During the ongoing coronavirus disease (COVID‐19) pandemic, COVID‐19 vaccination is rapidly progressing in many countries of the world. Given the rapid administration of COVID‐19 vaccines, it is speculated that dermatologists also have the opportunity to experience side effects of these vaccines. Here, we report a case of unilateral lymphadenopathy associated with COVID‐19 vaccination that presented to our outpatient department of dermatology with subcutaneous nodules.
A Study of Depressive State and Background Factors in Community-DwellingOlder Persons Ryuichi Kawamoto1)2), Takaaki Doi1), Akihiro Yamada1), Takashi Oguni1), Masanobu Okayama2), Kouki Tsuruoka2), Motomi Satho3) and Eiji Kajii2)In order to maintain and improve the mental health of elderly people living in the community, a cross-sectional survey was conducted to elucidate their depressive state and its background factors. Subjects were elderly persons living in the community who were able to fill in the questionnaire themselves. The study used the self recording questionnaire sheets used in the Kahoku Longitudinal Aging Study by Matsubayashi et al and the Zung Self-rating Depression Scale (SDS). Out of 2,379 elderly persons who were able to fill in the questionnaire by themselves in the community, 2,361 (99.2%) returned the questionnaire sheets. After removing inadequate responses, analysis was possible for 1,181 (49.6%) (542 males (average persons (61.9%); mild, 240 (20.3%); moderate, 181 (15.3%); and severe, 29 (2.5%). The average age became higher as the SDS became high, of being indicating the seriousness of the depressive state (p=0.0155), with the ratio women significantly higher (p=0.0077). Among those with severe SDS, the ratio of single persons was high (p<0.001) as well as those who were non-drinkers (p=0.0015), without regular habit of walking (p<0.001), or without work (p<0.001). The ratio of those receiving medication regularly was also significantly high (p=0.0022). As for the relation of SDS with various of the scores, the higher the SDS score became, the scores for ADL, information-related function, functional and emotional support network, family relationship, friendship, economic condition became significantly lower (p<0.001, respectively). In logistic regression analysis using the background factors for SDS as explanatory variables, factors such as being women (odds ratio, 1.73; 95% confidence interval, 1.10-2.72), ADL (0.80; 0.69-0.93), emotional support network (0.88; 0.81-0.96), friendship (0.98; 0.96-0.99) were significant independent contributing factors. As for the relation between SDS and subjective senses, the more serious the SDS score became, the scores for feelings of healthiness and satisfaction became significantly smaller (both p<0.001). For prevention and amelioration of the depressive state of elderly persons living in the community, attempts should be made to improve the background factors which were clarified by the present study by efficiently utilizing health, medical and welfare services and following the future course with a positive attitude.
The alternatively spliced from mRNA of platelet glycoprotein IIb (GPIIb) with a deletion of exon 28 (GPIIb-28) has been isolated from the HEL cell cDNA library. The defective expression on the surface of DNA cotransfected COS-1 cells with GPIIb-28 and GPIIIa cDNAs was described in an earlier report. We studied siblings with Glanzmann's thrombasthenia who expressed only the GPIIb-28 mRNA in their platelets. Flow cytometry showed that the patients' platelets failed to bind GPIIb/IIIa complex-specific and GPIIb-specific monoclonal antibody. Western blotting showed that the patients' platelets had defective GPIIb and have trace amounts of GPIIIa. Sequence analysis was performed after polymerase chain amplification of the patients' GPIIb and GPIIIa mRNAs. The patients' GPIIb cDNA had a deletion of the exon 28 nucleotides. The polymerase chain reaction (PCR) from exon 27 to 29 showed that the GPIIb-28 mRNA was 3% +/- 1.6% of the normally, spliced form in control platelets, and 61% in the megakaryoblastic cell line UT- 7. The patients' platelets showed only the GPIIb-28. Family study and quantitative PCR studies showed that these patients were compound heterozygotes of two GPIIb gene defects. The father's allele is described in this report and involves skipping exon 28 secondary to a base substitution at codon Gln948, CAG-->TAG. The mothers allele appears to involve decreasing GPIIb mRNA levels in platelets. Our results indicate that the GPIIb-28 is not expressed on platelet membranes as a stable GPIIb/IIIa heterodimer or left as a monomer in platelets. Our studies confirm the previous data observed in COS-1 cells expressing recombinant GPIIb-28.
Autoantibody against erythrocytes has occasionally been observed in patients with de novo acute myelocytic leukemia (AML). However, it is not clear whether this autoantibody in AML patients induces frank hemolysis (autoimmune hemolytic anemia, AIHA), as seen in lymphoid neoplasms. We present two de novo AML patients who showed hemolysis due to antiglobulin test-positive and test-negative AIHA, respectively. AIHA should be considered as one cause of anemia in de novo AML patients, and blood transfusions should be given carefully in such cases to avoid harmful hemolysis.
BackgroundIt is necessary to establish an effective subcutaneous injection procedure for adult and elderly individuals because many drugs such as hormones and interferon are generally delivered by subcutaneous injection. We tested whether pain during subcutaneous injection can be decreased by prior application of localized manual pressure at the injection site.MethodsIn this semirandomized, open-label study evaluating the manual pressure method for transient analgesia, physicians applied pressure with their thumbs for 10 seconds to create a nonpainful skin depression at the injection site immediately before subcutaneous injection of the influenza vaccine to patients. Control patients received the vaccine by the same route, but without prior application of focal pressure. In addition to pain, we evaluated patient age, gender, height, weight, body mass index, body temperature, and fat thickness at the brachial triceps muscle. Pain intensity was estimated using a 100 mm visual analog scale (VAS) and the face scale (FS). Categorical variables were compared using Chi-square tests and continuous variables were compared using unpaired t-tests between the intervention group and control group. Multivariate analysis was performed using the VAS or FS score as the dependent variable and weight, age, height, fat thickness at the brachial triceps muscle, and body temperature as independent variables.ResultsThere were no significant differences in demographic variables, VAS scores (22.5 ± 23.0 versus 21.2 ± 23.6, P = 0.4), or FS scores (2.5 ± 2.1 versus 2.4 ± 2.1, P = 0.4) between the intervention and control groups. There was a significant negative correlation between age and subjective pain intensity (VAS, r = −0.32; FS, r = −0.28).ConclusionThe manual pressure method was not effective in decreasing pain during subcutaneous injection. Alternative methods of focal transient analgesia should be developed to improve vaccination rates and relieve anxiety associated with subcutaneous injection.
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