Demographic and clinical characteristics of patients with zinc deficiency: analysis of a nationwide Japanese medical claims database.

Zinc deficiency, affecting more than 2 billion people globally, poses a significant public health burden due to its numerous unfavorable effects, such as impaired immune function, taste and smell disorders, pneumonia, growth retardation, visual impairment, and skin disorders. Despite its critical role, extensive large-scale studies investigating the correlation between patient characteristics and zinc deficiency still need to be completed. We conducted a retrospective, cross-sectional observational study using a nationwide Japanese claims database from January 2019 to December 2021. The study population included 13,100 patients with available serum zinc concentration data, excluding individuals under 20 and those assessed for zinc concentrations after being prescribed zinc-containing medication. Significant associations with zinc deficiency were noted among older adults, males, and inpatients. Multivariate analysis, adjusting for age and sex, indicated significant associations with comorbidities, including pneumonitis due to solids and liquids with an adjusted Odds Ratio (aOR) of 2.959; decubitus ulcer and pressure area (aOR 2.403), sarcopenia (aOR 2.217), COVID-19 (aOR 1.889), and chronic kidney disease (aOR 1.835). Significant association with medications, including spironolactone (aOR 2.523), systemic antibacterials (aOR 2.419), furosemide (aOR 2.138), antianemic preparations (aOR 2.027), and thyroid hormones (aOR 1.864) were also found. These results may aid clinicians in identifying patients at risk of zinc deficiency, potentially improving care outcomes.

An aberrant carotid artery in the temporal bone with fatal complication.

We report the case of an 84-year-old female presenting with an aberrant ICA with cerebral air embolization caused by Eustachian tube air inflation (ETAI). High pressure of air inflation developed because of an aberrant ICA blocking the tympanic orifice of the Eustachian tube, with release of the high-pressure air into the aberrant ICA. It must be kept in mind that complications may occur not only during transtympanic treatment, but also in any treatment, such as ETAI, in aberrant ICA cases.

[A case report: primary nasal tuberculosis].

A 62-year-old female visited us complaining of lacrimination and the swelling of the left side of the nasal dorsum. Granulation tissues were seen on the anterior-lateral wall of the left nasal cavity, and an imaging study revealed a mass occupying both the left nasal cavity and the anterior ethmoid sinuses invading the face with erosion of the nasal bone. Histological examination showed an epithelioid granuloma without caseous necrosis which mostly suggested sarcoidosis. The affected lesions became larger 11 months after the initial examination, and a biopsy was performed again, which revealed the same pathological findings. Although the biopsy specimen was negative based on the PCR findings, tubercle bacillus was detected in the culture 7 weeks later. The patient was finally diagnosed as having primary tuberculosis of the nose and paranasal sinuses because systemic examination showed no evidence of tuberculosis in other areas. She was treated with antituberculosis medication, and the affected nasal lesions disappeared. It is important to perform a biopsy and tissue culture repeatedly when we encounter an intractable and undiagnosed disease in the nasal cavity.

Value of barium swallow studies in predicting the response to rabeprazole in elderly patients with laryngopharyngeal reflux disease and nonerosive reflux disease in particular.

OBJECTIVES: Laryngopharyngeal reflux disease (LPRD) is an important cause of throat discomfort in the elderly. Our objective was to investigate the usefulness of barium swallow studies for the diagnosis of LPRD. METHODS: The subjects were 59 patients at least 60 years of age with LPRD suspected on laryngoscopic findings. We evaluated esophageal clearance using a barium swallow study and the upper gastrointestinal tract endoscopic findings of gastroesophageal reflux disease according to the revised Los Angeles classification, and correlated these findings with the effect of rabeprazole, a proton pump inhibitor. RESULTS: Among subjects with positive reflux findings in the esophageal phase of the barium swallow, rabeprazole was significantly effective (p = 0.0025). To identify nonerosive reflux disease, we analyzed the 50 cases with a negative Los Angeles classification of upper gastrointestinal tract endoscopic findings. Rabeprazole was again significantly effective in patients with positive findings for esophageal reflux (p = 0.0025). CONCLUSIONS: Among elderly patients with suspected LPRD, there was a positive correlation between impaired esophageal clearance on the barium swallow study and the effectiveness of rabeprazole. The barium swallow study could be a screening test for LPRD in elderly patients with throat discomfort.

[Relationship between globus sensation and esophageal clearance abnormalities in an elderly group].

Recent studies suggest that gastroesophageal reflux disease (GERD) may be a cause of globus sensation. However, it is difficult to examine the reflux of acidic gastric contents directly. We hypothesized that the esophageal clearance capacity against reflux acid may be responsible for the clinical symptoms of GERD. The purpose of this study was to investigate the bolus residue and reflux in the esophagus during swallowing in elderly patients and to discuss the relationship between globus sensation and esophageal clearance abnormalities. Videopharyngoesophageal examinations in the prone position were performed in 156 elderly patients with globus sensation (average age: 74.7 years old). Esophageal clearance in the prone position was classified into 4 subgroups according to the movement of a contrast bolus: Group 1, normal; group 2, retension in esophagus; group 3, reflux of contrast bolus within esophagus; group 4, reflux of contrast bolus into pharyngo-laryngeal regions. Group 1 contained 36 cases (23.1%), group 2 contained 8 cases (5.1%), group 3 contained 79 cases (50.6%), and group 4 contained 33 cases (21.2%). Overall, the reflux of a contrast bolus in the esophagus was observed in 112 cases (71.8%). We concluded that decreased esophageal clearance in elderly subjects affects the defense mechanism against acid exposure and may be a risk factor for the appearance of globus sensation. Videopharyngoesophageal examination in the prone position may be an easy and valuable method for evaluating the function of esophageal clearance.

Short-term effect of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy.

The aim of this study was to clarify the short-term effects of argon plasma coagulation (APC) of the inferior turbinate in patients with perennial nasal allergy. In a retrospective study, 32 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. Grades of nasal stuffiness, rhinorrhea, sneezing, nasal airflow resistance (NAR) and overall seriousness were evaluated before and then 1-4 and 8 weeks after APC. Subjective symptoms were assessed using a questionnaire in which nasal stuffiness, rhinorrhea and sneezing were graded on a four-point scale (severe, moderate, mild and none) using the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. NAR was measured using active anterior rhinomanometry (AAR) at the 100 Pa point; this was deemed to be an objective measurement of nasal obstruction. The numbers of patients examined before and 1-4 and 8 weeks after APC were 32, 31, 25, 17, 18 and 14, respectively. Both nasal stuffiness and NAR were significantly improved 2 weeks after APC, overall seriousness was significantly improved after 3 weeks and rhinorrhea was improved after 4 weeks. Sneezing did not significantly improve during this study. There was no significant change in the grades of the examined parameters during the period between 4 and 8 weeks after APC. The beneficial effects of APC begin to appear within 2 weeks after APC and no further improvement after about 4 weeks.