Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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The Changes in Blood HbA1c Levels of the Patients with Diabetes Mellitus, Who Used Teleconsultation in the COVID-19 Pandemic -A Single Center Study-
Get PDFWe provided teleconsultation to outpatients for the purpose of infection control in the COVID-19 pandemic between March 1st and October 31st, 2020. The patients eligible for teleconsultation were only those who were taking oral anti-hypoglycemic agents. Doctors obtained information about patients' condition through telephone, and the patients received their regular prescriptions via fax at the nearest pharmacy. The present study examined the changes of HbA1c levels after teleconsultation on patients with diabetes mellitus (DM). We enrolled 218 outpatients with DM, who used teleconsultation and analyzed changes in HbA1c levels after teleconsultation. HbA1c levels in all patients significantly decreased after teleconsultation. Patients with HbA1c levels that increased by more than 0.5% after teleconsultation were significantly younger than those with HbA1c levels that decreased by more than 0.5% after teleconsultation, suggesting that in the younger generation, lifestyle changes due to the COVID-19 pandemic such as teleworking, might have reduced daily exercises. Despite a single-center study, our teleconsultation did not deteriorate HbA1c levels of patients with diabetes, who were taking oral anti-hypoglycemic agents. However, physicians should pay attention to younger, especially female, patients whether their glycemic control would be worsened at the first visit after teleconsultation use.journal articl
A Comprehensive Overview of Basic and Clinical Epileptology
Get PDFてんかんは，大脳皮質の神経細胞の過剰な興奮によって引き起こされる慢性疾患である．世界的に 1% の人口が罹患し，日本国内でも約 100 万人の患者が推定される．高齢者の発症率が上昇する一方で，小児期にも多く見られる．その社会的認知度は不十分であり，誤解も多い．動物の脳においても大脳皮質を持つものはてんかんが見られ，脳の大きさやニューロンの数とてんかんの発症率には関連がある．てんかんの発作は脳の機能局在によって異なり，ホムンクルスの理解がその解明を助ける．生理学的，生化学的，分子生物学的には，脳波検査や神経細胞の過剰放電が重要であり，てんかん重積状態では神経細胞の機能障害が生じる．治療薬の進歩により発作のコントロールが向上しているが，てんかんを専門に診る医師の不足が課題である．今後は，幅広い医師がてんかん診療に関心を持ち，患者支援が充実することが望まれる．Epilepsy is a chronic condition characterized by excessive neuronal activity in the cerebral cortex. It affects approximately 1% of the global population, with an estimated one million patients in Japan alone. While onset occurs across all age groups, it is more prevalent in children and increases again in older adults. Despite its prevalence, epilepsy remains poorly understood and often misunderstood in society. In animals, epilepsy is observed in species with a cerebral cortex, with incidence rates correlating with brain size and neuron count. Epileptic seizures manifest differently based on the localization of cerebral functions, a concept elucidated by understanding the homunculus. Physiologically, biochemically, and molecularly, epileptic seizures involve excessive neuronal discharge, detected through techniques such as EEG, and can lead to conditions like status epilepticus and subsequent neuronal dysfunction. While advancements in treatment have improved seizure control, there remains a shortage of specialists in epilepsy care. It is hoped that broader interest among healthcare professionals and enhanced support for patients will address this gap in the future.journal articl
Aorto-Enteric Fistula with Hematochezia: Report of a Case
Get PDFA man in his 70s visited our hospital with the chief complaint of hematochezia. He had undergone endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm 8 months prior. Colonoscopy was performed, revealing no active source of bleeding. On hospital day 7, hematemesis and hematochezia occurred suddenly. Emergent abdominal contrast-enhanced computed tomography (CE-CT) and esophagogastroduodenoscopy yielded findings indicating aorto-enteric fistula (AEF) at the third portion of the duodenum. Subsequent angiography during EVAR identified retention of the contrast medium in the aortic aneurysm and leakage into the duodenum (aorto-duodenal fistula, ADF). After an additional stent graft was placed, the disappearance of contrast medium leakage into the duodenum was confirmed. For gastrointestinal bleeding in patients with a history of artificial vessel replacement or stent graft insertion, AEF should also be regarded as a differential disease. Early CE-CT and detailed examination of upper gastrointestinal bleeding are necessary.journal articl
