ABSTRACT
The treatment of rheumatoid arthritis (RA) has advanced from the use of steroids to disease-modifying anti-rheumatic drugs (DMARDs) and biologics such as tumor necrosis factor (TNF) and interleukin-6 (IL-6) inhibitors. Historically, steroids have been the mainstream in the clinical treatment of RA; however, the development of DMARDs has changed the RA treatment structure. In addition, biologics can alleviate RA symptoms. This case report describes the secondary failure of tocilizumab in treating RA with fatigue symptoms. Treatment with tocilizumab decreases C-reactive protein (CRP) levels, which may make detecting RA exacerbation difficult; therefore, obtaining the patient's precise history and thorough physical examinations are necessary. This case demonstrates the complexity of treating elderly-onset RA and reports practical methods for effective treatment.
ABSTRACT
Myasthenia gravis (MG) is a neuromuscular junction disease caused by an autoimmune response against cholinergic receptors. The challenge in diagnosing MG in older patients is the variety of symptoms and clinical manifestations. Clinical reasoning, precise history, and physical examination leading to a logical diagnosis should be performed to diagnose seronegative MG. We report a case of seronegative MG with the chief complaint of dizziness in a 91-year-old female. Despite the complicated clinical course, continuous clinical reasoning and testing can lead to appropriate diagnosis and treatment. As the dizziness symptoms in this older patient could not be explained by chronic or peripheral symptoms alone, ocular MG was considered as a possible diagnosis based on her history and physical examination findings. Appropriate diagnosis of seronegative ocular MG reactivated older patients with a good quality of life. In community medicine, where the behavior of elderly patients varies, it is important to improve the accuracy of diagnosis and treatment through appropriate history and physical examination, which will lead to longer home life in older patients.
ABSTRACT
Social prescribing is critical during the coronavirus disease 2019 (COVID-19) pandemic. Social prescribing refers to non-medical interventions related to culture and traditions; they are increasingly being proposed to address wider determinants of health as well as help patients improve health behaviors and manage their conditions effectively. Traditional and cultural behaviors in the community can be utilized for effective social prescribing. Due to the pandemic, social participation opportunities have decreased, resulting in the absence of Osekkai, a traditional Japanese behavior. A driver of Osekkai is the Osekkai conference; it is the model through which Osekkai is implemented in communities to bring resources and individuals together to address community needs. This research aims to clarify the Osekkai conference's development process and how it can solve social problems, thereby leading to the creation of sustainable communities. We conducted semi-structured interviews with Osekkai conferences' participants and organizers during the COVID-19 pandemic. We used thematic analysis to achieve the research aims. A total of 12 participants were interviewed. Five themes were developed from the thematic analysis: driver of the Osekkai conference's development, trajectory of continuity, chain of Osekkai, changes in communities and participants, and sustainability of the conferences. This study showed how reviving traditional behaviors helps face initial difficulties. It described these increasing traditional behaviors in terms of social prescribing that changes the community's and citizens' social capital. Reviving traditional behaviors created new challenges and solutions during the pandemic.