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  • Kobayashi, Tadashi  (14)
  • 1
    Online Resource
    Online Resource
    An undiagnosed patient with skin rash, polyarthritis, and edema responding to low-dose colchicine: A case report
    SAGE Publications ; 2021
    In:  SAGE Open Medical Case Reports Vol. 9 ( 2021-01), p. 2050313X2110245-
    Details
    In: SAGE Open Medical Case Reports, SAGE Publications, Vol. 9 ( 2021-01), p. 2050313X2110245-
    Abstract: A 54-year-old man was referred to our hospital with painful rashes on the extremities. He also developed polyarthritis and pitting pedal edema. Blood tests showed no specific autoantibodies and were negative for human leukocyte antigens B51, B15, and B27. Lower extremity venous ultrasonography and computed tomography angiography showed no vascular disorders. Skin biopsy showed no evidence of thrombosis or vasculitis. Direct fluorescence antibody analysis showed no antibody or complement deposition. Joint ultrasonography showed mild synovial thickening and/or synovial effusion in the extremities. Non-steroidal anti-inflammatory drugs and topical steroids were administered, followed by oral steroids. However, the signs and symptoms did not improve. Oral steroids were discontinued, and colchicine (0.5 mg/day) was administered. Thereafter, the symptoms of arthritis improved, and no skin rash developed. In potentially inflammatory conditions with skin rash, edema, and polyarthritis that are difficult to diagnose, low-dose colchicine administration may be considered for prompt relief of symptoms.
    Type of Medium: Online Resource
    ISSN: 2050-313X , 2050-313X
    URL: Article
    DOI: 10.1177/2050313X211024508
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2736953-5
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  • 2
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    Functional hyperthermia caused by obstructive sleep apnea syndrome: A case report
    SAGE Publications ; 2022
    In:  SAGE Open Medical Case Reports Vol. 10 ( 2022-01), p. 2050313X2211233-
    Details
    In: SAGE Open Medical Case Reports, SAGE Publications, Vol. 10 ( 2022-01), p. 2050313X2211233-
    Abstract: A 47-year-old farm worker with diabetes mellitus, dyslipidemia, and hyperuricemia was referred to our hospital for a 3-month history of fever and malaise. He had no respiratory tract or abdominal symptoms, skin rashes, or joint pain. There was no change to his regular medication or pesticide exposure. Blood tests and echocardiography revealed no abnormalities. Whole-body computed tomography revealed a fatty liver; however, non-alcoholic steatohepatitis was excluded. We diagnosed the patient with functional hyperthermia. He had a history of snoring and weight gain, and we suspected the obstructive sleep apnea syndrome to be a stressor. Polysomnography revealed severe obstructive sleep apnea syndrome with an apnea–hypopnea index of 44.5. Continuous positive airway pressure was introduced; the axillary temperature decreased gradually and malaise was resolved. Functional hyperthermia should be considered a cause of fever with a negative inflammatory response. Obstructive sleep apnea syndrome can be a stressor for functional hyperthermia, which can be improved by interventions.
    Type of Medium: Online Resource
    ISSN: 2050-313X , 2050-313X
    URL: Article
    DOI: 10.1177/2050313X221123308
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2736953-5
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  • 3
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    Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 7 ( 2022-07), p. e055910-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 7 ( 2022-07), p. e055910-
    Abstract: To elucidate the diagnostic accuracy of pretest probability of influenza (%) by physicians and the factors affecting the clinical diagnosis. Design Retrospective, single-centre observational study. Setting A community primary care clinic in Japan. Participants The participants were recruited from a database of studies conducted during the influenza season from December 2017 to April 2019. Primary outcome measure Sensitivity and specificity of the physician’s clinical diagnosis of influenza recorded in the medical record as pretest probability. Results A total of 335 patients (median age, 31 years; male, 66.6%) were analysed in this study. The area under the curve (AUC) of the physician’s pretest probability was 0.77. At a cut-off value of 30%, the sensitivity and negative likelihood ratio were 92.0% (95% CI 86.7 to 95.7) and 0.19 (95% CI 0.11 to 0.33), respectively. At a cut-off value of 80%, the specificity and positive likelihood ratio were 90.8% (95% CI 85.4 to 94.6) and 4.01 (95% CI 2.41 to 6.66), respectively. The AUCs of patients who had and had not taken any medications before visiting the clinic were 0.77 (95% CI 0.69 to 0.85) and 0.78 (95% CI 0.71 to 0.84), respectively. The AUCs of patients with type A and B influenza were 0.78 (95% CI 0.72 to 0.84) and 0.76 (95% CI 0.70 to 0.82), respectively. The AUCs of vaccinated and unvaccinated patients were 0.80 (95% CI 0.72 to 0.88) and 0.76 (95% CI 0.63 to 0.89), respectively. The AUC for patients less than 12 hours after onset was 0.69 (95% CI 0.51 to 0.88), and that for patients aged younger than 6 years was 0.69 (95% CI 0.49 to 0.88). Conclusions The physician’s pretest probability of influenza (%) may be useful for both definitive and exclusionary diagnoses within the limits of our study.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2021-055910
    DOI: 10.1136/bmjopen-2021-055910.supp1
    DOI: 10.1136/bmjopen-2021-055910.supp2
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 4
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    Factors associated with seasonal influenza self-diagnosis: a prospective observational study in Japan
    Springer Science and Business Media LLC ; 2020
    In:  npj Primary Care Respiratory Medicine Vol. 30, No. 1 ( 2020-03-23)
    Details
    In: npj Primary Care Respiratory Medicine, Springer Science and Business Media LLC, Vol. 30, No. 1 ( 2020-03-23)
    Abstract: This prospective observational study, conducted at a community clinic in Japan during the influenza season, from December 2017 to April 2018 aimed to investigate the accuracy of factors used for influenza self-diagnosis. Data were collected from pre-examination checklists issued to patients with suspected influenza and electronic medical records. Receiver operating characteristic (ROC) curve analysis was performed using a rapid influenza diagnostic test as the reference standard, and 2 × 2 contingency tables were analysed at each cut-off point. We analysed data from 290 patients (72.8% males, median age: 38 years, interquartile range: 26–50 years). The area under the ROC curve (AUC) for patients who were aware of other patients presumed to have influenza within close proximity was 0.74 (95% confidence interval (CI): 0.66–0.82). The AUCs for patients with a history of influenza, unvaccinated status, cough, or nasal discharge were 0.68 (95% CI: 0.60–0.75), 0.66 (95% CI: 0.59–0.73), 0.67 (95% CI: 0.59–0.75), and 0.70 (95% CI: 0.62–0.78), respectively. The sensitivity, specificity and positive likelihood ratio at a 90% cut-off point was 19.5% (95% CI: 13.5–26.6%), 94.1% (95% CI: 88.7–97.4%) and 3.31 (95% CI: 1.57–6.98). The sensitivity, specificity and negative likelihood ratio at a 10% cut-off point was 95.5% (95% CI: 90.9–98.2%), 9.6% (95% CI: 5.2–15.8%) and 0.48 (95% CI: 0.20–1.16). After multivariate logistic regression analysis, the AUC increased significantly from 0.77 (95% CI: 0.70–0.83) to 0.81 (95% CI: 0.76–0.86) when self-diagnosis-related information was added to basic clinical information. We identified factors that improve the accuracy and validity of influenza self-diagnosis. Appropriate self-diagnosis could contribute to the containment efforts during influenza epidemics and reduce its social and economic burden.
    Type of Medium: Online Resource
    ISSN: 2055-1010
    URL: Article
    DOI: 10.1038/s41533-020-0165-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2780812-9
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  • 5
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    Severe edema and blood blisters of the lower extremities caused by sitagliptin, a dipeptidyl peptidase‐4 inhibitor
    Wiley ; 2022
    In:  Journal of General and Family Medicine Vol. 23, No. 2 ( 2022-03), p. 124-125
    Details
    In: Journal of General and Family Medicine, Wiley, Vol. 23, No. 2 ( 2022-03), p. 124-125
    Type of Medium: Online Resource
    ISSN: 2189-7948 , 2189-7948
    URL: Issue
    URL: Article
    DOI: 10.1002/jgf2.v23.2
    DOI: 10.1002/jgf2.502
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2886539-X
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  • 6
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    Factors associated with children’s seasonal influenza diagnosis by their guardians: a prospective observational study in Japan
    CSIRO Publishing ; 2022
    In:  Journal of Primary Health Care Vol. 14, No. 1 ( 2022-4-13), p. 29-36
    Details
    In: Journal of Primary Health Care, CSIRO Publishing, Vol. 14, No. 1 ( 2022-4-13), p. 29-36
    Abstract: Introduction Children’s influenza diagnosis by their guardians has been reported to be highly accurate, but clinical factors that improve the reliability of a guardian’s diagnosis are unclear. Aim To determine the accuracy of guardians’ influenza diagnosis of their children, investigate clinical factors that improve the diagnostic accuracy, and determine the additional clinical value of the guardian’s diagnosis. Methods A prospective observational study was conducted at a primary care clinic in Japan from December 2017 to April 2019. Pre-examination checklists completed by guardians accompanying children aged 〈 12 years with clinically suspected influenza were analysed. Receiver-operating characteristic curve analysis was performed to evaluate the diagnostic accuracy at multiple cut-off points and to compare the area under the curve (AUC), using a rapid influenza diagnostic test as the reference standard. Multivariable logistic regression was performed to validate additional contribution of guardians’ diagnosis. Results A total of 112 patient pairs of child (median age, 6 years) and guardian (mother, 81.2%; father, 16.1%; grandmother, 1.8%; other, 0.9%) were included in the analysis. The AUC for guardians’ influenza diagnosis was higher in mothers (0.72), as well as pairs with children with a history of influenza (0.72), guardians who were aware of the influenza epidemic (0.71), and unvaccinated children (0.76), than in other guardians. After multivariate analysis, the AUC increased significantly from 0.79 to 0.85. Discussion Guardians’ influenza diagnosis for their children was highly accurate. We identified factors that improve the accuracy of the guardians’ diagnosis and demonstrated that the guardians’ diagnosis can support physicians’ diagnostic accuracy.
    Type of Medium: Online Resource
    ISSN: 1172-6156
    URL: Article
    DOI: 10.1071/HC21135
    Language: English
    Publisher: CSIRO Publishing
    Publication Date: 2022
    detail.hit.zdb_id: 2572943-3
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  • 7
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    A case of Raynaud's phenomenon of toes induced by whole‐body warm stimulation
    Wiley ; 2022
    In:  Journal of General and Family Medicine Vol. 23, No. 2 ( 2022-03), p. 113-115
    Details
    In: Journal of General and Family Medicine, Wiley, Vol. 23, No. 2 ( 2022-03), p. 113-115
    Abstract: Raynaud's phenomenon, induced by cold stimulation and emotional stress, is also induced by whole‐body warm stimulation. A 74‐year‐old man was referred to our department because of nocturnal toe pain from 2 years prior and immediate color change of the toes from 1 year prior when submerging himself into a warm bath. Physical examination and blood tests revealed no abnormal findings suggestive of secondary Raynaud's phenomenon. Two years later, the signs and symptoms persisted. When physicians confirm Reynaud's phenomenon, they should check for the possibility of secondary Reynaud's phenomenon. Additional research on Reynaud's phenomenon induced by warm stimulation is needed.
    Type of Medium: Online Resource
    ISSN: 2189-7948 , 2189-7948
    URL: Issue
    URL: Article
    DOI: 10.1002/jgf2.v23.2
    DOI: 10.1002/jgf2.503
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2886539-X
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  • 8
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    Initial assessment of femoral proximal fracture and acute hip arthritis using pocket-sized ultrasound: a prospective observational study in a primary care setting in Japan
    Springer Science and Business Media LLC ; 2020
    In:  BMC Musculoskeletal Disorders Vol. 21, No. 1 ( 2020-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2020-12)
    Abstract: Acute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Although pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. Thus, we aimed to validate the diagnostic accuracy of PsUS for both disorders. Methods In this prospective observational study, outpatients with acute hip pain were diagnosed according to a fixed procedure of the PsUS probe handling. We verified the diagnostic accuracy of PsUS findings (cortical discontinuity and joint fluid retention) and compared it with that of radiography, computed tomography, and magnetic resonance imaging. Results Our study included 52 outpatients (mean age, 78.0 years; female, 88.5%). Of 26 patients diagnosed with femoral proximal fractures, 14 had femoral neck fractures and 12 had femoral trochanteric fractures. The sensitivity and specificity for identifying cortical discontinuity in femoral proximal fractures were 0.96 and 0.92, respectively. The sensitivity for identifying either cortical discontinuity or joint fluid retention in femoral proximal fractures or acute hip arthritis was 0.97. Conclusions Negative PsUS findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. PsUS and radiography have comparable diagnostic accuracies, and PsUS could aid in the initial assessment of acute hip pain among the elderly in primary care settings.
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-020-03326-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041355-5
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  • 9
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    Pseudo-fever caused by predictive electronic thermometers: A case report
    SAGE Publications ; 2022
    In:  SAGE Open Medical Case Reports Vol. 10 ( 2022-01), p. 2050313X2211297-
    Details
    In: SAGE Open Medical Case Reports, SAGE Publications, Vol. 10 ( 2022-01), p. 2050313X2211297-
    Abstract: A 33-year-old man was referred to our hospital with chief complaints of fever, dizziness, and headache. Although he had recurring fever and dizziness for 7 months, neurological examination, magnetic resonance imaging, computed tomography, electrocardiograms, and blood tests were normal. He was diagnosed with functional hyperthermia, cervical vertigo, and tension headache and was treated with oral medication and physical therapy. After treatment, the dizziness and headache resolved; however, the fever and anxiety did not. During follow-up, he noticed differing results from different electronic thermometers. The physician decided to use an accurate analog thermometer, a gallium thermometer, in combination with the other thermometers. The results differed significantly among the thermometers, and the electronic thermometer readings were found to be inappropriately high. The physician made a diagnosis of pseudo-fever, and the patient recognized that the gallium thermometer’s results were the most accurate reflection of his physical condition, resolving his anxiety.
    Type of Medium: Online Resource
    ISSN: 2050-313X , 2050-313X
    URL: Article
    DOI: 10.1177/2050313X221129772
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 10
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    Vestibular migraine without headache treated with lomerizine: A 35‐year‐old woman undiagnosed for 10 years
    Wiley ; 2020
    In:  Journal of General and Family Medicine Vol. 21, No. 4 ( 2020-07), p. 140-142
    Details
    In: Journal of General and Family Medicine, Wiley, Vol. 21, No. 4 ( 2020-07), p. 140-142
    Abstract: A 35‐year‐old woman presented with recurrent vertigo without headache, which had persisted for 10 years. Detailed medical history revealed that she experienced hearing loss, tinnitus, nausea, photophobia, phonophobia, and slight discomfort in the head during vertigo attacks, which often led to absence from work. Based on the diagnostic criteria of the International Classification of Headache Disorders, third edition, she was diagnosed with vestibular migraine and was prescribed lomerizine, as prophylaxis. Her symptoms markedly improved, enabling her to go to work. Accurate diagnosis and treatment are important for improving the quality of life of patients, since vestibular migraine is commonly underdiagnosed.
    Type of Medium: Online Resource
    ISSN: 2189-7948 , 2189-7948
    URL: Issue
    URL: Article
    DOI: 10.1002/jgf2.v21.4
    DOI: 10.1002/jgf2.311
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2886539-X
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