Incidence and Mortality of Emergency Patients Transported by Emergency Medical Service Personnel during the Novel Corona Virus Pandemic in Osaka Prefecture, Japan: A Population-Based Study.

Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and patient outcomes. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. The incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with the year 2019 as the reference were calculated. A total of 500,194 patients were transported in 2019, whereas 443,321 patients were transported in 2020, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.89, 95% CI: 0.88-0.89). The number of deaths of emergency patients admitted to hospital was 11,931 in 2019 and remained unchanged at 11,963 in 2020 (IRR: 1.00, 95% CI: 0.98-1.03). The incidence of emergency patients transported by ambulance decreased during the COVID-19 pandemic in 2020, but the mortality of emergency patients admitted to hospital did not change in this study.

G20 Summit and emergency medical services in Osaka, Japan.

AIM: To assess the impact of the Summit on Financial Markets and the World Economy held in Osaka City, Japan (G20 Osaka Summit) on the emergency medical services (EMS) system. METHODS: This study used the ORION database with its population-based registry of emergency patients comprising both ambulance and in-hospital records in Osaka Prefecture, Japan. The G20 Osaka Summit was held in Osaka City from 28 to 29 June, 2019. Changes in the EMS system and traffic regulations in Osaka were made during the period from 27 to 30 June, but we focused on the two summit days as the G20 period. The control periods comprised the same calendar days 1 week before and 1 week after the G20 period. We evaluated differences in the number of emergency transports, difficulties in obtaining hospital acceptance of patients, deaths among hospitalized emergency patients, and ambulance transport times between the two periods. RESULTS: In total, 2,590 cases in the G20 period and 5,152 cases in the control periods were registered. The relative risk of cases during the G20 versus control periods was 1.01 (0.96-1.05). Significant decreases were observed in the number of traffic accidents as ambulance calls (relative risk = 0.77; 95% confidence interval, 0.64-0.91). There were no significant differences in difficulties in obtaining hospital acceptance or deaths among hospitalized emergency patients between the G20 and control periods. In addition, ambulance transport times during the G20 period were not significantly longer than those in the control periods. CONCLUSION: The G20 Osaka Summit did not adversely impact the provision of emergency medical care in the Osaka area.

Reduction of influenza in Osaka, Japan during the COVID-19 outbreak: a population-based ORION registry study.

Objectives: The spread of COVID-19 has affected the incidence of other infectious diseases, but there are no reports of studies using comprehensive regional population-based data to evaluate the impact of COVID-19 on influenza incidence. We attempted to evaluate the impact of COVID-19 on influenza using the population-based ORION (Osaka Emergency Information Research Intelligent Operation Network) registry. Methods: The ORION registry of emergency patients treated by emergency medical service (EMS) personnel was developed by the Osaka Prefecture government. From ORION, we included emergency patients with influenza using the ICD (International Statistical Classification of Diseases and Related Health Problems) 10 codes. Influenza incidence rate ratio (IRR) and associated 95% CI were calculated. Results: The number of influenza patients transported by EMS decreased during the COVID-19 pandemic. The IRR showed a substantial decrease in influenza patients in 2020 (IRR 2020/2018 0.39, 95% CI 0.37-0.41). Conclusions: A comprehensive regional analysis using the population-based ORION registry confirmed that from January 2020, when the first confirmed cases of COVID-19 infection were reported in Osaka, Japan, the number of influenza patients transported by EMS decreased dramatically.

Adenoendocrine cell carcinoma of the gallbladder clinically mimicking squamous cell carcinoma.

We present the case of a 62-year-old Japanese man whose histological diagnosis was adenoendocrine cell carcinoma of the gallbladder at autopsy, but whose antemortem diagnosis was squamous cell carcinoma. The patient was admitted to hospital with complaints of occasional vomiting and abdominal pain. Abdominal computed tomography revealed a large tumor on the gallbladder involving the adjacent liver, colon, and duodenum, with multiple metastases in the greater omentum and paraportal lymph nodes. The serum level of squamous cell carcinoma antigen (SCCA) was high, whereas that of carbohydrate antigen (CA) 19-9, as well as that of carcinoembryonic antigen (CEA) was within the normal range. Due to these clinical features, we first suspected advanced squamous cell carcinoma of the gallbladder. After two cycles of gemcitabine monotherapy, the tumor had become enlarged and the regimen was changed to a combination of docetaxel and cisplatin. Though tumor regression was achieved and his serum SCCA level normalized after 3 months, the patient rejected additional chemotherapy and died 8 months after the diagnosis. The histopathological findings made by autopsy demonstrated the tumor to be an adenoendocrine cell carcinoma without squamous carcinoma cells. The case is interesting in that the clinical features were similar to those of squamous cell carcinoma of the gallbladder.

Pseudomyxoma peritonei occurring after an uneventful 23 years interval from appendectomy.

A 77-year-old male was admitted to our hospital for a bulky abdominal mass. He had a history of appendectomy under the diagnosis of appendiceal rupture 23 years previously. He also had received a radical lung resection for an early lung cancer 2 years earlier in another hospital. Tentative diagnosis of peritoneal metastases from the lung cancer was made. He then received 3 courses of chemotherapy, but failed to reach a remission. The final diagnosis of pseudomyxoma peritonei was made by means of abdominocentesis, and he underwent debulking surgery. However, he died on day 56 after the surgery. Pseudomyxoma peritonei requires careful observation, as it has the possibility to be detected after a long-term follow-up period of more than 20 years.

Sensory aphasia after closed head injury.

A 51-year-old, right-handed male injured his head when drunk. After an initial mute state lasting for several hours, he exhibited fluent aphasia, impaired word finding, some verbal paraphasia and impaired verbal comprehension. A CT scan revealed a contusion in the left anterior temporal lobe. He was treated conservatively, and at the follow-up 6 months later, his sensory aphasia had recovered well. The relationship between closed head trauma and aphasia is reviewed with special attention to its nature and clinical course.

[Frontal lobe hematoma associated with transcortical motor aphasia: case report].

An 81-year-old woman with left medial frontal lobe hematoma, which involved the supplementary motor area, is reported. She was right-handed and was initially mute for several hours after the onset. On admission, she exhibited mild paresis of the right lower extremity. Her spontaneous speech was sparse and not fluent, but her articulation and auditory comprehension were normal and repetition was good. She exhibited excellent performance in the confrontation naming task, but showed difficulty in recalling words from a given category during the word fluency task. On the basis of these clinical features, she was diagnosed as having transcortical motor aphasia. Our case may corroborate previous findings that the left medial frontal lobe is important in word fluency but not in confrontation naming.