No abstract

The number of aspiration pneumonia cases has increased in recent times. A definitive diagnosis of aspiration pneumonia is difficult in resource-limited settings where radiological equipment is unavailable. We report the initial diagnosis and subsequent monitoring of aspiration pneumonia in a home medical care setting. An 88-yearold Japanese male presented an acute onset of dyspnea, fever, and productive cough. At home, lung ultrasound displayed pleural effusion along with B-lines and subpleural consolidations. Upon admission, tests revealed increased total leucocyte counts with left-shifted neutrophils, elevated C-reactive protein levels, and positive sputum Gram stain. Chest X-ray imaging and computed tomography (CT) showed bibasilar infiltrates and wall thickening in the left S10 bronchi. The patient was diagnosed with aspiration pneumonia and treated with an antibiotic. After a 10-day hospitalization, lung ultrasound showed some remaining B-lines and disappearance of pleural effusion and subpleural consolidation. Chest X-ray image was normal, and CT revealed pleural abnormality and disappearance of bibasilar infiltrates, consistent with the ultrasound findings. Aspiration pneumonia develops with various clinical signs. However, diagnosis using chest X-ray imaging or CT in resource-limited settings is difficult. Ultrasound might allow physicians to make more accurate judgments, particularly while monitoring aspiration pneumonia following initial diagnosis in resource-limited settings.

Clostridium difficile is one of the most common causes of antibiotic-associated diarrhoea. Despite C. difficile infection (CDI) has increased in all ages worldwide, episodes of CDI are often misdiagnosed due to the lack of clinical suspicion. Macrolides are also associated with CDI. Additionally, exposure to macrolides in the 12 weeks preceding infection is reported to be a significant risk factor of CDI in a child. We report here a 5-year-old Japanese boy who presented with acute onset of watery diarrhoea. He was diagnosed with community-acquired CDI induced by long-term (20 weeks), low-dose, oral clarithromycin for otitis media with effusion, and he recovered by conservative treatment. Physicians should be more cautious of community-acquired CDI in children who take long-term, low-dose macrolides, not to misdiagnose as diarrhoea by its side effect, and avoid unnecessary use of systemic antibiotics.

Fracture of the styloid process (SP) of the temporal bone is a rare traumatic injury in normal patients. The present report describes a fracture of the SP in an elderly patient caused by rolling over during sleep. A 67-year-old Japanese woman presented with sudden neck pain that had occurred upon rolling over in bed the previous night. A computed tomography scan revealed a fracture of the SP. She recovered with conservative treatment. Clinicians should consider a fracture when an elderly patient develops sudden neck pain by rolling over.

Yonaguni Island is a remote and isolated westernmost island in Japan, which is the fastest aging country in the world. This study evaluated the current status of medical supply-and-demand on the island and compared these results with previous surveys carried out in rural parts of Japan. This was a retrospective cohort study conducted at the Yonaguni Municipal Clinic, the only medical facility in Yonaguni Island. The participants were patients who visited the clinic over one year, between July 2015 and June 2016. We calculated the rate per 1,000 persons per month of clinic visits, referrals to off-island medical facilities (e.g., hospitals and specialist clinics), referrals to off-island emergency departments, off-island hospitalizations after referral, home visits, and overnight observations at the clinic. In total, 6,197 patients (males, 46.3%) visited the clinic. The rate of clinic visits per 1,000 persons per month was 516.4 (Standard deviation [SD] 28.1, 95% confidence interval [CI]: 500.5–532.3). The rate per 1,000 persons per month was 14.0 (SD 3.9, 95% CI: 11.8–16.2) for off-island referrals, 3.8 (SD 2.1, 95% CI: 2.6–5.0) for referrals to emergency departments, 4.8 (SD 2.6, 95% CI: 3.3–6.2) for hospitalizations, and 3.2 (SD 1.7, 95% CI: 2.2–4.1) for home visits. The rate of clinic visits was higher in Yonaguni Island than in other rural areas, although the rate of off-island referrals was lower. There were no significant differences between the number of referrals to emergency departments, hospitalizations, and home visits in Yonaguni Island, in comparison to other studies. Our study showed that patients presenting with emergencies had similar rates of healthcare-seeking behavior to those reported in previous studies in Japan; however, the referral rate was lower. We assessed the ecology of medical care in this district by evaluating patient behavior on an isolated island where access to medical care is geographically limited.