Omuta hospital

<h3>Background and Importance</h3> Severe uncontrolled asthma (SUA) significantly impairs quality of life and increases healthcare resource use. Assessing adherence to inhaled therapy through the Test of Adherence to Inhalers (TAI) and dispensing data is essential before initiating biologic therapy, as adherence ensures treatment effectiveness. <h3>Aim and Objectives</h3> To evaluate adherence to inhaled therapy and the effectiveness of biologic treatment in adult patients with SUA. <h3>Material and Methods</h3> A retrospective observational study was conducted in adult patients diagnosed with SUA who started funded biologic therapies between March 2022 and September 2025. Variables included age, sex, asthma type, comorbidities, biologic treatment, TAI score and percentage of inhalers dispensed during the six months prior to biologic initiation. Effectiveness variables were Asthma Control Test (ACT), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and FEV₁/FVC ratio, measured six months before and after treatment initiation. <h3>Results</h3> Forty-one patients were included, 63.4% (26/41) women, mean age 60 ± 15 years and 48.7% (20/41) had mixed asthma. Comorbidities included rhinitis 65.8% (27/41), anxiety and/or depression 41.4% (17/41), atopic dermatitis 29.2% (12/41) and nasal polyposis 29.2% (12/41). Biologic therapies used were dupilumab 48.7% (20/41), benralizumab 24.4% (10/41), tezepelumab 12.2% (5/41), mepolizumab 12.2% (5/41), and reslizumab 1 patient. Mean TAI score was 52.1 ± 3.5 points. Median percentage of inhalers dispensed in the six months before biologic therapy was 83.3% (IQR 66.6–100%). Median ACT improved from 9 (IQR 8–15) to 21 (IQR 17.5–23) after six months of biologic treatment. Mean spirometric values before and after therapy were FVC 81.6 ± 14.2% vs 89.2 ± 18.6%, FEV₁ 71.8 ± 21.3% vs 82.7 ± 18.3%, and FEV₁/FVC 75.1 ± 20.3% vs 79.7 ± 17.2%. <h3>Conclusion and Relevance</h3> In patients with SUA, adherence to inhaled therapy was intermediate to high according to both TAI scores and dispensing data. The introduction of biologics was associated with improved asthma control and lung function. These findings highlight the importance of assessing adherence before initiating biologics and support their effectiveness in real-world clinical practice. <h3>Conflict of Interest</h3> No conflict of interest

<h3>Background and Importance</h3> Inadequate control of LDL cholesterol persists in a considerable proportion of patients with dyslipidaemia despite intensive treatment with statins and ezetimibe. Inclisiran, a small interfering ribonucleic acid that inhibits hepatic synthesis of PCSK9, represents an innovative therapeutic alternative with a twice-yearly dosing schedule after the initial phase. <h3>Aim and Objectives</h3> To evaluate the effectiveness and safety of inclisiran in patients with primary hypercholesterolaemia or mixed dyslipidaemia in real-world clinical practice. <h3>Material and Methods</h3> A retrospective multicentre observational study including all patients who initiated treatment with inclisiran up to September 2025. Data collected in Excel included demographic variables, cardiovascular diagnosis, reason for initiation, previous use of PCSK9 inhibitors, statin intolerance, concomitant lipid-lowering therapies and adherence. The primary variables were the median and interquartile range (IQR) of percentage reduction from baseline in LDL cholesterol, total cholesterol, non-HDL cholesterol, HDL cholesterol and triglycerides at 90 and 270 days after treatment initiation. Safety was assessed through reported adverse events and treatment discontinuations. Adherence to concomitant lipid-lowering therapies was evaluated according to dispensing records. Data were obtained from electronic medical records and hospital pharmacy databases. <h3>Results</h3> A total of 63 patients were included (mean age 64 ± 11 years; 63% male). At 90 days, the reduction in LDL cholesterol was 36% (IQR 6–62) and at 270 days 39% (IQR 26–51). Total cholesterol decreased by 23% (IQR 0–42) and 24% (IQR 17–34), respectively. Non-HDL cholesterol was reduced by 33% (IQR 1–56) at 90 days and 36% (IQR 19–50) at 270 days. HDL cholesterol remained stable with minimal changes (3% (IQR 0–11) and 0% (IQR 0–9)). Triglycerides showed median reductions of 12% (IQR 0–29) at 90 days and 7% (IQR 0–22) at 270 days. No serious adverse events were reported; however, 8% (5/63) experienced local injection site reactions and 3% (2/63) discontinued treatment due to lack of effectiveness. Adherence to concomitant lipid-lowering therapies was &gt;80% in 82% (52/63) of patients. <h3>Conclusion and Relevance</h3> Inclisiran was associated with reductions in LDL cholesterol and total cholesterol in real-world clinical practice, with an acceptable safety profile. Nevertheless, the magnitude of LDL cholesterol reduction was lower than that reported in pivotal clinical trials. <h3>Conflict of Interest</h3> No conflict of interest

ABSTRACTHepatopulmonary syndrome (HPS) is a rare pulmonary vascular complication of liver disease characterised by impaired oxygenation due to intrapulmonary vascular dilatation. Herein, we report a case of HPS associated with metabolic dysfunction‐associated steatotic liver disease (MASLD) in a patient with interstitial pneumonia and chronic obstructive pulmonary disease. The patient presented with progressive hypoxemia and the radiological findings were disproportionate to the degree of oxygen desaturation. Imaging and Tc‐99 m MAA lung perfusion scintigraphy confirmed the presence of an intrapulmonary right‐to‐left shunt. Liver imaging revealed MASLD‐related cirrhosis and the patient later developed drug‐induced hypersensitivity syndrome (DIHS) with cytomegalovirus reactivation and hepatic dysfunction. Following antiviral therapy and supportive management, oxygenation partially improved, whereas hypoxemia remained disproportionate to radiological lung findings, consistent with hepatopulmonary syndrome. Transplantation was considered but unavailable, and the patient remained under observation. This case highlights that MASLD‐related systemic inflammation can predispose patients to HPS and that careful hepatic evaluation is crucial in DIHS.

- Este estudo objetivou analisar a percepção da equipe de saúde da família quanto à atuação do fisioterapeuta na Estratégia de Saúde da Família (ESF) em uma cidade do interior paulista. Trata-se de uma pesquisa de campo, descritiva e transversal, com abordagem qualitativa, aprovada pelo Comitê de Ética em pesquisa. Utilizou-se a técnica de Grupo Focal para coleta de dados que foi realizado com a equipe de saúde de uma ESF. Os dados foram analisados pela Técnica de Análise de Conteúdo, modalidade temática. Da equipe de saúde, participaram do estudo a enfermeira, auxiliar de enfermagem e agentes comunitárias de saúde (n=06), todas mulheres e com idade média de 42±10,6 anos. Elencaram-se duas categorias temáticas: “Compreensão e reconhecimento da fisioterapia como proposta de trabalho em equipe na ESF” e “Possibilidades de atuação do fisioterapeuta para atendimento da Atenção Primária à Saúde”, demostrando que a equipe de saúde compreende, parcialmente, as formas de atuação do fisioterapeuta e que o atendimento multidisciplinar possibilitou novos aprendizados e experiências. Concluiu-se que a equipe de saúde da família possui a compreensão sobre o papel do fisioterapeuta na APS como agente de educação, promoção e prevenção a saúde, ao invés de um agente reabilitador somente. Demonstraram ainda, o acolhimento à proposta de atendimento domiciliar que contribui para seus aprendizados, bem como no auxílio à resolução das situações-problema apresentados pelas famílias.

Slender percutaneous coronary intervention (PCI) is a minimally invasive technique that uses smaller catheters, typically 5-French devices, to reduce bleeding complications and eliminate the need for unnecessarily large catheters. While these techniques are highly effective for non-complex lesions, they face inherent challenges, such as limitations in device compatibility and technical constraints. These challenges emphasize the importance of thorough pre-procedural planning to ensure optimal equipment selection and successful procedures. Cardiac computed tomography (CT) addresses these limitations by providing a comprehensive three-dimensional view of the coronary artery anatomy and lesion characteristics. This consensus statement outlines the role of cardiac CT in optimizing slender PCI strategies, emphasizing the importance of detailed anatomical assessments and advanced evaluations of lesion complexity. Cardiac CT enables precise measurements of vessel dimensions, identification of optimal landing zones, and accurate characterization of lesion complexity, including calcified plaque. Thin-slab maximum intensity projection reconstruction provides simultaneous longitudinal and cross-sectional views, comparable with findings of coronary angiography and intravascular imaging, facilitating interventional planning. For complex lesions, CT is essential. It accurately predicts the risk of side branch occlusion in bifurcation lesions, characterizes the distribution of calcification in heavily calcified lesions to aid in device selection, and helps in the appropriate selection of cases for chronic total occlusion lesions based on CT-derived scores and detailed morphological assessments. To systematically apply these principles, a practical pre-procedural checklist for CT-guided planning is proposed. The integration of cardiac CT into the slender PCI workflow extends beyond anatomical assessment to encompass the optimization of resource utilization, potentially enabling interventionists to proceed with appropriately minimally invasive techniques from the outset.

Disease duration of urticaria is variable from days to decades. However, the mechanism of persistence for urticaria is largely unknown. To investigate factors which relate to the prognosis of urticaria, we conducted a cross-sectional analysis on disease durations of 1061 patients with urticaria who visited nine primary dermatology clinics from 1st October to 11th November 2020. Among them, 216 (20.4%) had acute urticaria, while 383 (36.1%) and 125 (11.8%) had suffered from urticaria for 3 years or more and for 10 years or more, respectively. There was no significant difference between males and females in disease duration. In patients under 20 years old, 75 (38.9%) had acute urticaria. By contrast, more than 20% of patients older than 50 years had urticaria for 10 years or more. Disease duration for 3 years or more of patients with dermographism and those with cholinergic urticaria was 42% and 45.3%, respectively. Although a majority of urticaria likely remit, more than one-third of patients at primary dermatology clinics suffer from urticaria for 3 years or longer. The disease duration was longer in older patients, those with dermographism and/or cholinergic urticaria.

Abstract Background Patients with advanced renal cell carcinoma (RCC) undergoing hemodialysis are often excluded from clinical trials. We aimed to evaluate real-world outcomes of first-line molecular targeted therapy (MTT) and immuno-oncology (IO) combination therapies in patients with advanced RCC receiving hemodialysis. Methods We retrospectively analyzed data from 88 patients undergoing hemodialysis who received first-line systemic therapy for advanced RCC at 18 institutions in Japan between 2008 and 2023. Patients were divided into three groups by first-line regimen: MTT (n = 53), IO–IO (n = 18), or IO-tyrosine kinase inhibitor (IO–TKI, n = 17). Treatment response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were evaluated. Prognostic factors were identified using univariate and multivariate Cox regression analyses. Results The median PFS and OS were 3.9 and 18.9 months, respectively. IO–IO and IO–TKI groups achieved significantly longer PFS than the MTT group (median PFS 3.5, 5.4, and 7.5 months, respectively; p = 0.003); OS did not differ significantly among groups. Grade ≥ 3 TRAEs occurred in 30.2%, 33.3%, and 41.2% of MTT, IO–IO, and IO–TKI groups, respectively. Multivariate analysis identified poor Eastern Cooperative Oncology Group performance status, longer hemodialysis duration (≥ 10 years), and first-line regimen as independent PFS predictors. International Metastatic RCC Database Consortium risk classification and hemodialysis duration independently predicted OS. Conclusions Systemic therapy, including MTT and IO combination therapy such as IO–IO and IO–TKI, demonstrated acceptable safety profiles for patients with advanced RCC undergoing hemodialysis. IO combination therapy significantly improved PFS, supporting its utility as a first-line treatment option.

ABSTRACTBackground and ObjectiveGenetic polymorphisms have been associated with susceptibility to interstitial lung diseases including idiopathic pulmonary fibrosis (IPF). We have now examined the relation between single nucleotide polymorphisms (SNPs) and clinical course, including acute exacerbation (AE), in addition to disease susceptibility for IPF and unclassifiable idiopathic interstitial pneumonias (IIPs).MethodsDNA samples were collected from 223 IPF patients and 160 unclassifiable IIP patients included in a prospective, multicentre observational study in Japan. Nonfibrotic control subjects (n = 379) were selected from a previous study. Genotyping of TERT rs2736100, TERC rs1881984, MUC5B rs35705950, DSP rs2076295, and AKAP13 rs62025270 was conducted with commercial assays. The association between these SNPs and disease susceptibility, prognosis, or the cumulative incidence of AE was assessed.ResultsTERT rs2736100 and MUC5B rs35705950 were significantly associated with IPF risk, and DSP rs2076295 was linked to prognosis and the incidence of AE in IPF patients. TERT rs2736100 was significantly associated with prognosis in IPF patients and the incidence of AE in patients with unclassifiable IIPs. No individuals with the TT genotype of MUC5B rs35705950 were identified, and the proportion of those with the T allele was low (minor allele frequency of 0.005 in control subjects). In addition, no individuals with the minor allele (A) of AKAP13 rs62025270 were detected.ConclusionConsideration of genetic polymorphisms has the potential to facilitate prediction not only of prognosis but also of AE in individuals with IIPs, providing a foundation for the development of personalised management strategies based on genetic profiles.