Impact of the COVID-19 pandemic on a trauma center of a university hospital in Japan.

BACKGROUND: The Coronavirus disease 2019 pandemic caused the Japanese government to declare a State of Emergency on April 7, 2020. The aim of this study is to provide an overview of the effects of the pandemic on surgical cases at a university hospital trauma center. METHODS: An observational study was performed at a trauma center in a tertiary hospital in Tokyo, Japan. The number of surgeries was compared between two periods: a historical control period (Tuesday April 9 to Monday May 27, 2019) and the period of the Japan State of Emergency due to COVID-19 (Tuesday April 7-Monday May 25, 2020). Information on patient age, gender, and surgical diagnosis, site, and procedure was collected for cases operated on in each period. The number of trauma surgeries was compared between the two periods. Data from the two periods were compared statistically. RESULTS: The total number of surgical cases was 151 in the control period and 83 in the COVID-19 period (including no cases with COVID-19), a decrease of 45.0%. There were significantly more surgeries for patients with hip fractures in the COVID-19 period (9 vs. 19, P < 0.001 by Fisher exact test). CONCLUSIONS: During the State of Emergency in Japan, the number of operations for trauma patients at the trauma center decreased, but surgeries for hip fracture increased.

[ADULT ANAPHYLAXIS AT THE DEPARTMENT OF EMERGENCY MEDICINE OF TEIKYO UNIVERSITY HOSPITAL IN AN URBAN AREA OF TOKYO].

BACKGROUND: Anaphylaxis is a severe, potentially fatal, systemic allergic reaction. But its real-world evidence is limited. Both treatment of allergic symptoms and prevention of future anaphylactic episodes are clinically important. We have strongly recommended that patients visit our outpatient allergy clinic. OBJECTIVE: To classify the clinical features and triggers of anaphylaxis in patients (≥16 years old) in an urban area of Tokyo. METHODS: We used the medical records to analyze patients with anaphylaxis as the primary diagnosis who visited the emergency department in our hospital from January 2015 through December 2017. RESULTS: Among approximately 60000 patients who visited the emergency department, 181 subjects (mean age, 43.0; 44% male) were diagnosed with anaphylaxis. Fourteen of those patients had a systolic blood pressure of lower than 90mmHg. Upon arrival, 126 patients were treated with adrenaline. All patients recovered from the anaphylactic episode. Subsequently, 133 patients visited our outpatient allergy clinic. The trigger of the anaphylaxis were assessed; the most popular trigger was foods (n = 78), followed by drugs (n = 38), insect stings/bites or animal bites (n = 3) and others (n = 11). Adrenaline auto-injectors were prescribed to 84 patients. CONCLUSION: It is important for patients with anaphylaxis to undergo allergy testing after discharge from an emergency department. Collaboration between emergency medicine and allergy departments may be helpful for improving the patients' QOL through effective instruction and prevention of recurrent anaphylaxis.

[Case report: anaphylaxis caused by linseed included in baked bread].

We recently experienced a 29-year-old female with anaphylaxis caused by linseed included in homemade bread. This is the first report of linseed-induced allergy in Japan. She obtained the linseed-containing ingredients of bread by mail order. We performed skin-prick tests and basophil degranulation tests using extracts of the ingredients and commercially available linseeds; both tests showed positive results for linseed. The patient's serum was also positive for linseed-specific IgE. Since linseeds are included in various kinds of foods and exposure to them is increasing, linseeds may need to be recognized as a potential trigger of immediate-type allergy in Japan.

Relationship between decrease in ambulatory blood pressure and heart rate variability due to the effects of taking olmesartan medoxomil.

UNLABELLED: BACKGROUNDS AND METHODS: A higher degree of clinical efficacy with olmesartan compared with other angiotensin receptor blockers, has been reported by several sources. In this study of 31 examples of cases of essential hypertension, Holter electrocardiogram, ambulatory blood pressure monitoring and pulse wave velocity (PWV) measurements were performed before and after substituting olmesartan 20 mg for candesartan 8 mg antihypertensive drug therapy. RESULTS: Following the therapeutic change, daily average systolic and diastolic blood pressures were decreased by 6.7 +/- 9.3 mmHg and 3.6 +/- 8.3 mmHg, respectively, with olmesartan 20 mg; PWV was also significantly decreased. Holter electrocardiogram heart rate variability spectral analysis demonstrated that none of the very low frequency (VLF), high frequency (HF) and low frequency (LF)/HF components were significantly altered. However, a significant correlation was observed between the LF/HF component and blood pressure difference, when blood pressure and heart rate variability components in each individual case were studied. CONCLUSION: This study shows that olmesartan has a stronger antihypertensive effect in comparison to candesartan, and does not generate reflex sympathoexcitatory activity.

Red cell and platelet distribution widths in patients with angina pectoris and acute myocardial infarction.

Aim: We aimed to determine the relationship of red cell and platelet distribution widths with the onset of acute myocardial infarction, to enable the early detection and prevention of acute myocardial infarction. Methods: Red cell and platelet distribution widths were retrospectively determined in 46 patients with stable angina pectoris and 140 patients with acute myocardial infarction who were brought to the emergency department of our institution. Red cell and platelet distribution widths were determined with an automatic blood cell analyzer, and the results were compared between the acute myocardial infarction and angina pectoris groups. Results: Both red cell and platelet distribution width values obtained at onset were significantly higher in the acute myocardial infarction group than in the angina pectoris group (red cell distribution widths, 46.4 ± 0.51% versus 44.5 ± 0.59%; mean difference -1.91 [95% confidence interval (CI), -3.79 to -0.34]; platelet distribution widths, 12.1 ± 0.22 fL versus 11.1 ± 0.17 fL; mean difference -1.03 [95% CI, -1.58 to -0.47]). The red cell distribution widths before onset was not different between the acute myocardial infarction and angina pectoris groups; however, the platelet distribution widths before onset was higher in the acute myocardial infarction group (red cell distribution widths, 46.5 ± 0.85% versus 45.9 ± 0.59%; mean difference -0.71 [95% CI, -2.74 to 1.30]; platelet distribution widths, 11.4 ± 0.39 fL versus 10.6 ± 0.21 fL; mean difference -0.83 [95% CI, -1.66 to 0.11]). Conclusion: Red cell distribution widths and especially platelet distribution widths may contribute to the early detection of acute myocardial infarction.

Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study.

BACKGROUND: Persistent nosebleed episodes have occurred in patients with idiopathic epistaxis from Kiesselbach's area despite confirmed location of the bleeding site, but the cause remains unclear. We tried to determine whether persistent epistaxis was associated with blood pressure. METHODS AND RESULTS: Between May 2009 and May 2010, the records for 133 adult patients with idiopathic epistaxis from Kiesselbach's area were obtained from the emergency department of our hospital. The bleeding site was pressed with a cotton strip for about 30 minutes, followed by checking for nosebleed. Comparison of background factors by the presence or absence of persistent epistaxis revealed a significantly higher systolic blood pressure in patients with persistent nosebleed than in those without (181.3 ± 26.9 vs. 156.6 ± 26.1 mm Hg; P < .0001). Persistent epistaxis was significantly more frequent in patients with hypertension than in those without (26% vs. 8%; P = .002). Multivariate logistic analysis revealed systolic blood pressure to be an independent factor associated with epistaxis persistence (odds ratio, 1.03; 95% confidence interval, 1.01-1.06; P = .002). CONCLUSION: Proper blood pressure management is necessary for the prevention of persistent epistaxis from Kiesselbach's area in the clinical setting of emergency care practice.

Activation of cardiac ryanodine receptors by cardiac glycosides.

This study investigated the effects of cardiac glycosides on single-channel activity of the cardiac sarcoplasmic reticulum (SR) Ca2+ release channels or ryanodine receptor (RyR2) channels and how this action might contribute to their inotropic and/or toxic actions. Heavy SR vesicles isolated from canine left ventricle were fused with artificial planar lipid bilayers to measure single RyR2 channel activity. Digoxin and actodigin increased single-channel activity at low concentrations normally associated with therapeutic plasma levels, yielding a 50% of maximal effect of approximately 0.2 nM for each agent. Channel activation by glycosides did not require MgATP and occurred only when digoxin was applied to the cytoplasmic side of the channel. Similar results were obtained in human RyR2 channels; however, neither the crude skeletal nor the purified cardiac channel was activated by glycosides. Channel activation was dependent on [Ca2+] on the luminal side of the bilayer with maximal stimulation occurring between 0.3 and 10 mM. Rat RyR2 channels were activated by digoxin only at 1 microM, consistent with the lower sensitivity to glycosides in rat heart. These results suggest a model in which RyR2 channel activation by digoxin occurs only when luminal [Ca2+] was increased above 300 microM (in the physiological range). Consequently, increasing SR load (by Na+ pump inhibition) serves to amplify SR release by promoting direct RyR2 channel activation via a luminal Ca2+-sensitive mechanism. This high-affinity effect of glycosides could contribute to increased SR Ca2+ release and might play a role in the inotropic and/or toxic actions of glycosides in vivo.