Internal medicine
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A 60-year-old woman developed opsoclonus-myoclonus syndrome (OMS) a week after being diagnosed with influenza A infection by a rapid antigen test. She had no loss of consciousness. Opsoclonus, myoclonus, and truncal ataxia were noted. ⋯ There has been no previous report of postinfectious OMS following confirmed influenza A infection. OMS without a loss of consciousness has been reported to be statistically less common in cases of non-paraneoplastic OMS. This finding was consistent with the present patient's clinical manifestations.
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Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). After performing an initial titration study, most physicians do not have the CPAP equipment retitrated unless the patient complains about the CPAP use. Several automated CPAP devices are used clinically that can detect upper airway obstructive events and provide information about residual events while patients are on CPAP. The aim of this study was to compare the apnea-hypopnea index (AHI) determined by automated CPAP devices to that obtained from polysomnography. ⋯ Strong correlations between the AHI-PSG and the AHI-RAM were observed. The correlations were weakened when the analysis was limited to the HI and the therapeutic phase.
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Comparative Study
Usefulness of tuberculin skin test and three interferon-gamma release assays for the differential diagnosis of pulmonary tuberculosis.
We compared the usefulness of tuberculin skin test (TST) and three interferon-gamma release assays (IGRAs) [QuantiFERON-TB Gold (QFT-2G), QuantiFERON-TB Gold In-tube (QFT-3G), T-SPOT.TB] as the supportive method for diagnosing pulmonary tuberculosis (TB). ⋯ There were no significant differences among the three IGRA tests in this study. However, because the three IGRA tests showed a significantly higher positive response rate for patients with pulmonary TB and a lower positive response rate for patients with non-pulmonary TB than TST, the three IGRA tests seemed to be more useful than TST for the differentiation of patients with pulmonary TB.
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Infection with Aeromonas species has been reported to occur in neutropenic patients. Necrotizing fasciitis caused by Aeromonas species is uncommon but potentially life-threatening. We herein describe three cases of fulminant necrotizing fasciitis caused by Aeromonas sobria in neutropenic patients. ⋯ Our experience suggests that necrotizing fasciitis caused by Aeromonas sobria is a distinctive and fatal entity. As the use of quinolones is not usually considered in cases of febrile neutropenia, it is important to adjust the antibiotics in time when culture results become available. In some cases, early treatment with quinolones and surgical intervention should be considered, especially when this complication occurs in patients with profound neutropenia.
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We describe the first case of genetically diagnosed congenital dyserythropoietic anemia (CDA) type 1 in a Japanese man. The patient had hemolytic anemia since he was a child, and he developed diabetes, hypogonadism, and liver dysfunction in his thirties, presumably from systemic iron overload. ⋯ His serum hepcidin-25 level was inappropriately low. We conclude that physicians should be aware of the possibility of CDA in a patient with anemia and systemic iron overload at any age.