著者

Akihiko Miyamoto Shigeyuki Watanabe

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.2, pp.51-60, 2011 (Released:2011-12-28)

参考文献数

24

被引用文献数

10

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Background: Rapid and accurate diagnosis is essential for containing the novel influenza A/H1N1 pandemic. Polymerase chain reaction (PCR) testing is an accurate diagnostic method, but it is not routinely available worldwide. We herein evaluated the usefulness of pharyngeal “influenza follicles” in diagnosing seasonal influenza and influenza A/2009 (H1N1) pdm.Methods: Between August 3 and October 29, 2009, we evaluated 87 patients with influenza-like symptoms. Twenty-three had influenza follicles (22 on initial evaluation; 1 on follow-up) while 64 did not. Considering these two groups, we then compared the positive cases using rapid diagnostic testing (confirmed by PCR). In addition, 419 cases of seasonal influenza diagnosed between 2003 and 2009 were examined for the presence of influenza follicles based on Miyamoto's 2007 definition9, and new exclusion criteria were developed.Results: Among the 23 patients with influenza follicles, 21 were diagnosed with novel influenza. Of these, follicles were present on initial evaluation in 20 and on follow-up in 1. None of the 64 patients without influenza follicles were diagnosed with influenza (sensitivity 100%, specificity 97%). Among the 419 patients diagnosed with seasonal influenza between 2003 and 2009, influenza follicles occurred in all type A/H3N2, A/H1N1, and B cases (sensitivity 95.46%, specificity 98.42%). Thus, follicles were considered a specific sign of influenza.Conclusion: Influenza follicles occur in both seasonal and novel influenza. This identification method has higher diagnostic sensitivity and specificity than rapid diagnostic testing and is a promising clinical tool for diagnosing influenza when PCR is unavailable, or in pandemic situations.

著者

Shuya Takahashi Machi Suka Hiroyuki Yanagisawa

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.15, no.2, pp.126-135, 2014-12-20 (Released:2014-12-24)

参考文献数

18

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Objective: We performed a meta-analysis to examine the effectiveness of face masks for preventing influenza infection.Methods: A literature search was conducted to identify clinical trials that compared the incidence of influenza infection among family members with and without the use of antiviral face masks; some trials also contained the use of hand hygiene in the intervention group. Data from each trial were combined using a random effects model with the DerSimonian-Laird method to calculate pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).Results: The meta-analysis included seven randomized controlled trials that met our inclusion criteria. With the use of antiviral face masks, the pooled ORs (95% CIs) of laboratory proven infection were 0.69 (0.22–2.18). The pooled ORs (95% CIs) of influenza-like illness (ILI) were 1.07 (0.65–1.78). With the use of antiviral face masks and concomitant hand hygiene, the pooled ORs (95% CIs) of laboratory proven infection were 0.70 (0.35–1.39) in early intervention cases, and 0.93 (0.66–1.30) in all cases. The pooled ORs (95% CIs) of ILI were 1.01 (0.47–2.19) in early intervention cases, and 1.06 (0.53–2.13) in all cases.Conclusion: No statistically significant differences were detected in the incidence of influenza infection by wearing antiviral face masks, suggesting that distribution of face masks in primary care settings may not be enough to prevent influenza-like illnesses amongst family members.

著者

Hiroshi Noto Atsushi Goto Tetsuro Tsujimoto Mitsuhiko Noda

出版者

Japan Primary Care Association

雑誌

Journal of General and Family Medicine (ISSN:21896577)

巻号頁・発行日

vol.17, no.1, pp.60-70, 2016-03-18 (Released:2016-03-25)

参考文献数

51

被引用文献数

10

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Objective: Low-carbohydrate diets have favorable short-term effects on body weight and risk factors for cardiovascular disease. However, they are potentially associated with an increased long-term risk of mortality. Our objective was to elucidate their effects on the incidence of diabetes.Methods: Several databases (MEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalTrials.gov) were searched for relevant articles that were published prior to May 2015. Cohort studies with a follow-up period of at least one year were included. Identified articles were systematically reviewed, and those with pertinent data were selected for inclusion in a meta-analysis. The pooled risk ratio (RR) with 95% confidence interval (CI) for the incidence of diabetes was calculated using the random-effects model with inverse-variance weighting.Results: We included 13 studies in a systematic review, followed by a meta-analysis using pertinent data. Among the 440,669 people that were included in 11 cohort studies, 27,887 (6.3%) cases of diabetes were documented. The risk of incident diabetes among individuals with a low-carbohydrate diet was not significantly different from that of individuals with a high-carbohydrate diet: the pooled RR was 1.03 (95% CI, 0.91–1.16).Conclusion: Low-carbohydrate diets did not show any benefit on the risk of diabetes. However, this analysis is based on limited observational studies, and large-scale trials examining the complex interactions between low-carbohydrate diets and long-term outcomes are needed.

著者

Kentaro Iwata Tomoko Toma Akihiro Yachie Hideaki Oka Goh Ohji Wataru Igarashi Tatsuyoshi Kitamura Yuichiro Oba

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.1, pp.29-31, 2011 (Released:2011-07-05)

参考文献数

7

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A 23-year old female was referred to our clinic for intermittent fever occurring over a period of eight years. Every time she developed fever, blood examination revealed elevated leukocytes and C-reactive protein (CRP). Antibiotics were always given based on elevated CRP with apparent improvement. However, the pattern of periodicity with absence of symptoms in between suggested periodic fever syndrome, particularly Familial Mediterranean Fever (FMF), which was later confirmed by mutation analysis. In Japan there is a tendency to use antibiotics solely based on "elevated CRP"; however, careful review of patient history is essential to identify FMF while avoiding the use of unnecessary antibiotics.

著者

MIYAMOTO Akihiko WATANABE Shigeyuki

出版者

Japan Primary Care Association

雑誌

General medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.2, pp.51-60, 2011-12-01

被引用文献数

2 10 9

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<b>Background:</b> Rapid and accurate diagnosis is essential for containing the novel influenza A/H1N1 pandemic. Polymerase chain reaction (PCR) testing is an accurate diagnostic method, but it is not routinely available worldwide. We herein evaluated the usefulness of pharyngeal "influenza follicles" in diagnosing seasonal influenza and influenza A/2009 (H1N1) pdm.<br><b>Methods:</b> Between August 3 and October 29, 2009, we evaluated 87 patients with influenza-like symptoms. Twenty-three had influenza follicles (22 on initial evaluation; 1 on follow-up) while 64 did not. Considering these two groups, we then compared the positive cases using rapid diagnostic testing (confirmed by PCR). In addition, 419 cases of seasonal influenza diagnosed between 2003 and 2009 were examined for the presence of influenza follicles based on Miyamoto's 2007 definition⁹, and new exclusion criteria were developed.<br><b>Results:</b> Among the 23 patients with influenza follicles, 21 were diagnosed with novel influenza. Of these, follicles were present on initial evaluation in 20 and on follow-up in 1. None of the 64 patients without influenza follicles were diagnosed with influenza (sensitivity 100%, specificity 97%). Among the 419 patients diagnosed with seasonal influenza between 2003 and 2009, influenza follicles occurred in all type A/H3N2, A/H1N1, and B cases (sensitivity 95.46%, specificity 98.42%). Thus, follicles were considered a specific sign of influenza.<br><b>Conclusion:</b> Influenza follicles occur in both seasonal and novel influenza. This identification method has higher diagnostic sensitivity and specificity than rapid diagnostic testing and is a promising clinical tool for diagnosing influenza when PCR is unavailable, or in pandemic situations.

著者

Chiaki Yoshida Takeshi Morimoto

出版者

Japan Primary Care Association

雑誌

Journal of General and Family Medicine (ISSN:21896577)

巻号頁・発行日

vol.16, no.3, pp.131-137, 2015-09-20 (Released:2015-10-30)

参考文献数

5

著者

Hidetaka Wakabayashi Hironobu Sashika

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.2, pp.69-74, 2011 (Released:2011-12-28)

参考文献数

13

被引用文献数

19

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Background: To determine whether nutrition is associated with rehabilitation outcome in the disuse syndrome.Methods: A retrospective cohort study was performed in 223 inpatients admitted to a university hospital who were diagnosed by physicians in the rehabilitation department as having the disuse syndrome, and subsequently prescribed physical therapy. Malnutrition was defined as a body mass index<18.5 kg/m2, hemoglobin level<10.0 g/dl, serum albumin level<3.0 g/dl, or total lymphocyte count<1200 cells/mm3. Rehabilitation outcome was defined as whether or not the ADL score improved during rehabilitation. Nutritional status was assessed at referral using the Onodera's prognostic nutritional index (PNI).Results: The study cohort included 136 men and 87 women (mean age 67.5 years; median duration between admission and referral 17 days; median rehabilitation duration 32 days). A total of 202 patients (91%) were defined as being malnourished. Mean PNI was 32.9, with the ADL score improving in 135 patients (61%) during rehabilitation. Rehabilitation outcome was better in patients with normal nutrition compared to malnourished patients (relative risk: 0.72, p=0.04). Patients with a hemoglobin level>10.0 g/dl (relative risk: 0.69, p=0.001), total lymphocyte count>1200 cells/mm3 (relative risk: 0.78, p=0.03), or PNI>35.0 (relative risk: 0.74, p=0.01) had a better rehabilitation outcome. Logistic regression analysis showed that hemoglobin level was associated independently with rehabilitation outcome (odds ratio 2.34, p=0.005).Conclusions: Malnutrition is common in patients with the disuse syndrome. Patients with low hemoglobin level and PNI at referral are more likely to have a poor rehabilitation outcome.