-injection technique (SIT) in patients with diabetes mellitus undergoing insulin therapy. METHODS: Patients who received appropriate SIT and were treated with insulin for more than a year were re-educated. For the observation period of six months, the subjects' SIT was checked, and hemoglobin A1c (HbA1c) levels were measured at each visit. HbA1c levels, insulin doses, and behavioral changes in SIT were investigated at baseline and at the end of the observation period. RESULTS: In the per-protocol set population, the HbA1c level decreased by 0.2 % (2.0 mmol/mol) on average, showing a significant difference (p = 0.009). No significant difference was observed in the proportion of subjects with decreased HbA1c levels, changes in total daily insulin doses, or blood glucose levels. Four of the six SIT items covered by re-education were improved. CONCLUSIONS: Providing re-education on insulin SIT was considered effective in reducing HbA1c levels and improving adherence to proper SIT.

Diagnostic utilities of a fully automated molecular test for toxigenic Clostridium difficile.

Laboratory underdiagnosis of toxigenic Clostridium difficile can lead to inappropriate management of C. difficile infection (CDI). A fully automated molecular test (FAMT), BD MAX, and enzyme immunoassays for C. difficile glutamate dehydrogenase (GDH) and for toxin A/B antigen test were evaluated using clinical specimens. Laboratory analysis of 231 fecal specimens from patients suspected with CDI, indicated that the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of FAMT was 98.1%, 98.9%, 96.3%, and 99.4%, while that of toxin A/B antigen was 52.8%, 100.0%, 100.0%, and 87.7%, respectively, compared to toxigenic culture. Sn, Sp, PPV, and NPV of GDH test compared to toxigenic culture was 92.5%, 94.4%, 83.1%, and 97.7%, respectively. FAMT can support the accurate laboratory diagnosis of toxigenic C. difficile and be an effective tool for appropriate treatment of CDI.

Unfavorable peripheral intravenous catheter replacements can be reduced using an integrated closed intravenous catheter system.

PURPOSE: To evaluate the clinical usefulness of an integrated closed intravenous catheter system (CICS) with a preattached stabilization platform and extension tube (BD Nexiva™; Becton, Dickinson and Company) in Japanese patients. METHODS: In this open, single-center study, patients who required peripheral intravenous (PIV) catheterization for ≥72 hours were quasi-randomized to receive a CICS or a conventional intravenous catheter. Study outcomes included adverse events during catheter insertion, catheter replacements during the initial 72 hours, catheter survival rate at 72 hours after insertion and costs of initial catheterization and catheter replacement. RESULTS: Of 359 patients enrolled, 194 received the CICS and 165 received the conventional catheter. The incidence rates of ≥1 failed insertion attempts, blood leakage and blood exposure were similar in both groups. The survival rate of the CICS group (83.7%) was significantly higher than that of the conventional catheter group (62.6%) in the intention-to-treat analysis (p=0.0085). There were significantly fewer catheter replacements due to catheter-related complications (e.g., catheter failure or extravasation) in the CICS group (p=0.0056). Although the initial cost per patient was greater for the CICS group (US$17.07 vs. US$13.26), the total cost per patient over 72 hours was similar (US$21.00 vs. US$20.30) because of the cost of unplanned replacements of conventional catheters. CONCLUSIONS: Although rates of adverse events at insertion were similar for both catheters, significantly fewer patients required unplanned reinsertion with the CICS. The results suggest that the longer survival rate for the CICS can offset the higher initial catheterization costs.

[A case of ring melanoma found while treating traumatic glaucoma].

BACKGROUND: Ring melanoma, a malignant melanoma which infiltrates over 180 degrees degrees of the ciliary body is very rare in Japan. We report a case of ring melanoma found while treating treatment of traumatic glaucoma with an ultrasound biomicroscope (UBM). CASE: A 44-year old woman presented with high intraocular pressure after blunt trauma in her left eye. CLINICAL FINDINGS: Best-corrected visual acuity OS was 1.2, and intraocular pressure was 30 mmHg. Gonioscopy showed about 180 degrees of the angle recession. Intraocular pressure was difficult to control in spite of anti-glaucoma drug treatment. Rapid progression of iris elevation and 360 degrees thickening of the ciliary body were detected by UBM. We detected atypical cells with melanine granules in the aqueous fluid and positive findings in PET-CT, leading to a diagnosis of ciliary body malignant melanoma. Consequently we enucleated the left eye. The histopathological diagnosis was ring melanoma. CONCLUSION: Ring melanoma is an important element in the differential diagnosis for untreatable secondary glaucoma.

Clinical and histopathological features of a suspected case of fish-eye disease.

PURPOSE: To report the clinical and histopathological features of a suspected case of fish-eye disease. CASE: A 57-year-old man presented with blurred vision. The best corrected visual acuity was 0.8 OD and 1.0 OS. The patient had no family history of cloudy cornea. Slit-lamp examination revealed massive bilateral diffuse corneal clouding. Because of progressive corneal clouding during the previous 3 years, we performed penetrating keratoplasty and cataract surgery. He had a low-plasma, high-density lipoprotein (HDL) concentration. Histopathologically, numerous small vacuoles were dispersed, especially in the anterior corneal stroma. An electron microscope revealed distinct 0.2-3.0-µm lipid vacuoles with a conserved stromal structure. CONCLUSION: We suspected a case of sporadic fish-eye disease in a Japanese patient. Lipid deposition needs to be considered as a cause of diffuse corneal opacity.

[A rapidly progressed metastatic choroidal tumor from a hepatocellular carcinoma].

BACKGROUND: Metastatic choroidal tumor stemming from a hepatocellular carcinoma (HCC) is very rare. We report a case of a metastatic choroidal tumor stemming from a hepatocellular carcinoma. CASE: A 50-year-old man became aware of a visual field defect in his left eye starting 1 month previously. He had undergone surgery for HCC nine years before, and had received radiation therapy for lung and brain metastasis of HCC. Funduscopic examination revealed a red choroidal mass with subretinal bleeding. One month later, light perception of the left eye disappeared with rapid growth of the tumor and high intraocular pressure. Because the ocular pain was uncontrollable, enucleation of the left eyeball was performed. In histopathological examination, the choroidal tumor consisted of tumor cells showing characteristics of HCC such as intracytoplasmic glycogen granules, fatty degeneration, and necrosis of the tumor cells. CONCLUSION: The clinical characteristics of metastatic choroidal tumors from an HCC are a red appearance and rapid growth with retinal detachment and subretinal hemorrhage.