Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Educational Effects of a Webinar about COVID-19 Prevention by a Regional Core Hospital for Therapists Working in Local Facilities
Get PDFBackground: A new role of a regional core hospital for educating medical personnel through a regional therapy association has been previously reported in the COVID-19 crisis. In the present study, physical (PT), occupational (OT), and speech language hearing therapist (ST) and physiatrists, who have been providing COVID-19 rehabilitation in a regional core hospital, were instructed how to control infection via a webinar. The purpose of this report was to investigate the effects of webinars on therapists working in local facilities.
Methods: The webinar was sponsored by the Wakayama Physical Therapy Association. A PT, OT, ST, and physiatrist from Wakayama Medical University Kihoku Hospital, who had been providing rehabilitation for mildly and/or moderately infected COVID-19 patients. All participants answered the 18-item online questionnaire after the webinar to assess the educational effects.
Results: There were 41 participants in this region and 30 participants from 19 facilities responded the questionnaire (valid responses ratio was 73%) and 30% of the respondents had experienced COVID-19 rehabilitation. Most responders (83%) felt that difficulty level of the contents was appropriate and 80% of the respondents replied that rehabilitation was necessary for the patients. 70% of the respondents replied that got confidence after this webinar, even 7 of the 13 respondents (43%), who attended the webinar about infection control of COVID-19 for the first time, were involved.
Conclusion: A webinar from therapists and physiatrists in a regional core hospital, who had experiences to provide COVID-19 rehabilitation, were satisfactory and effective for the education of regional therapists.journal articl
Management of Anaphylaxis Associated with Vaccination for COVID-19 in Children
Get PDF2022年9月現在，COVID-19の小児用mRNAワクチンは約288万回接種され，ワクチンに関連したアナフィラキシーとして報告されたのは9件であった．そのうち，専門家による検討で明らかなアナフィラキシーと判断されたのは2名で，100万接種あたり0.7件の発生率であった．これは既存のワクチンの副反応によるアナフィラキシー発生率と同等と考えられる．ワクチンの副反応はブライトン分類に基づき評価されるが，迷走神経反射を含む予防接種ストレス関連反応等の紛れ込みがみられるため，正確に診断することが必要である．アナフィラキシーが生じた場合は，治療の第一選択であるアドレナリンの筋肉内注射を躊躇せずに行う．
mRNAワクチンに含まれるアレルゲンは，ポリエチレングリコール（PEG）である可能性が高いとされる．そのため，これまでにPEGを含む薬剤でアレルギー症状を生じた既往がある者に対するワクチン接種は慎重に判断する必要がある．しかし，接種前にPEGのアレルギー反応を確認する臨床検査は確立していないため，問診によるハイリスク患者の抽出が試みられている．いずれにしても，アナフィラキシーへの対応法を各施設で明文化し，スタッフ間で情報の共有を行うことで，アナフィラキシー発生時，確実に治療を行えるようにしておく必要がある．By September 2022, approximately 2.88 million doses of COVID-19 mRNA vaccine had been administered in Japanese children, and 9 cases of vaccine-related anaphylaxis had been reported. Of these, 2 cases were determined to be definite anaphylaxis by expert review, for an incidence rate of 0.7 cases per million doses. This is equivalent to the incidence of anaphylaxis from adverse reactions to existing vaccines. If anaphylaxis occurs, pediatricians should administer an intramuscular injection of adrenaline, the first choice of treatment for anaphylaxis.
The allergen contained in mRNA vaccines is likely to be polyethylene glycol （PEG）. Therefore, we must be cautious in our decision to vaccinate individuals with a history of allergic reactions to PEG-containing agents. However, since no clinical test has been established to confirm allergic reactions to PEG prior to vaccination, efforts are being made to identify high-risk patients by questionnaire. It is necessary for each facility to clearly state how to respond to anaphylaxis and share information among staff so that treatment can be reliably administered in the event of anaphylaxis.journal articl
The cancer immunohistogram, a functional status of tumor-infiltrating cells evaluated by immunohistochemistry, predicts the efficacy of checkpoint inhibitors.
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Reperfusion Injury after Acute Myocardial Infarction
Get PDFAcute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (PPCI) is the gold standard treatment for patients presenting with ST-segment elevation myocardial infarction (STEMI). PPCI reperfusion therapy has the potential to reduce infarct size, preserve the left ventricle ejection fraction (LVEF), prevent lethal complications, and improve prognosis. A significant proportion of STEMI patients, however, develop post-infarct heart failure despite optimal PPCI. One of the reasons for post-infarct heart failure is that reperfusion injury increases the infarct area after PPCI. This article reviews the current understanding and up-to-date evidence basis for therapeutic intervention of reperfusion injury. Specifically, the combination of myocardial ischemia secondary to acute coronary occlusion and reperfusion injury leads to further myocardial injury and cell death. Multiple treatment modalities have been shown to be cardioprotective and reduce reperfusion injury in experimental animal models. Recent clinical trials have assessed multiple cardioprotective strategies, including ischemic pre- and post-conditioning, pharmacologic therapies, and mechanical devices. While several therapies have been shown to reduce infarct size in animal models or proof-of-concept studies, many large-scale trial results have proven inconsistent and disappointing. To decrease the incidence of severe heart failure in patients and extend healthy life expectancy in an aging society, further development of prevention strategies for reperfusion injury is needed, including novel maneuvers, drugs, devices, and combinations of the three.journal articl
Relationship between Cyclical Fluctuations in Renal Disease and Trends in Infectious Diseases
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Background: Infection is an important factor in the development of renal diseases. We investigated the relationship between infection trends and the disease trends in renal biopsies.
Methods: The frequency of renal biopsy diseases in our department over the past 25 years was plotted annually and monthly and compared with the trends of sentinel observation of infectious diseases.
Results: IgA nephropathy increased in a cycle of 3 to 7 years, but its peak gradually decreases. IgA nephropathy showed a weak correlation with group A hemolytic streptococcus and drug-resistant Pseudomonas aeruginosa. On the other hand, in Henoch-Schönlein purpura showed a significant positive correlation with the secular variation of MRSA (r = 0.57, p < 0.01), influenza (r = 0.46, p < 0.05), and genital herpes (r = 0.45, p < 0.05) and condyloma (r = 0.43, p < 0.05). The frequency of ANCA nephritis was significantly correlated with the infection trends of adenovirus pharyngoconjunctival fever (r = 0.48, p < 0.05), hand-foot-mouth disease (r = 0.48, p < 0.05), influenza (r = 0.41, p < 0.05). It also showed a weak correlation with the secular and seasonal trends of group A hemolytic streptococcus. Minimal change nephrotic syndrome increased in a cycle of 4-5 years, and significantly correlated with group A hemolytic streptococcus (r = 0.561, p < 0.01), and the seasonal variation was associated with mycoplasma pneumonia, infectious erythema. Focal segmental glomerulosclerosis showed a significant correlation with the infectious trend of drug-resistant Pseudomonas aeruginosa (r = 0.62, p < 0.01), MRSA (r = 0.53, p < 0.05), Roseola (r = 0.53, p < 0.01), whooping cough (r = 0.42, p < 0.05).
Conclusion: Renal diseases diagnosed by renal biopsy have cyclical variations associated with seasonal and secular variations in infectious disease epidemics.journal articl