JANUARY 2022 Volume 4-1

ISSN 2436-018X

JOURNAL OF HOSPITAL GENERAL MEDICINE

JHGM 2022：4(1)：1-5

Original article

Quality, as well as Quantity, of Universal Masking
Matters amid the COVID-19 pandemic:
A Comparison of Appropriate Masking between
Healthcare Workers and Non-medical Personnel

Hideharu Hagiya 1)※　　Hitoshi Osada 2)　　Hana Iguchi 2)　　Kotaro Takahashi 2)
Kazuki Tokumasu 1)　　Mikako Obika 1)　　Fumio Otsuka 1)

1) Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
2) Department of Medicine, Okayama University School of Medicine

Key Words：COVID-19, healthcare workers, universal masking, infection prevention and control, droplet infection

[Objective] During the COVID-19 global pandemic, universal masking has been widely recognized as an important way to prevent the infection from spreading in both clinical and non- clinical settings. In addition to the quantity (wearing a mask at all times), the quality (wearing a mask as appropriate) should matter. In this study, we compared the quality of the universal masking among healthcare workers (HCWs) and non-medical personnel after the first wave of COVID-19.
[Methods] In June 2020, we collected data on wearing mask among HCWs at Okayama University Hospital and that of non-medical personnel outside the hospital. Improper masking was defined as wearing a mask but having the nose or mouth uncovered. Data were stratified by place (in wards, outside wards, and outside the hospital) and subject (HCWs and non-medical personnel) for comparison.
[Results] In total, we collected data on 1,359 subjects in- and 2,620 outside-hospital. The appropriate mask wearing rate among HCWs (86.0%) was significantly lower than that of non- medical personnel observed in-hospital (92.6%) and outside the hospital (91.4%).
[Conclusions] Quality, as well as quantity, of masking should be highlighted more among HCWs to prevent the further spread of COVID-19.

JHGM 2022：4(1)：6-11

Original article

Effect of Recovery-Phase Rehabilitation
on Physical Function and Prognosis for Very Elderly
Patients with Cerebrovascular Disorders

Masaru Nakayama 1)※　　　Fumie Nakayama 2)　　　Shinnosuke Fujii3)　　Taku Nagai 3)
Izumi Ohwada 3) 　Manabu Fujihara 3) 　Satoko Watanabe 3) 　Astushi Ishii 3)

Youjyoukai Kashima Hospital
1) Division of Cardiology
2) Division of Radiology
3) Division of General Practice

Key Words：cerebrovascular disorders, aging, rehabilitation, prognosis

The effect of recovery-phase rehabilitation on the prognosis of very elderly patients with cerebrovascular disorders is unknown. A total of 418 patients (mean age 73 ± 12 years) with cerebrovascular disorders admitted to our hospital for recovery-phase rehabilitation were classified according to age, and their modified Rankin Scale (mRS) scores before onset and at discharge, functional independence measure (FIM) on admission and at discharge, and outcomes were compared. Pre-onset mRS scores were higher and FIM on admission were lower in older groups compared with younger groups. FIM at discharge showed significant improvement in older groups, but was significantly lower compared with younger groups. The home discharge rate decreased with age, and 7 patients (3%), only in older groups, had in-hospital deaths. Although there was no difference in the mRS score at discharge, it became more difficult to discharge patients to home as age increased. In very elderly patients with cerebrovascular disorders, it is necessary to understand the limitations of rehabilitation in their recovery phase, share the goals to be achieved at an early stage, and carefully judge the indications for inpatient treatment.

JHGM 2022：4(1)：12-20

Original article

Clinical Evaluation of Reverse Transcription-
Polymerase Chain Reaction and Rapid Antigen
Tests of Tongue Swabs for Detecting COVID-19

Toru Yamada 1)※　　Risa Suzuki 1) 　　Naoya Ichimura2)　　Suguru Mabuchi 1)
Yuiko Nagamine 1) 　Chihiro Sassa 2) 　Shuji Tohda 2)

1) Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
2) Department of Clinical Laboratory, Medical Hospital, Tokyo Medical and Dental University

Key Words：COVID-19, reverse transcription-polymerase chain reaction, tongue swab, saliva, sensitivity

[Introduction] There are few reports about tongue swab use for priming reverse transcription- polymerase chain reaction (RT-PCR) and rapid antigen tests (RATs) for the detection of coronavirus disease 2019 (COVID-19). Especially, their sensitivity and specificity and the effects of time from symptom onset or from last meal to test time are unknown.
[Methods] Enrolled outpatients referred to the COVID-19 Outpatient Center and patients with COVID-19 transferred to the general ward of Tokyo Medical and Dental University Medical Hospital from August–October 2020 each provided two nasopharyngeal and two tongue swabs for RT-PCR and RAT, their symptom onset date, and time of last food/beverage consumption.
[Results] The sensitivities of RT-PCR and RAT using tongue swabs and of RAT using nasopharyngeal swabs from 42 patients were 0.61, 0.04, and 0.43, respectively. All tests had a specificity of 1.00. The RT-PCR sensitivities between tongue swabs obtained 8–14 days (0.67) and ＜ 7 days from symptom onset (0.63) or between tongue swabs taken at ＜ 1 h (0.67) and 1-4 h post-eating (0.59) were not significantly different.
[Conclusions] RATs primed by tongue swabs were unhelpful, whereas RT-PCR primed by tongue swabs showed moderate sensitivity and high specificity for detecting COVID-19. Sensitivity was maintained for ≤ 2 weeks and was unaffected by mealtime.

JHGM 2022：4(1)：21-24

Case report

A case of intravascular lymphoma in a patient
with septic shock-like condition
and elevated serum lactate dehydrogenase

Mamoru Komatsu 1)※　　Hiroki Isono 2)　　Hiroya Hagiwara 3)　　Tsuji Naruhito 4)

1) Department of General Medicine, Obihiro-Kosei Hospital
2) Department of General Medicine, HITO Medical Center
3) Advanced Medical Emergency Department and Critical Care Center, Japanese Red Cross Maebashi Hospital
4) Department of Anesthesiology, Obihiro-Kosei Hospital

Key Words：Intravascular large cell lymphoma, higher serum lactate dehydrogenase, shock

　　Intravascular lymphoma (IVL) is a rare type of B-cell lymphoma of blood vessels. We encountered an IVL case diagnosed in a patient treated for shock in the intensive care unit. An 83-year-old man was transported to our hospital for shock with fever and was initially diagnosed with septic shock. However, we could not identify an infection source, and broad-spectrum antibiotics were ineffective. Blood tests performed on admission revealed a serum lactate dehydrogenase (LDH) level > 800 IU/L. Based on these findings, we suspected IVL and performed a random skin biopsy of his senile hemangioma. Large lymphocytes were collected in the lumens of small vessels. Immunostaining findings indicated IVL. Hemophagocytic lymphohistiocytosis was diagnosed based on pathological assessment of bone marrow samples. In patients with septic shock-like hypotension with serum LDH levels > 800 IU/L, IVL should be considered. Random skin biopsy, a simple and minimally invasive procedure, can be performed at the bedside and is useful for IVL diagnosis. The standard treatment for IVL is a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone. We used hydrocortisone for relative adrenal insufficiency;afterwards, his condition improved. In septic-shock like conditions associated with IVL, steroids may be the keystone to recovery.

JHGM 2022：4(1)：25-28

Brief report

Low IgG antibody production in the elderly
Japanese population after full BNT162b2 vaccination

Hiroaki Ikezaki 1)2)※　　Yuichi Hara　　2)　　Jun Hayashi　2)
Hiroshi Hara 2)　　Hideyuki Nomura　2)　　Nobuyuki Shimono　1)

1) Department of General Internal Medicine, Kyushu University Hospital
2) Haradoi Hospital

Key Words：COVID-19, BNT162b2, IgG antibody

JHGM 2022：4(1)：29-31

Key Image of General Medicine

A case of medication-related osteonecrosis
of the jaw preceding neck skin lesion

Yoshio Hisata 1)※　　Hisataka Mekata 2)　　Masaru Mori 3)　　Yoshio Naya 3)

1) Department of Internal Medicine, Nagahama City Kohoku Hospital
2) Department of Dental Medicine, Nagahama City Kohoku Hospital
3) Department of Urology, Nagahama City Kohoku Hospital

Key Words：extraoral fistula, medication-related osteonecrosis of the jaw, neck skin lesion

JHGM 2022：4(1)：32-33

Key Image of General Medicine

Thymic hyperplasia associated with Graves’ disease

Naoya Fujita ※　　Azusa Sano 　　Yosuke Ono 　　Yuji Tanaka

Department of General Medicine, National Defense Medical College

Key Words：Graves’ disease, Thymic hyperplasia

JHGM 2022：4(1)：34-35

LETTERS TO THE EDITOR

Both pre- and post-event tetanus vaccinations
are essential

Hiroki Isono

Department of General Medicine, HITO Medical Center

Key Words：tetanus

JHGM 2022：4(1)：36-39

Special contribution

Five tips to help young,
non-native speakers of English write reports
of cases presented at academic conferences

Shun Yamashita 1)※　　Yosuke Sasaki 2)　　Taijyu Miyagami 3)　　Takeshi Kondo 4)

1) Department of General Medicine, Saga University Hospital
2) Department of General Medicine and Emergency Care, Toho University School of Medicine
3) Department of General Medicine, Faculty of Medicine, Juntendo University
4) Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital

Key Words：academic conference, case report, general medicine

　　Case reports can contribute to academic development and help trigger new clinical research. However, among cases presented at annual academic conferences for Japanese generalists, only a small proportion become published in peer-reviewed journals. There are some impediments in the process of starting to write reports of cases previously presented at conferences. Thus, we conducted an interactive interview survey and narrative review with four Japanese generalists who have extensive experience in publication of case reports in international peer-reviewed journals. As a result, we propose the following five tips to help overcome those impediments:(1) recognize the advantage that authors can obtain from writing case reports;(2) correctly understand the significance and eligibility of cases for reports;(3) do not think negatively about cases before writing reports;(4) do not start writing case reports alone;(5) before writing case reports, obtain consent forms with signatures of the associated patients or family members. We hope that more young, non-native speakers of English will write reports about cases presented at academic conferences and that their supervisors will be able to support them in writing case reports according to these five tips.