Fatigue is a common symptom of long COVID. Fatigue can majorly disrupt daily life and be challenging to treat. Herein, we describe the effect of saikokeishito, a Kampo medicine, on fatigue in patients with long COVID.Between October 2020 and March 2023, we prescribed saikokeishito to 22 patients with long COVID in the general medicine outpatient department of our hospital. Among them, seven patients (age: 15-58 years, two females) had fatigue, a previously confirmed diagnosis of COVID-19, and no concomitant use of other Kampo formulas. We compared their condition at the start of saikokeishito administration to that 3 months later. Five patients had a slight fever, and four had inflammatory findings on blood tests. Within 3 months, all patients had a 20% or greater reduction in fatigue on a visual analogue scale. Six patients had a 20% or greater increase in health-related QOL and were able to return to society. On the other hand, one patient required a transition to an alternative medication, and one patient's follow-up was prematurely discontinued. Fatigue after COVID-19 may be improved by saikokeishito, especially for the treatment of patients with slight fever or inflammatory findings.

A 24-year-old man was admitted due to fever for two days. He had undergone modified Bentall operation at the age of 18. Transthoracic echocardiography (TTE) showed no findings of infective endocarditis (IE), and he was treated with a course of antibiotics. On the next day, he suffered from aphasia and right hemiplegia, and computed tomography (CT) showed left cerebral infarction due to left middle cerebral artery embolism. The emergent endovascular reperfusion was done, but mild subarachnoid hemorrhage occurred. The following day, TTE showed vegetations and aortic annular abscess, and MSSA was confirmed by blood culture. He was transferred to our institution for surgical treatment for IE. High fever continued, and inflammatory response was recurrent, because the infection was not under control. In addition, multiple systemic thromboembolisms were revealed by contrast-enhanced CT. He recovered to the level of moving his limbs slightly, but he could not speak. We did aortic homograft root replacement and coronary bypass grafting 6 days after the cerebral infarction. His postoperative course was uneventful and he was transferred to rehabilitation hospital on postoperative day 31. He reintegrated into society without neurological complications, and there are no recurrent infections and have been no structural valve deteriorations of the homograft in 5 years.

"Brain fog" is a symptom of long COVID. Brain fog is suspected to be a neurocognitive dysfunction; however, the underlying pathology remains to be elucidated. To provide better medical care for patients with "brain fog", we collaborated with a hospital outpatient department that specializes in the assessment and treatment of cognitive impairment. For the establishment of the collaborative system, we devised a questionnaire for "brain fog" based on medical reports, internet resources, and clinical experiments to be used as a screening tool. The questionnaire was used to calculate a "brain fog score" (BFS). A BFS of more than 5 points was established as the criterion for patient referral. The present retrospective evaluation suggests that BFS is useful for predicting prognosis and prioritizing patients within limited outpatient appointment slots.

Some simulation-based education tools have been introduced in Kampo medicine. However, there are only a few brief simulation tools to learn qi-blood-fluid (QBF) patterns of traditional Chinese medicine (TCM). In this study, we developed a self-diagnostic questionnaire that allows students learn TCM interviews and QBF patterns by answering the questionnaire and evaluated its reliability and validity. We extracted questionnaire items to classify six QBF patterns (qi deficiency, blood deficiency, yin deficiency, qi stagnation, blood stasis, and phlegm-fluid retention) based on some textbooks of TCM and Kampo medicine. Then we developed an initial questionnaire comprising 35 items. Fifth year medical students at Tohoku University School of Medicine answered the questionnaire of small group teaching during 2017-2020. We evaluated the accuracy of the questionnaire if compared with the diagnosis of academic supervisors. To improve the accuracy, we adjusted the questionnaire’s thresholds and created a predictive model of the patterns using logistic regression analysis. The questionnaire’s sensitivity improved by adjusting the thresholds. Logistic regression analysis resulted in a predictive model that could determine QBF patterns with the same level of accuracy as the original for 20 items overall. The results suggest that the use of a simple questionnaire with ensured accuracy may contribute to better pre-graduate education by making it easier for students to understand their own Kampo medicine patterns.

Prolonged cough in coronavirus disease 2019 (COVID-19) is not only uncomfortable for patients, but also prolongs the length of stay in an isolation facility. This results in delays in patients' return to their daily life. Therefore, the prompt treatment of cough is important. In this report, we used Japanese traditional (Kampo) medicine, chikujountanto for the treatment of cases with residual cough, airway secretions, slight fever, anxiety, and insomnia, several days after the onset of coronavirus. From October 2020 to September 2021, we prescribed chikujountanto for thirty-three COVID-19 patients with prolonged cough in an isolation facility. Seven patients (6 women and 1 man with ages ranging 37-70 years) were treated with no other medication. Comorbid symptoms included slight fever, sputum, sore throat, nasal discharge, headache, anxiety/insomnia, and taste/olfactory disorders. The start date of treatment ranged from 9 to 21 days after the onset of COVID-19, and the time until cough and comorbid symptoms improved to values less than NRS 2 or less, was 2 to 6 days after treatment. Three patients had persistent cough and needed to switch to other medication. In COVID-19, chikujountanto may be useful for coughing during the period when the peak of the viral proliferative phase has passed but airway inflammation is still present.

The purpose of this study is to assess the impact of coronavirus disease 2019 (COVID-19) on the performance of cardiovascular surgery in Japan. The information gathered may be useful to prepare for a surgery in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) positive patients and prevent COVID-19 transmission from surgical patients to healthcare workers. [Methods] A web-based questionnaire was distributed to all accredited cardiovascular surgery centers in Japan. A total of 550 questionnaires were sent, and 310 (56.4%) were returned. [Results] Preoperative PCR or antigen testing was performed in all patients at 68.8% of centers. The proportion of surgeries postponed or cancelled was the highest for elective valvular and aortic surgeries and for emergency aortic surgeries. In most facilities elective surgeries were restricted to less than 50% of usual case volumes, while approximately 40% did not experience any negative impact on the case volume. Among the surgical patients, 32 were suspected to be SARS-CoV-2 positive, and 10 were confirmed. As preventive measures against spreading infection, more than 90% of the patients wore N95 masks, 33.3% full PPE, and 66.7% N95 mask+face shield. No case of patient-to-healthcare-worker transmission was reported. There were no postoperative deaths among the confirmed SARS-CoV-2 patients. [Conclusion] Restriction of surgical practice was placed on many institutions in the COVID-19 pandemic, but the degree of restrictions varied. Preoperative screening of all surgical patients and intraoperative use of PPE in those with suspected or confirmed SARS-CoV-2 infection adequately prevented transmission to healthcare workers. Since COVID-19 has a nationwide impact, it is important to continuously monitor surgical outcomes and infection rate by conducting perioperative surveys of COVID-19 patients.

BACKGROUND/AIMS: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. METHODS: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. RESULTS: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. CONCLUSIONS: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abscess ; Asian Continental Ancestry Group ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Endoscopy, Gastrointestinal ; Erythrocyte Transfusion ; Fibrinolytic Agents* ; Hemorrhage* ; Hemothorax ; Humans ; Incidence ; Japan ; Male ; Melena ; Prospective Studies*

An 84-year-old woman was referred due to an abnormal shadow on her chest X-ray. Computed tomography and coronary angiography revealed a left coronary artery aneurysm associated with a complex coronary-pulmonary artery fistula. We present our surgical strategy used to treat this complicated pathology.