We report on a case of the altered mental status from hyperammonemia due to a urinary tract infection of urease-producing (urea-splitting) bacteria. A 98-year-old Japanese woman, who had no history of liver cirrhosis or portal hypertension, presented with altered mental status. The cause of the altered mental status was attributed to an elevation of ammonia in her blood. The urine culture grew Proteus vulgaris. Complete recovery occurred with the use of an antibiotic for the urinary tract infection. Among patients with urinary tract infections, but without liver cirrhosis or portal hypertension, production by urea-splitting bacteria and the subsequent tubular reabsorption of ammonia, may result in hyperammonemic encephalopathy.

22q11.2 deletion syndrome (22qDS) resulting from a microdeletion of 22q11.2, is usually diagnosed in the postnatal period, and generally manifests as various combinations of cardiac defects, hypoparathyroidism, facial dysmorphism, palate deformity and cellular immunodeficiency. We report a case of a 32-year-old woman presenting with seizures and hypocalcemia, who was diagnosed with 22qDS, along with a literature review of adult cases. Physicians should recognize the 22qDS in adults presenting with any combinations of hypocalcemia, hypothyroidism, cardiac defects and psychiatric disorders. Pathognomonic facial dysmorphism or short stature can be the key to diagnosis.

We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken. Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.

Background: Socioeconomic status (SES) is correlated with morbidity and mortality rates, in addition to people of a lower social status. Many of such people have health-related problems and do not undergo a regular health checkup or consult a medical practitioner. We investigated whether a correlation exists between SES, psychological state and the number of weeks of gestation at the time of the first examination. We clarified the influence of SES on the subjects' life events (e.g. pregnancy and childbirth), in order to understand appropriate support measures. Methods: A total of 151 female study subjects were selected from among women hospitalized for postpartum care, who underwent prenatal checkups, and delivered their children in the study center. Questionnaire surveys, one of which involved an interview, were conducted in a cross-sectional manner for the subjects' during their pregnancy and in the postpartum period. Results: The results show that women who perceived financial constraints showed a significantly stronger tendency to develop depression. Multiple logistic regression analysis showed that women whose partners had an educational background of junior high school level underwent their first gestational examination at week 12 or later of pregnancy (odds ratio of 10.99, P = 0.001; 95% confidence interval, 3.15–86.79). Conclusion: The present study suggests the importance of observing the correlation between SES and health among pregnant women, such that strategic interventional services can be provided to such persons.

Purpose: This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan. Methods: This cross-sectional study enrolled all patients aged 65 years or older who received regular home visiting services. Results: This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40). Conclusion: Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.

Background Gastric and colorectal cancers are the leading cause of cancer-related deaths in Japan. In an attempt to control such cancer-related deaths, gastric and colorectal cancer screenings (GCSs) are readily available in Japan. Despite this, the rate of participation has been lower than expected. Previous studies have reported that some intervention tools can improve participation in cancer screenings and others cannot. Such studies conducted in rural areas are quite rare. Methods The subjects were residents of Kozu Island. All subjects were aged 40 and over. In the clinical setting, primary care physicians (PCPs) handed their patients a screening invitation, in an attempt to improve participation in GCSs. We examined participation trends before and after this intervention. In addition, we administered questionnaires to examine subjects' reasons for attendance and relevant characteristics of the subjects. Results Following the intervention, participation in GCSs did not significantly improve in the short term. In 2011, the number of participants in gastric cancer screening was 173 (22.1%) and was not significantly different from the 2010 results (P = 0.80). Furthermore, the number of participants from year to year (2005–2011) was not significantly different (P = 0.07). In addition, the number of participants in colorectal cancer screening was 145 (16.5%) and was not significantly different from the 2010 results (P = 0.65). Moreover, the number of participants from year to year (2005–2011) was not significantly different (P = 0.17). 172 out of 211 (82%) participants submitted the questionnaire. Results taken from the questionnaires showed that our screening invitation influenced non-elderly people (49.5 ± 3.9 vs. 56.4 ± 6.5, P = 0.04) and first-attendance people showed a significant tendency for more gastrointestinal symptoms (4 vs. 2, P = 0.03). Conclusion On the whole, the screening of invitations from PCPs did not improve participation rates in GCSs in the short term. However, we believe that screening invitations can influence non-elderly people, and this intervention can be effective in increasing the numbers of gastrointestinal-symptomatic people attending for the first time (first-attendance people).

General MedicineVolume 14, Issue 1 p. 4-6 EditorialOpen Access Managing Microbe-associated Health Problems in Primary Care Takeshi Morimoto MD, PhD, MPH, Corresponding Author Takeshi Morimoto MD, PhD, MPH Editor, General Medicine tm@hyo-med.ac.jp Author responsible for correspondence : Takeshi Morimoto, MD, PhD, MPH Division of General Internal Medicine Hyogo College of Medicine 1–1 Mukogawa, Nishinomiya, Hyogo 663–8501, Japan Phone +81–798–45–6809 FAX +81–798–45–6920 E-mail address: tm@hyo-med.ac.jpSearch for more papers by this author Takeshi Morimoto MD, PhD, MPH, Corresponding Author Takeshi Morimoto MD, PhD, MPH Editor, General Medicine tm@hyo-med.ac.jp Author responsible for correspondence : Takeshi Morimoto, MD, PhD, MPH Division of General Internal Medicine Hyogo College of Medicine 1–1 Mukogawa, Nishinomiya, Hyogo 663–8501, Japan Phone +81–798–45–6809 FAX +81–798–45–6920 E-mail address: tm@hyo-med.ac.jpSearch for more papers by this author First published: 05 July 2013 https://doi.org/10.14442/general.14.4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1van Nood, E.; Vrieze, A.; Nieuwdorp, M.; Fuentes, S.; Zoetendal, E. G.; de Vos W. M.; Visser, C. E. et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013, 368: 407– 415. 2Takayama, N. et al. Oral environments of pregnant women and factors associated with the risk of caries development. Gen Med. 2013, vol. 14, p. 48 3Iwata, K. et al. Gingyo Gedokusan vs oseltamivir for the treatment of uncomplicated influenza and influenza-like-illness: An open-label prospective study. Gen Med. 2013, vol. 14, p. 13 Volume14, Issue1July 2013Pages 4-6 ReferencesRelatedInformation