In Lao PDR, the National Malaria Control Program (NMCP) evaluates bednet coverage, often at the village level, using a coverage target of one net per 2.5 (or fewer) persons in a given population. However, in villages that meet the target, not all households necessarily meet the target or utilize all available bednets. This study explored households that fell short of the target and household utilization of bednets in villages that met the target of bednet coverage set by the NMCP. The person per net ratio (PPNR), which is defined as the population divided by the number of available bednets in a household/village, was used to determine whether a household/village met the NMCP target. Using a household survey, we collected and analyzed the data of 635 households in 17 villages in Xepon district in 2012. Households that fell short of the target (households with a PPNR of > 2.5 or no bednet) existed in every village. The proportion of these households differed greatly among the villages, ranging from 3.4–50%, with some households falling far short. Of the 635 households, 275 (43.5%) had at least one bednet that was not being used on the night preceding the survey and 131 (20.6%) had at least two. In conclusion, in villages that met the NMCP target, a considerable number of households fell short of the target, and the available bednets were not fully utilized in many of the surveyed households.

InLao PDR, the National Malaria Control Program (NMCP) evaluates bednet coverage,often at the village level, using a coverage target of one net per 2.5 (or fewer)persons in a given population. However, in villages that meet the target, notall households necessarily meet the target or utilize all available bednets. Thisstudy explored households that fell short of the target and household utilizationof bednets in villages that met the target of bednet coverage set by the NMCP. Thepersons per net ratio (PPNR), which is defined as the population divided by thenumber of available bednets in a household/village, was used to determine whethera household/village met the NMCP target. Using a household survey, we collectedand analyzed the data of 635 households in 17 villages in Xepon district in2012. Households that fell short of the target (households with a PPNR of >2.5 or no bednet) existed in every village. The proportion of these households differedgreatly among the villages, ranging from 3.4–50%, with some households fallingfar short. Of the 635 households, 275 (43.5%) had at least one bednet that wasnot being used on the night preceding the survey and 131 (20.6%) had at leasttwo. In conclusion, in villages that met the NMCP target, a considerable numberof households fell short of the target. Available bednets were not fullyutilized in many of the surveyed households.

Objective: The prevalence of complementary and alternative medicine (CAM) in patients with various urologic disorders is unknown. We conducted the survey to determine the prevalence of CAM use in ambulatory patients.
Methods: We distributed questionnaires to 331 ambulatory patients with various urologic disorders in our department from March 10 to 31, 2004.
Results: One in third (30.5%) patients reported the use of at least one CAM. Patient age and gender were not associated with the frequency of the use of CAM. Although not statistically significant, patients with malignant disease showed a higher frequency of CAM use compared with patients with benign disease; 36.2% vs 27.0%, P=0.08. Among the CAM users, only 16 patients (15.8%) informed health care staff of their CAM use.
Conclusion: This result shows the current situation of CAM use in patients with urologic disorders. Because of the high prevalence, health care professionals should ask about patients' use of CAM.

Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.

Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.

Purpose: The development of assistive devices has allowed for the performance of capsule endoscopy in children. Anticipating the capsule’s transit time could affect the efficacy of the investigation and potentially minimize the fasting period. This study determined the predictors of small bowel transit time for small-bowel capsule endoscopy in children and adolescents with inflammatory bowel disease. Methods: We retrospectively examined children and adolescents with inflammatory bowel disease who underwent capsule endoscopy by the age 18 at a Japanese tertiary care children’s hospital. Small bowel transit time predictors were analyzed using multiple regression with explanatory variables. Results: Overall, 92 patients, aged 1–17 years, with inflammatory bowel disease (63 Crohn’s disease and 29 ulcerative colitis cases) were examined for factors affecting small bowel transit time. In the simple regression analysis, diagnosis, age, height, weight, serum albumin, general anesthesia, and small intestine lesions were significantly associated with small bowel transit time. In the multiple regression analyses, serum albumin (partial regression coefficient: −58.9, p=0.008), general anesthesia (partial regression coefficient: 127, p<0.001), and small intestine lesions (partial regression coefficient: 30.1, p=0.037) showed significant associations with small bowel transit time. Conclusion Hypoalbuminemia, the use of general anesthesia for endoscopic delivery of the capsule, and small intestine lesions appeared to be predictors of prolonged small bowel transit time in children and adolescents with inflammatory bowel disease. Expecting the finishing time may improve examination with a fasting period reduction, which benefits both patients and caregivers.

Mushroom poisoning with Russula subnigricans can lead to severe rhabdomyolysis. Here we describe a case of severe mushroom poisoning that resulted in severe rhabdomyolysis with acute kidney injury, hypotension, and shock 12 h after oral ingestion of R. subnigricans. The patient's serum myoglobin was 6,475 ng/mL and his creatine phosphokinase (CK) level was 38,100 IU/L on admission. Although aggressive fluid resuscitation and on-line hemodiafiltration (OHDF) were initiated, vascular permeability and shock failed to improve. Continuous hemodiafiltration (CHDF) and OHDF was repeated, but their effects were limited. He later developed generalized edema, and his weight increased from 55 kg to 72.5 kg within 4 days. On day 5, his CK level reached 203,800 IU/L. He died 160 h after oral ingestion of R. subnigricans. CHDF and OHDF filter out circulating myoglobin, potassium, and some toxic substances released due to muscle cell disruption. Although OHDF was performed nearly 24 h a day in our patient, it failed to remove toxic intracellular components from muscle cells due to the severe R. subnigricans mushroom poisoning in this case.

We encountered a case in which decreased cardiac afterload due to intra-aortic balloon pumping (IABP) caused left ventricular outflow tract obstruction (LVOTO), resulting in cardiogenic shock in a patient with hypertrophic obstructive cardiomyopathy (HOCM). The patient was a woman in her 60 with HOCM and angina, which were had been diagnosed before endometrial cancer surgery. An intra-aortic balloon pump was placed before surgery to maintain coronary artery blood flow, and increases in diastolic blood pressure were observed. However, she went into shock upon induction of anesthesia and required a large dose of vasopressor. The patient remained in shock after surgery and was admitted to the ICU while unresponsive and intubated. Transthoracic echocardiography showed LVOTO and mitral regurgitation, indicating the possibility that lowered cardiac afterload by IABP caused LVOTO. Discontinuation of IABP resulted in striking recovery from shock such that no vasopressor was required, and echocardiography findings improved. Although IABP offers a variety of benefits such as maintenance of coronary artery blood flow, we should keep in mind that decreased cardiac afterload due to IABP may cause LVOTO in patients with HOCM.

Deep neck abscess can cause upper airway stenosis and obstruction, and sometimes emergency airway management is required. Here we present a case of deep neck abscess in which awake intubation with a video laryngoscope (McGRATH™ MAC) was more useful than with flexible bronchoscope. A man in his 80s was transported to our hospital with throat and chest pain. Contrast-enhanced computed tomography revealed a deep neck abscess (right peritonsillar abscess). The otolaryngologist attempted drainage by puncture, but this was ineffective. There was a risk of upper airway obstruction, and emergency airway management was required. First, we attempted endotracheal intubation with a flexible bronchoscope but could not secure the field of view because of the upper airway edema and stenosis. Next, we attempted tracheal intubation using a video laryngoscope, which ultimately was successful. The blade of the video laryngoscope compressed and lifted the soft tissue and then it secured the space of the upper airway.

Placenta accreta spectrum (PAS) disorders may lead to massive postpartum hemorrhage but optimal treatment strategies have yet to be determined. This retrospective analysis involved 35 cases of PAS that occurred at our hospital between January 2014 and November 2021. Mean maternal age was 37 (21-43) years and 8 pregnancies were the result of assisted reproductive therapy. Fifteen patients had placenta previa, 12 had a history of cesarean delivery, and one had a history of PAS. Mean gestational age was 36 (26-41) weeks. Twenty deliveries were by cesarean section and 15 were vaginal deliveries. Mean blood loss was 2,970 (300-14,727) mL. Nine patients were treated by manual placenta removal, one of whom had a delayed hysterectomy because of bleeding. Eleven patients were treated by cesarean hysterectomy and 2 were treated by curettage. Thirteen patients were treated by conservative management, and in 3 of them, treatment was changed to curettage, abdominal placenta resection, or hysterectomy because of vaginal bleeding or intrauterine infection. Four patients thought to have PAS before delivery were treated by cesarean hysterectomy and the amount of bleeding was not severe. Conservative treatment for placenta accreta was successful in 10 patients (77%), and the uterus could be preserved in 12 women (92%). In cases thought to be PAS before delivery, if the placenta is not removed, cesarean hysterectomy should be selected. Conservative management tends to be selected in cases of PAS when the main part of the placenta can be removed. However, in cases of life-threatening hemorrhage or infection, clinicians might need to perform peripartum hysterectomy or uterine artery embolization when bleeding or infection occurs. Therefore, clinicians should obtain informed consent for such treatment in advance.