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Manabu Saito,1,&ast; Hiroshi Uchino,1,&ast; Yoko Iwata,1 Ayako Fuchigami,1 Genki Sato,1 Fukumi Yoshikawa,1 Masahiko Miyagi,1 Taito Miyazaki,2 Yoshihisa Urita,2 Kotaro Aoki,3 Yoshikazu Ishii,3 Kazuhiro Tateda,3 Takahisa Hirose1 1Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan; 2Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan; 3Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan&ast;These authors contributed equally to this workCorrespondence: Hiroshi Uchino, Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan, Tel +81-3-3762-4151, Fax +81-3-3765-6488, Email h.uchino@med.toho-u.ac.jpPurpose: The severe pathogenic ancient-type COVID-19, SARS-CoV-2/WA-1/2020 was the predominant gene variant in early 2020 in Japan, however, its transmissibility was uncertain. The period before the public commenced using any personal protective equipment (PPE) was evaluating to describe the transmissibility of the SARS-CoV-2/WA-1/2020. We analyzed the secondary attack rate (SAR) among close contacts and the risk factor for SAR.Methods: This retrospective cohort study included a total of 539 patients who were anticipated for the SARS-CoV-2/WA-1/2020 infection at Toho University Medical Center Omori Hospital from February to May 2020. We selected 54 patients with 1) exclude other pathogens infection, 2) include “Three Cs” condition: crowded places between distance< 6 feet, closed spaces indoor and close contact settings involving contact > 15min with a person tested positive for SARS-CoV-2/WA-1/2020 without PPE. We evaluated alternative infection risks: the body mass index (BMI) and diabetes (DM) status (non-DM, pre-DM, and DM) as demographic determi

type:TOHO University Scholarly Publication, Original Article

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type:TOHO University Scholarly Publication, Original Article, Introduction: Myocardial damage is reported in about 20% to 60% of sepsis cases. The circulatory system in early sepsis is hyperdynamic in state, but with time, cardiac function decreases and shifts toward cardiogenic shock. This study aimed to determine whether an intra-aortic balloon pump (IABP) could be an effective cardiac support for septic cardiomyopathy. Methods: Twelve patients with septic cardiomyopathy who were screened between April 2010 and March 2016 in the Saiseikai Yokohamashi Tobu Hospital Emergency and Critical Care Center were enrolled retrospectively for this observational study. Hemodynamics was evaluated using the following parameters: mean blood pressure; heart rate; catecholamine index; and serum lactate level. These parameters were compared before IABP insertion and at 24 and 72 hours after insertion. Cardiac function was assessed by evaluating the N-terminal pro b-type natriuretic peptide (NT-pro BNP) and left ventricular ejection fraction (LVEF) at days 0, 3, and 7 after intensive care unit admission. Results: The mean blood pressure tended to increase, the heart rate significantly decreased, and the catecholamine index and serum lactate levels decreased significantly after IABP insertion. Nine of the 12 patients survived and showed improved LVEF, which returned to the normal range during the follow-up period. Conclusions: From our experience of 12 cases, we suggest that IABP may be used for septic cardiomyopathy.

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Koichiro Tanaka,1 Kazuhiko Nara,1 Tetsuya Nishimura,1 Keiko Serizawa,1 Taito Miyazaki,2 Yoshihisa Urita,2 Oto Miura11Division of Traditional Japanese Medicine, Department of General Medicine and Emergency Care, Faculty of Medicine, Toho University, 2Department of General Medicine and Emergency Care, Faculty of Medicine, Toho University, Tokyo, JapanAbstract: Oren-gedoku-to is a traditional medicine used for treating inflammatory conditions and is given by prescription in Japan, People's Republic of China, and Korea. Its anti-inflammatory effect is related to the arachidonate cascade and inhibition of cyclo-oxygenase, but research on other anti-inflammatory pathways is ongoing. We report a case of fever of unknown origin in a 33-year-old woman. The possibility of infection due to human immunodeficiency virus, autoimmune, neoplastic, or other disease was examined and excluded. Oren-gedoku-to was successfully used to treat her symptoms and may thus be a suitable treatment for patients with undiagnosed fever of unknown origin.Keywords: fever of unknown origin, oren-gedoku-to, huanglian-jie-du-tang, kampo

Osamu Kano,1 Yoshihisa Urita,2 Hirono Ito,1 Takanori Takazawa,1 Yuji Kawase,1 Kiyoko Murata,1 Takehisa Hirayama,1 Ken Miura,1 Yuichi Ishikawa,1 Tetsuhito Kiyozuka,3 Jo Aoyagi,3 Yasuo Iwasaki11Department of Neurology, 2Department of General Medicine and Emergency Care, Toho University Omori Medical Center, Tokyo, Japan; 3Department of Neurology, Federation of National Public Service Personnel Mutual Aid Associations, Mishuku Hospital, Tokyo, JapanObjective: While acetylcholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, are beneficial in treating behavioral symptoms of patients with Alzheimer's disease (AD), their dose-limiting effects include gastrointestinal disturbances, such as nausea, vomiting, and diarrhea. We aimed to predict the occurrence of these gastrointestinal disturbances with rivastigmine therapy for optimal drug choice and improved compliance.Materials and methods: Thirty patients with mild-to-moderate AD (scores 10–22 on the Mini-Mental State Examination) were administered a rivastigmine 18 mg patch with domperidone 30 mg (RWD) and without domperidone (RWOD; n = 15 each) for 20 weeks. Gastrointestinal disturbances were evaluated using a frequency scale for symptoms of gastroesophageal reflux disease (FSSG), Bristol stool form scale, laboratory data (hemoglobin, albumin, total cholesterol), body weight, and amount of food intake.Results: After 12 weeks, FSSG scores were higher in the RWOD group compared to baseline scores; however, no significant differences were noted between the RWD and RWOD groups. We then subdivided each group based on high and low baseline scores; the RWOD high-score (≥4) subgroup showed increased FSSG after 12 weeks compared with the baseline score. In both RWD and RWOD groups, the low-score (≤3) subgroups showed no changes during the dose-escalation phase.Conclusion: For AD patients with higher FSSG scores at baseline, domperidone was effective in preventing rivastigmine

http://www.tulips.tsukuba.ac.jp/mylimedio/dl/page.do?issueid=102359843&old_issueid=413946&tocid=100058657&page=117-119

Yoshihisa Urita, Toshiyasu Watanabe, Hiroki Ota, Motohide Iwata, Yosuke Sasaki, et alDepartment of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Tokyo, JapanAbstract: Although there have been many studies that showed a close association between gastroesophageal reflux disease (GERD) symptoms and chronic cough, it has been unknown whether acute cough is also associated with GERD. The aim of this study was to evaluate the relationship between GERD and respiratory symptoms in general practice. 1725 consecutive patients who first attended our hospital were enrolled in the present study. They were asked to respond the F-scale questionnaire regardless of their chief complaints. Over all, 656 (38%) patients were diagnosed as GERD and 226 (13%) had respiratory symptoms. Patients with respiratory symptoms had GERD symptoms more frequently than patients without respiratory symptoms (p < 0.05). Forty-three (37%) of 115 patients with acute cough and 48 (43%) of 111 with nonacute cough had GERD symptoms, suggesting that development of GERD is not associated with the period of respiratory symptoms. Patients with respiratory  symptoms are at a significantly increased risk of developing GERD. Whether or not treatment for GERD or respiratory diseases is useful for the prevention of respiratory symptoms and GERD, respectively, should not be driving management decisions in primary care.Keywords: acute cough, gastroesophageal reflux, chronic cough, F-scale