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1.
Int J Environ Health Res ; : 1-11, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-33941000

RESUMO

While photochemical oxidants (Ox = O3+ NO2) are known to increase asthma flare-ups, there is a paucity of studies of the Japanese population, especially for Tokyo residents. We used data on asthma cases (n = 7,455) from ambulance dispatches in Tokyo, 2015-2016. Variables included date and time of incidence, age, sex, occurrence location at the ward (ku) level, and the symptom/cause of dispatch as recorded by paramedics. Ox data were obtained from the nearest air quality monitoring station to the occurrence location, then linked them with the outcomes based on occurrence date. We directly incorporated a distributed lag model into a bi-directional case-crossover study design controlling for ambient temperature and day of week. A 10-ppb increase in Ox for lag days 0-3 was associated with a 5.51% (95% CI: 0.13 to 11.18) increase in ambulance dispatches related to asthma. The association was strongest on lag day 1 (4.67%, 95% CI: 0.51 to 9.00). Exposure to high levels of Ox was associated with increased ambulance dispatches related to asthma exacerbations in Tokyo, Japan.

2.
BMJ Case Rep ; 14(3)2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692043

RESUMO

A 24-year-old man with Down syndrome and congenital tracheal stenosis, who had undergone cartilage patch tracheoplasty twice in infancy, was transferred from a local hospital to manage an airway emergency. On arrival, the patient was in severe respiratory distress. Increased airway pressure following endotracheal intubation complicated the administration of mechanical ventilation. CT of the chest showed widespread consolidation and tracheal stenosis 3 cm above the carina distal to the tip of the endotracheal tube. The diagnosis was tracheal stenosis with type A influenza infection. The patient was transferred to another hospital for initiating venovenous extracorporeal membrane oxygenation (VV-ECMO). Intubation with a 6.0 mm spiral tube was successful after intraluminal balloon dilatation of the tracheal stenosis. The patient was admitted to the intensive care unit and was weaned off VV-ECMO on day 3 due to improvement in respiratory status. A tracheotomy was performed on day 28 and the tracheal tube was removed on day 41.


Assuntos
Obstrução das Vias Respiratórias , Oxigenação por Membrana Extracorpórea , Estenose Traqueal , Adulto , Humanos , Masculino , Respiração Artificial , Traqueia , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/terapia , Adulto Jovem
3.
Acute Med Surg ; 8(1): e621, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33604054

RESUMO

Background: Complicated empyema accompanied by bronchopleural fistula (BPF) has high mortality. The treatment strategy for severe respiratory failure due to empyema with BPF has yet to be established. Case Presentation: A 70-year-old man was brought to our hospital and diagnosed with right empyema, BPF (at bronchi B4-10), and secondary left pneumonia. We initiated drainage followed by veno-venous extracorporeal membrane oxygenation due to the severe hypoxia. First, the patient underwent endoscopic treatment with obstructive materials (known as endobronchial Watanabe spigot [EWS]) at B8-10, and was weaned off veno-venous extracorporeal membrane oxygenation on day 7. A secondary EWS was carried out at B4-6. A combination of medical treatments (drainage, antibiotics, nutritional therapy, and rehabilitation) improved his general condition. The patient was able to leave the hospital on foot. Conclusion: A comprehensive approach could explain the success of the medical treatment. The principal components are the repeated application of EWS as damage control.

4.
BMC Infect Dis ; 21(1): 163, 2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563218

RESUMO

BACKGROUND: Many studies have been published about critically ill coronavirus disease 2019 (COVID-19) during the early phases of the pandemic but the characteristic or survival of critically ill Japanese patients have not yet been investigated. We sought to investigate the characteristics, inflammatory laboratory finding trends, and outcomes among critically ill Japanese patients who were admitted to the intensive care unit (ICU) with the first wave of COVID-19. METHODS: A retrospective observational study was performed in a single institution in the center of Tokyo. Laboratory-confirmed COVID-19 patients admitted to the ICU from March 19 to April 30, 2020 were included. Trends for significant inflammatory laboratory findings were analyzed. In-hospital death, days of mechanical ventilation or oxygen supplementation, days of ICU or hospital stay were followed until May 26, 2020. RESULTS: Twenty-four patients were included. Median age was 57.5 years, and 79% were male. The neutrophil-to-lymphocyte ratio was elevated to a median of 10.1 on admission and peaked on Day 10 of illness. Seventeen patients were intubated on Day 11 of illness and received mechanical ventilation. One patient underwent extracorporeal membrane oxygenation. The majority (88%) received systemic steroids, including 16 patients who received high dose methylprednisolone (500-1000 mg). Favipiravir was used in 38% of patients. Two patients, including 1 who refused intensive care, died. Eighteen patients were discharged. Median length of ICU and hospital stay for all patients was 6 and 22 days, respectively. Median length of ventilator dependency was 7 days. Four patients underwent a tracheostomy and received prolonged ventilation for more than 21 days. One patient receiving mechanical ventilation died. All survivors discontinued ventilator use. CONCLUSIONS: Mortality was remarkably low in our single institutional study. Three survivors received mechanical ventilation for more than 3 weeks. Trends of clinically significant laboratory markers reflected the clinical course of COVID-19.


Assuntos
COVID-19/fisiopatologia , COVID-19/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Proteína C-Reativa/análise , COVID-19/imunologia , COVID-19/mortalidade , Estado Terminal , Oxigenação por Membrana Extracorpórea , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Contagem de Leucócitos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Tóquio
8.
Acute Med Surg ; 7(1): e610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33318804

RESUMO

Background: Early onset pneumonia (EOP) in patients with cardiac arrest treated with targeted temperature management is a recently debated issue. We assessed the association between C-reactive protein (CRP) levels and development of EOP in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). Methods and Results: We reviewed the data of all patients admitted to our hospital after out-of-hospital cardiac arrest treated with ECPR between April 2006 and April 2019 who survived for at least 48 h. We collected demographic data, cardiac arrest characteristics, prophylactic antibiotic use, and neurologic outcomes. Diagnosis of EOP was made based on clinical, radiological, and microbiological criteria. The primary endpoint was the association between the incidence of EOP and CRP levels from day 1 to day 4. A total of 55 patients were included, of which 20 developed EOP. CRP levels on days 3 and 4 were significantly elevated in patients who developed EOP (13.1 [11.8-21.1] mg/dL versus 11.6 [7.4-15.2] mg/dL, P = 0.005; and 19.0 [16.9-27.1] mg/dL versus 14.7 [7.4-21.2] mg/dL, P = 0.019, respectively). In the multivariable logistic regression model, the CRP level on day 3 was significantly associated with the development of EOP (odds ratio 1.22; 95% confidence interval 1.06-1.41; P = 0.001). Conclusions: Increased inflammation in acute phase was associated with development of EOP in patients treated with ECPR.

9.
SN Compr Clin Med ; : 1-3, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33073172

RESUMO

The first coronavirus 2019 (COVID-19) patients were reported in China on December 12, 2019, and the first COVID-19 patients were reported in Japan on January 16, 2020. Here, we investigated the number of patients in Emergency Departments (EDs) in three major hospitals in Tokyo, and also briefly discussed about the relationship between the number of patients in EDs and health system's capacity. We compared the number of patients in 2020 to the average number of patients from 2016 to 2019. Numbers were compared in three periods: before the first COVID-19 patient was reported in Japan (January 1 to January 16), after the government encouraged social distancing (February 26 to March 10), and the interval between them (January 17 to February 25). The average number of daily patients in 2020 (n = 122) decreased by 17% compared to the average number of patients from 2016 to 2019 (n = 144) (Mann-Whitney test, p < 0.001). This phenomenon might be due to a fear of contracting the virus at hospitals, companies having their employees work remotely and postponing events, people following the Japanese Ministry of Health, Labour and Welfare's instructional guidelines for going to the hospital, prevention awareness becoming widespread, and a decreased number of tourists. The number of patients visiting Emergency Departments in Tokyo was decreased and the number of COVID-19 infections has remained within the health system's capacity during the early phase of COVID-19 first wave.

10.
J Am Coll Emerg Physicians Open ; 1(4): 494-501, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33000076

RESUMO

Objective: Even if performing rapid influenza diagnostic tests test will not change clinical decision making, we sometimes perform at triage to reduce length of stay in Japan. Whether performing rapid influenza diagnostic tests at triage may shorten emergency department (ED) length of stay (LOS) is remains unclear. We aimed to determine the utility of rapid influenza diagnostic tests at triage in shortening ED length of stay LOS. Methods: We retrospectively reviewed medical records of patients discharged from our ED after receiving results from rapid influenza diagnostic tests during the influenza season from December, 2013 to March, 2019. Eligibility criteria were a walk-in visit, age ≥15 years, triage performed, rapid influenza diagnostic test administered, and no admission. The triage group received rapid influenza diagnostic tests at triage. The after-examination group received their tests only after examination by a doctor. The primary outcome was ED LOS after propensity score matching to adjust for several covariates. Results: Of 2,768 eligible patients, 2,554 patients were enrolled in the triage group (n = 363) or after examination group (n = 2,191). There were 329 matched pairs after propensity score matching. Median ED LOS was significantly shorter in the triage group than in the after-examination group after propensity score matching (81 min (interquartile range [IQR] 60 to 111) vs 106 min (IQR 80-142); median difference 24 min (95% confidence interval 17-30)). Conclusions: Performing rapid influenza diagnostic tests at triage was associated with shorter ED LOS during the influenza season.

11.
Crit Care Explor ; 2(9): e0221, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32984839

RESUMO

Objectives: It is still not known why cases of coronavirus disease 2019 during the first wave in Tokyo have fallen without lockdown restrictions. People with low socioeconomic status are not dominant among coronavirus disease 2019 patients in Tokyo in contrast with New York, where the opposite demographics have been in play. Thus, we set out to examine the association between socioeconomic status and the rate of coronavirus disease 2019 infections using public data from Tokyo. Design: We obtained data from each of the 23 wards of Tokyo, showing population size, density, age, sex, number of graduates, income, and hospital attendance numbers. Coronavirus disease 2019 infections were gathered for 2 separate days: April 9, 2020, when new daily coronavirus disease 2019 infections were at their peak during the first wave in Japan; and May 9, 2020, to observe any changes in incidence over the preceding month. Setting: The primary outcome was set as the number of coronavirus disease 2019 infections per 100,000 population. Interventions: None. Measurements and Main Results: By conducting simple linear regression modeling, the incidence of cases on April 9 was associated significantly with four variables: population age greater than 65 years (%), university rate, hospital, and income. Using these four variables, multivariate linear regression analyses demonstrated that only income remained significant (p = 0.006 at April 9 and p = 0.03 at May 9). This indicates that the highest case numbers were dominant in high-income areas, and affected fewer patients in districts in the low-income areas. Conclusions: The result of the current study is exactly opposite to the data from New York. This may be considered one of the main reasons why the rate of death and new patients of coronavirus disease 2019 has been so low in Tokyo. That is, appropriate hygienic status, free access to hospital by ambulance, and universal health insurance system may contribute to the outcome in such low-income areas.

14.
Acute Med Surg ; 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32837734

RESUMO

Background: Severe respiratory failure patients with coronavirus disease 2019 (COVID-19) sometimes do not receive post intensive care syndrome prevention bundles. No detailed report has been published on the practical observations of mental impairments in these patients. Case presentation: A 33-year-old man was admitted with COVID-19 pneumonia. On day 6, he was admitted to the intensive care unit (ICU). Considering the risk of nosocomial infection, as per the hospital policy, early rehabilitation could not be initiated for COVID-19 patients at that the time and family visits were not allowed. Thereafter, his respiratory condition gradually improved; he was discharged on day 19. Then, when the ICU nurse called to assess his medical condition, the patient complained insomnia after ICU discharge. Therefore, we called him for an outpatient visit 28 days after discharge and scored his mental health status. Conclusion: Careful follow-up is required to treat mental impairment in patients with COVID-19.

16.
Am J Emerg Med ; 38(10): 2243.e1-2243.e3, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32473756

RESUMO

We report the first two cases of Coronavirus Disease 2019 (COVID-19) who were receiving intensive care including favipiravir, and were clinically diagnosed with neuroleptic malignant syndrome (NMS) to focus attention on NMS in COVID-19 management. Case 1: A 46-year-old-man with acute respiratory distress syndrome (ARDS) caused by COVID-19 infection was being administered favipiravir. Fentanyl, propofol, and rocuronium were also given. On day 3, midazolam administration was initiated for deep sedation. On day 5, his high body temperature increased to 41.2 °C, creatine kinase level elevated, and he developed tachycardia, tachypnea, altered consciousness, and diaphoresis. NMS was suspected, and supportive therapy was initiated. High-grade fever persisted for 4 days and subsided on day 9. Case 2: A 44-year-old-man with ARDS caused by COVID-19 infection was being treated with favipiravir. On day 5, risperidone was started for delirium. On day 7, his body temperature suddenly increased to 40.8 °C, his CK level elevated, and he developed tachycardia, tachypnea, altered consciousness, and diaphoresis. NMS diagnosis was confirmed, and both, favipiravir and risperidone were discontinued on day 8. On the same day, his CK levels decreased, and his body temperature normalized on day 9. Patients with COVID-19 infection frequently require deep sedation and develop delirium; therefore, more attention should be paid to the development of NMS in patients who are being administered such causative agents. The mechanism underlying the occurrence of NMS in COVID-19 patients treated with favipiravir remains unknown. Therefore, careful consideration of NMS development is necessary in the management of COVID-19 patients.


Assuntos
Antipsicóticos/efeitos adversos , COVID-19/tratamento farmacológico , Hipnóticos e Sedativos/efeitos adversos , Síndrome Maligna Neuroléptica/etiologia , Síndrome do Desconforto Respiratório/tratamento farmacológico , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia
17.
J Cardiol ; 76(2): 177-183, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199753

RESUMO

BACKGROUND: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.


Assuntos
Doenças Cardiovasculares/terapia , Cuidados Paliativos/normas , Indicadores de Qualidade em Assistência à Saúde , Adulto , Consenso , Técnica Delfos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade
18.
Am J Emerg Med ; 37(11): 2118.e1-2118.e3, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31623982

RESUMO

Bidirectional ventricular tachycardia (BVT) is a tachyarrhythmia characterized by 180-degree beat-to-beat alteration in the QRS axis. BVT is traditionally known as an electrocardiography (ECG) finding pathognomonic of digitalis poisoning and a hallmark of catecholamine-induced ventricular tachycardia. Apart from digitalis poisoning, aconitine poisoning is the only reported cause of poisoning-related BVT, and no report of caffeine-poisoning-related BVT is as yet available. A-27-year-old woman was transported to hospital with cardiac arrest from ventricular fibrillation after taking a massive dose of a caffeine-containing supplement (corresponding to 6 g of caffeine) 6 h before presentation. Return of spontaneous circulation (ROSC) was achieved by defibrillation. She developed BVT after ROSC. Hemodialysis was performed to remove the causative drug from the blood, with subsequent resolution of BVT and hemodynamic stabilization. At presentation, she had a blood caffeine concentration of 232 µg/mL. A suggested mechanism of development of BVT is that increased intracellular calcium concentration causes delayed afterdepolarization, which induces alternate occurrence of triggered activities within different His-Purkinje fibers, and thereby produces characteristic ECG findings. Caffeine acts on the ryanodine receptor to promote calcium release from the sarcoplasmic reticulum, and thus can induce BVT via the same mechanism. Caffeine poisoning can be treated by dialysis. In cases of BVT induced by caffeine poisoning, hemodynamic stabilization can be achieved by emergency dialysis.


Assuntos
Cafeína/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Taquicardia/induzido quimicamente , Adulto , Feminino , Humanos , Taquicardia/diagnóstico
19.
Intern Med ; 58(18): 2627-2632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527368

RESUMO

Objective In the management of patients with suspected acute drug poisoning, a screening test using the patient's urine is usually performed. The Triage DOA® and INSTANT-VIEW M-1® kits are two commonly used point-of-care screening kits in Japan. However, the relationship between the results of these screening kits and the blood concentration of the poisoning drug is not clear. In this study, we evaluated which kit is more useful for acute drug poisoning screening based on a comparison of their results with the results of a serum drug analysis. Methods This prospective cross-sectional study investigated all patients with acute drug poisoning admitted to a general hospital in Tokyo, Japan, over a nine-month period. The Triage DOA® and INSTANT-VIEW M-1® screening kits were used, and a qualitative serum analysis was conducted simultaneously in all cases. We compared the kits for use in screening patients with acute drug poisoning and evaluated the utility of the kits. Results For the 117 patients enrolled in this study, the 2 kits showed different sensitivities to benzodiazepines (Triage®, 78.6%; INSTANT-VIEW®, 90.5%). Both kits showed high sensitivity to barbiturates (Triage®, 87.0%; INSTANT-VIEW®, 91.3%) but low sensitivity to tricyclic antidepressants (Triage®, 25.0%; INSTANT-VIEW®, 45.8%). Conclusion Because the sensitivity varies depending on the kind of drug, it is difficult to discuss the superiority of these kits. However, this study compared the results of two types of urinary drug screening kits with the results of qualitative analysis of drugs in serum as a gold standard, providing important reference data.


Assuntos
Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Triagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos Tricíclicos/sangue , Antidepressivos Tricíclicos/urina , Barbitúricos/sangue , Barbitúricos/urina , Benzodiazepinas/sangue , Benzodiazepinas/urina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tóquio , Adulto Jovem
20.
Circ Rep ; 1(12): 575-581, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33693103

RESUMO

Background: We examined the association between initiation of extracorporeal cardiopulmonary resuscitation (ECPR) and the incidence of infectious complications, such as pneumonia, sepsis, and bacteremia, after out-of-hospital cardiac arrest (OHCA) in patients who received targeted temperature management (TTM). Methods and Results: This retrospective study used data from hospital medical records of patients with OHCA treated with TTM who had been admitted to St. Luke's International Hospital between April 2006 and December 2018. The primary endpoint was the association between the type of CPR and the incidence of early onset pneumonia in the intensive care unit (ICU; between 48 h and 7 days of hospitalization). Univariate and multivariate logistic regression analyses were performed for the primary endpoints. After applying the inclusion/exclusion criteria, 254 patients were included in the analyses; of these, 52 were enrolled in the ECPR group, and 202 were enrolled in the CCPR group. Median age was 58 years, 88.5% were male, prophylactic antibiotics were used in 80.3%, and favorable neurological outcomes were observed in 51.9%. On multivariate analysis, ECPR (odds ratio [OR], 2.78; 95% CI: 1.16-6.66; P=0.037) was significantly associated with the development of early onset pneumonia. Conclusions: ECPR was an independent predictor of pneumonia after OHCA in patients who received TTM.

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