Reports, Volume 2, Issue 4 (December 2019) – 6 articles

Wood creosote, Seirogan, is a non-prescription drug used to treat diarrhea. However, reports of its clinical use are rare. Here, we report the efficacy of wood creosote (3 capsules daily) in alleviating diarrheal symptoms in 148 patients from 10 clinics in Osaka, Japan. Wood creosote was classified to be remarkably effective, effective, partially effective, or not effective on the basis of the degree of alleviation of diarrheal symptoms. The anti-diarrheal efficacy of wood creosote soft capsules did not differ between males and females. Younger patients (21–30 years) showed greater improvement in diarrhea symptoms than elderly patients (>61 years) did. Wood creosote soft capsules were remarkably effective (44 patients), effective (71 patients), and partially effective (13 patients) in alleviating diarrhea symptoms due to a variety of causes. To the best of our knowledge, this is the first report on the clinical effectiveness of wood creosote soft capsules in treating diarrhea. Full article

A differential diagnosis of tuberculosis pleurisy is often difficult. A 48-year-old Japanese man with no previous medical history visited the outpatient department for dyspnea and fever. His chest-XP and laboratory findings, especially high C-reactive protein levels, indicated pleuritis with pleural effusion. Pleural lymphocytes showed high numbers of spot forming responses in interferon gamma release assay (IGRA). Pleural effusion contained high levels of adenosine deaminase and hyaluronic acid, but no Mycobacterium tuberculosis (TB) antigen was detected by culture or polymerase chain reaction (PCR). Although the infectious agent was not detected, the clinical and laboratory findings strongly suggested that he was suffering from tuberculosis pleurisy. After treatment with anti-TB drugs, a rapid decline of spot-forming cells (SFCs) of pleural lymphocyte was observed, despite persistently high levels of other biomarkers and increased pleural lymphocytes. This case demonstrates that an IGRA of pleural lymphocytes would be useful for therapeutic diagnosis for TB pleurisy suspected for TB. Full article

Increasing radiologist workloads and increasing primary care radiology services make it relevant to explore the use of artificial intelligence (AI) and particularly deep learning to provide diagnostic assistance to radiologists and primary care physicians in improving the quality of patient care. This study investigates new model architectures and deep transfer learning to improve the performance in detecting abnormalities of upper extremities while training with limited data. DenseNet-169, DenseNet-201, and InceptionResNetV2 deep learning models were implemented and evaluated on the humerus and finger radiographs from MURA, a large public dataset of musculoskeletal radiographs. These architectures were selected because of their high recognition accuracy in a benchmark study. The DenseNet-201 and InceptionResNetV2 models, employing deep transfer learning to optimize training on limited data, detected abnormalities in the humerus radiographs with 95% CI accuracies of 83–92% and high sensitivities greater than 0.9, allowing for these models to serve as useful initial screening tools to prioritize studies for expedited review. The performance in the case of finger radiographs was not as promising, possibly due to the limitations of large inter-radiologist variation. It is suggested that the causes of this variation be further explored using machine learning approaches, which may lead to appropriate remediation. Full article

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm constituting approximately 15% of newly diagnosed leukemia in adult patients. Development of tyrosine kinase inhibitors (TKIs) have dramatically improved outcomes in patients with chronic CML in chronic phase. However, adverse drug events (ADEs) associated with TKI therapy have influenced drug adherence, resulting in adverse clinical outcomes and a decline in the quality of life (QoL). In this study, we carried out a unique questionnaire survey to evaluate ADEs, which comprised 14 adverse events. We compared drug adherence rates between patients using imatinib and those who switched from imatinib to nilotinib, a second-generation TKI. Following the switch, the total number of ADEs decreased considerably in most cases. Simultaneously, better QoL was observed in the nilotinib group than in the imatinib group. Drug adherence was measured using Morisky’s 9-item Medication Adherence Scale (MMAS). MMAS increased significantly after switching to nilotinib in all cases. Drug adherence is a critical factor for achieving molecular response in patients with CML. In fact, our results showed a strong inverse correlation between clinical outcome (international scale (IS)) and adherence (MMAS), with a stronger tendency in the nilotinib group than in the imatinib group. In conclusion, low occurrence of ADEs induced a high level of QoL and a good clinical response with second-generation TKI nilotinib treatment. Full article

Background: Hepassocin is a liver-derived protein and its serum concentrations significantly increase in diabetes and fatty liver patients. Hepassocin is also a biomarker for diabetes and fatty liver; therefore, we aimed to investigate the impacts of different types of bariatric surgery on hepassocin plasma levels in obese patients with diabetes, and to determine if hepassocin could be a potential new marker for monitoring the effects of bariatric surgery and a treatment target. Methods: Overall, 12 patients undergoing gastric bypass (GB), 10 patients undergoing sleeve gastrectomy (SG) and 11 patients undergoing duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) were enrolled. Fasting hepassocin levels were measured at baseline, three, 12, and 24 months after surgery. Results: All the three groups significantly decreased their body mass index, waist-to-hip ratio, a body shape index (ABSI), triglycerides, fasting blood sugar, hemoglobin A1c, C-peptide levels and homeostasis model assessment of insulin resistance 24 months after surgery. There were no significant changes in hepassocin levels, even 24 months after the three surgeries. Hepassocin had a significant negative relationship with the ABSI (p< 0.001) 24 months after the SG. Conclusions: Neither GB, SG, nor DJB-SG altered plasma hepassocin levels in diabetic patients up to 24 months after surgery. The use of hepassocin in clinical settings requires more investigation. Full article

Bio-Alcamid is a non-FDA approved permanent dermal filler with a few known adverse effects including granuloma formation at injection site, skin infections, abscess and painful inflammation. Embolization of Bio-Alcamid has not been reported and likely represents a very rare complication. We present the case of a thirty-one-year-old female who presents with cough, dyspnea, hemoptysis, fever, and pleuritic chest pain several hours after receiving Bio-Alcamid gluteal injections. The patient’s symptoms progress rapidly and, within three days, she develops acute respiratory failure requiring intubation. A chest x-ray consistent with acute respiratory distress syndrome (ARDS) is viewed. Concurrently, a 2D echocardiogram reveals a patent foramen ovale (PFO) and severe pulmonary hypertension. Five weeks after initial presentation to the emergency department, the patient demonstrates flaccid quadriplegia, is poorly responsive when sedation is held, and her CT scan of the brain showed multifocal infarcts involving bilateral cerebral hemispheres. A CT of the abdomen reveals renal and splenic infarcts. This case study presents a rare complication of a nonbiodegradable dermal filler, Bio-Alcamid. Full article