Cough related to swallowing in asthma patients

BACKGROUND: Occurrence of cough during swallowing is common among asthma patients, but has not been investigated in detail. OBJECTIVE: We conducted an observational study to determine the prevalence of swallowing-related cough (SRC) and its characteristics in asthma patients. METHODS: Asthma patients attending our outpatient department between May 2005 and April 2007 were interviewed to investigate if they had ever experienced SRC, as well as postnasal drip or heartburn and cough related to these conditions. RESULTS: Among 417 patients who completed the questionnaire, 121 patients (29.0%) had experienced SRC. Spicy and sour foods were the most frequent tussigenic foods, causing cough in 76.0% and 53.7% of the 121 patients, respectively. In patients without SRC, the prevalence rates of postnasal drip and postnasal drip-induced cough were 35.8% (106 of 296) and 7.8% (23 of 296), respectively. The corresponding prevalence rates in patients with SRC were 50.4% (61 of 121) and 37.2% (45 of 121), which were both significantly higher than in patients without cough (p = 0.006 and p < 0.001 respectively). In patients without SRC, the prevalence rates of heartburn and heartburn-induced cough were 22.2% (66 of 296) and 2.4% (7 of 296), respectively. The corresponding prevalence rates in patients with SRC were 45.5% (55 of 121) and 16.5% (20 of 121), with both being significantly higher than in patients without cough (p = 0.002 and p < 0.001, respectively). CONCLUSION: SRC was frequent in asthma patients, and was closely related to postnasal drip and heartburn. Irritable larynx is one of the possible underlying mechanisms of SRC. This study was registered with the University Hospital Medical Information Network clinical trials registry (registration number: UMIN000017426).

Osteomyelitis of zygoma in a schizophrenia patient.

A 43-year-old man with schizophrenia presented to our hospital with appetite loss and general fatigue lasting 1-2 months. His face was flared and swollen, and he shed tears of pus. He could answer any questions, but never complained of pain. We found dacryocystitis with subcutaneous abscess with contiguous osteomyelitis with culture-proven Stapylococcus aureus, and diabetes mellitus (DM). Although DM neuropathy was mild, he did not complain of pain. We searched thoroughly for other abscesses since S aureus grew in all four of his blood cultures. We re-examined his whole body by CT, which revealed multiple muscle abscesses in both legs. It is reviewed that schizophrenia patients are relatively insensitive to physical pain. Thus, we should keep in mind that they may have multiple, unpredictable and rare underlying diseases, such as our case. Careful and thorough examinations are essential for treatment in schizophrenia patients.

Points requiring attention in primary-care settings in the treatment of patients with acute drug intoxication / 日本プライマリ・ケア連合学会誌

Objective: To develop an effective and safe therapeutic strategy, we studied the effect of the clinical characteristics of patients with acute drug intoxication on the duration of hospitalization. <br>Subjects and Methods: The subjects were 89 patients hospitalized for acute drug intoxication. They were divided into two subgroups; the short hospitalization group (duration of hospitalization < 7 days) and the long hospitalization group (duration of hospitalization ≥ 7 days). We compared age, sex, vital signs, drugs, and therapy between the two groups. <br>Results: There were no significant differences in sex or severity of consciousness disturbance between the short- and long-hospitalization groups. Age in the latter group was higher than that in the former, and age was significantly and positively correlated with the duration of hospitalization. Prolongation of hospitalization in patients with Japan Coma Scale (JCS) I or II is associated with psychiatric disease, and in patients with JCSIII, with physical disease. We used direct hemoperfusion (DHP) to treat patients with severe acute drug intoxication. The duration of hospitalization in patients treated by DHP tended to be shorter than those not so treated. <br>Conclusions: The present results suggest that aging is associated with prolongation of hospitalization and the onset of physical disease among patients with acute drug intoxication. When elderly patients with acute drug intoxication are treated in a primary-care setting, the question of whether or not physical diseases are present as complications should be considered. The appropriate use of DHP for the treatment of patients with severe acute drug intoxication requires further study.