A 63-year-old woman presented with exertional dyspnea. Marked eosinophilia, anemia, and left ventricular apical thrombus indicated eosinophilic myocarditis in hypereosinophilic syndrome (HES). However, since the direct and indirect Coombs tests were positive, we also diagnosed autoimmune hemolytic anemia (AIHA). The administration of prednisolone (60 mg/day) and warfarin promptly improved her symptoms, eosinophilia, and anemia. Thereafter, the Coombs test became negative, and the apical thrombus resolved. Idiopathic HES may involve multiple organs, whereas AIHA arises in diverse conditions, and its coexistence is rare. We herein discuss the differential diagnoses, management, and potential immunopathogenesis of these conditions.
Foot pronation is common in older adults and may be associated with altered plantar loading patterns during walking. This study aimed to investigate the impact of foot pronation on regional plantar force characteristics in community-dwelling older adults. Eighty-seven participants aged ≥65 years were classified into a pronated foot group (n = 36) or a control group (n = 51) based on Foot Posture Index-6 (FPI-6) scores. Plantar forces were measured during overground walking using loadsol® in-shoe sensors. Peak force (PF) and impulse were calculated for the forefoot, midfoot, and rearfoot regions. Between-group comparisons were conducted using analysis of covariance adjusted for age, sex, body mass index, and walking speed, and correlations between FPI-6 scores and plantar force variables were assessed. Compared with controls, the pronated foot group showed significantly higher midfoot PF and impulse and lower forefoot PF and impulse. FPI-6 scores were positively correlated with midfoot PF and impulse. Older adults with pronated feet exhibited altered regional plantar force profiles characterized primarily by increased midfoot loading. These findings suggest that meaningful differences in plantar loading patterns associated with foot posture may be detectable using a simplified wearable insole system despite reduced sensing resolution.
There are three types of diabetes-related stigma (DRS): perceived, experienced, and internalized, all of which negatively impact individuals with diabetes. Over the past 2 decades, research in Japan has grown, highlighting the significant clinical effects of DRS. In this study, we focused on the least-studied form, experienced stigma investigating its prevalence, clinical correlates, and the awareness of DRS and advocacy activities among Japanese people with diabetes. We conducted a single-center, cross-sectional study from April 3 to 28, 2023, at the Ohta Nishinouchi Hospital Diabetes Center in Japan, involving 114 adults with type 1 or type 2 diabetes. Participants with severe mental or physical conditions were excluded. Each participant completed a questionnaire assessing experienced stigma, the impact of diabetes on their social life, and their familiarity with the terms "diabetes stigma" and "advocacy activities." Associations between reported stigma and demographic or clinical factors were analyzed statistically. Our findings showed that only 19.3% of participants reported a significant impact of DRS on their social life, with younger individuals and those on multiple diabetes medications more likely to report experiencing stigma. Additionally, awareness of "diabetes stigma" and "advocacy activities" was notably low among participants. In conclusion, compared to international studies, the prevalence of experienced stigma among Japanese individuals with diabetes appears lower, based on this single-center face-to-face study of outpatients. However, age and polypharmacy were identified as significant factors associated with increased reports of stigma. Despite the limitations of a single-center design, small sample size, and use of non-validated survey tools, the observed low awareness of "diabetes stigma" and "advocacy activities" underscored the need for enhanced educational initiatives by healthcare professionals and diabetes-related organizations in Japan.
Tetanus is a serious infectious disease characterized by muscle rigidity and autonomic storm. In severe cases, long-term deep sedation is required, resulting in a high risk of post-intensive care syndrome (PICS). However, criteria for determining the timing of early rehabilitation intervention have not yet been established. We report the case of a woman in her 70s who developed tetanus following a wood-splinter injury to her right forearm and subsequently suffered bilateral humeral fractures due to muscle rigidity and convulsions. She was admitted to the intensive care unit (ICU) with an Ablett classification of Grade III, which progressed to Grade IV following ICU admission. On Day 11, rehabilitation was initiated after confirming the resolution of muscle hypertonicity and opisthotonos, a downward trend in creatine kinase (CK) levels, and the stabilization of hemodynamic parameters. No apparent recurrence of autonomic symptoms was observed during rehabilitation. The patient was gradually mobilized from edge-of-bed sitting to wheelchair use, and then to standing and walking. With multidisciplinary collaboration, she was discharged home on Day 114. The findings from this case may provide a basis for determining the timing of safe rehabilitation intervention in patients with severe tetanus.
