Aims: Epidemiologic evidence suggests that physical activity is associated with reduced risk of Type 2 diabetes. Walking is simple, effective, and by far the most prevalent physical activity among older adults. However, it is difficult to recognize and evaluate performance-based parameters of physical activity. The purpose of this study was to evaluate the importance of performance-based gait speed among several physical measurements in the development of Type 2 diabetes using long-term community-based data on elderly Japanese persons. Methods: 10 baseline physical measurements, including habitual (HGS) and fast (FGS) gait speed, were examined in 102 elderly Japanese persons living independently in the community (mean age: 71.1 years old) who were not previously diagnosed with diabetes. The subjects then participated in a daily exercise program consisting of walking, stretching, muscle strengthening, and balance exercises and were followed for an average of 4.16 years. Using Cox proportional hazards models with adjustment for age, sex, and category of fasting glucose status, we investigated whether gait speed and/or other physical measurements are associated with development of Type 2 diabetes. Results: 9 subjects developed Type 2 diabetes. Among the 10 physical parameters examined, prolongation of HGS and FGS per second was the only statistically significant factors, with hazard ratios 1.83 (1.15 -2.89, P = 0.010) and 2.93 (1.43 -6.03, P = 0.003), respectively. Conclusions: We found a negative association between the development of Type 2 diabetes and gait speed among elderly Japanese people. We conclude that encouraging physical activity and preserving walking capacity may be beneficial for preventing Type 2 diabetes.

BackgroundAcute pneumonia is a serious problem in the elderly and various risk factors have already been reported, but the involvement of QTc interval prolongation remains uncertain. The aim of this study was to elucidate the prognostic factors for the development of pneumonia in elderly patients and to study the possible involvement of QTc interval prolongation.MethodsThe subjects were 249 hospitalized pneumonia patients more than 65 years old in Aki-Ohta Hospital from January 2010 to December 2013. Community-acquired pneumonia patients and nursing care and healthcare-associated pneumonia patients were included in the study. The pneumonia severity index, vital signs, blood chemistry data and ECG findings were retrospectively compared using multiple logistic regression analysis.Results39 patients died within 30 days from onset. The clinical features related to poor prognosis were: advanced age, past history of cerebral vascular disease and/or diabetes mellitus, decreased serum albumin level, higher CURB-65 or PORT index scores and QTc interval prolongation. Patients showing a prolonged QTc interval had a higher mortality than those with a normal QTc interval. A prolonged QTc interval was not related to serum calcium concentration and/or treatment with QTc prolongation drug, clarithromycin or azithromycin, but related to age, lower albumin concentration and past history of diabetes mellitus.ConclusionsThese findings suggest potential prognostic factors for pneumonia in elderly patients, including a prolonged QTc interval (> 0.44 seconds).

Background: Acute pneumonia is a serious problem in the elderly and various risk factors have already been reported, but the involvement of QTc interval prolongation remains uncertain. The aim of this study was to elucidate the prognostic factors for the development of pneumonia in elderly patients and to study the possible involvement of QTc interval prolongation. Methods: The subjects were 249 hospitalized pneumonia patients more than 65 years old in Aki-Ohta Hospital from January 2010 to December 2013. Community-acquired pneumonia patients and nursing care and healthcare-associated pneumonia patients were included in the study. The pneumonia severity index, vital signs, blood chemistry data and ECG findings were retrospectively compared using multiple logistic regression analysis. Results: 39 patients died within 30 days from onset. The clinical features related to poor prognosis were: advanced age, past history of cerebral vascular disease and/or diabetes mellitus, decreased serum albumin level, higher CURB-65 or PORT index scores and QTc interval prolongation. Patients showing a prolonged QTc interval had a higher mortality than those with a normal QTc interval. A prolonged QTc interval was not related to serum calcium concentration and/or treatment with QTc prolongation drug, clarithromycin or azithromycin, but related to age, lower albumin concentration and past history of diabetes mellitus. Conclusions: These findings suggest potential prognostic factors for pneumonia in elderly patients, including a prolonged QTc interval (> 0.44 seconds).

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

A 46-year-old man without any previous history consulted to our hospital complained of delirium and headache. 2-week prior to visit, he noticed headache and general fatigue. 1-week prior, his family felt that content of his speech was irrational. Specific abnormal findings were not recognized on physical examination and laboratory data. Blood laboratory examination showed as following; white blood cell count 7,200/mL, hemoglobin 14.7 g/dL, platelet count 224,000/mL, total protein 6.9 g/dL, albumin 4.4 g/dL, AST 32 IU/mL, ALT 30 IU/ mL, LDH 202 U/mL (normal range: 106-211) fasting blood sugar level 107 mg/dL, Na 141 mEq/L, K 3.5 mEq/L, Cl 107 mEq/L, Ca 9.3 mg/ dL C-reactive protein 0.2 mg/dL, Vitamin B 1 31 ng/mL (normal range: 24-66), Vitamin B 12 780 pg/mL (normal range: 24-66), and folic acid 7.5 pg/mL (normal range: 3.6-12.9). And, atrial blood gas analysis showed as following; pH 7.44, PaCO 2 34 mmHg, PaO 2 95 mmHg, HCO 3 -22.4 mmol/L, base excess 0.1 mmol/L, and COHb 0.4% (normal range 0-0.8). Cerebral CT showed symmetrical low-density area on bilateral pallidum (Figure 1a), and cerebral MRI (T2-weighted image) showed high intensity area on the same lesion (Figure 1b). When recognizing bilateral basal ganglia abnormalities on MRI, causes should be considered as following, toxic diseases, metabolic diseases, vascular diseases, chronic infectious diseases, and degenerative diseases [1]. After careful medical interview, we diagnosed this case as his having chronic carbon monoxide intoxication. 4-week ago, he used wooden stove in closed-room. Since arterial COHb showed normal range in chronic carbon monoxide intoxication like this case, diagnosis of chronic intoxication is difficult without information of exposure of carbon monoxide [2]. Although incidence of carbon monoxide intoxication is not rare, diagnosis of chronic intoxication is difficult without information of exposure of carbon monoxide [2,3]. The diagnosis of acute carbon monoxide intoxication is based on known CO exposure and blood COHb level [3], but arterial COHb showed