Emergency Medical Services Calls Analysis for Trend Prediction during Epidemic Outbreaks: Interrupted Time Series Analysis on 2020-2021 COVID-19 Epidemic in Lazio, Italy.

(1) Background: During the COVID-19 outbreak in the Lazio region, a surge in emergency medical service (EMS) calls has been observed. The objective of present study is to investigate if there is any correlation between the variation in numbers of daily EMS calls, and the short-term evolution of the epidemic wave. (2) Methods: Data from the COVID-19 outbreak has been retrieved in order to draw the epidemic curve in the Lazio region. Data from EMS calls has been used in order to determine Excess of Calls (ExCa) in the 2020−2021 years, compared to the year 2019 (baseline). Multiple linear regression models have been run between ExCa and the first-order derivative (D') of the epidemic wave in time, each regression model anticipating the epidemic progression (up to 14 days), in order to probe a correlation between the variables. (3) Results: EMS calls variation from baseline is correlated with the slope of the curve of ICU admissions, with the most fitting value found at 7 days (R2 0.33, p < 0.001). (4) Conclusions: EMS calls deviation from baseline allows public health services to predict short-term epidemic trends in COVID-19 outbreaks, and can be used as validation of current data, or as an independent estimator of future trends.

Splenic hypereosinophilia in anaphylaxis-related death: different assessments depending on different types of allergens?

The aim of this study was to evaluate splenic eosinophil and mast cell accumulation using pagoda red stain in a series of anaphylaxis-related deaths that underwent medico-legal investigations. Our goal was to assess whether fatal reactions to insect stings, intramuscularly administered antibiotics and intravenously injected contrast media are responsible for specific patterns of eosinophil and mast cell accumulation. Two study groups were prospectively formed, an anaphylaxis-related death group and a control group. Autopsy, histology (haematoxylin-eosin stain, pagoda red stain and immunohistochemistry using anti-tryptase antibodies), toxicology and postmortem biochemistry (beta-tryptase, total IgE and specific IgE) were performed in all cases. All tested parameters (spleen weight, beta-tryptase and total IgE levels as well as eosinophil, mast cell and degranulated mast cell numbers in the spleen) were significantly higher in the anaphylaxis-related death group. No statistically significant differences were observed among the various groups (intramuscular antibiotic injection, intravenous contrast medium administration and stinging insects) in any combination, suggesting that mast cell and eosinophil accumulation in the spleen during anaphylaxis does not have any specific pattern related to the triggering allergen. Despite a lower sensitivity than immunohistochemical staining in discriminating eosinophil and mast cells, pagoda red stain allowed these cells to be identified and could therefore be proposed as a low-cost, first-line diagnostic procedure in those situations where immunohistochemistry is not systematically performed or cannot be carried out.

Lateral saccular laryngeal cyst and unexpected asphyxial death.

We present the case of a 41-year-old man with a herniated saccular laryngeal cyst in the left cervical region who died unexpectedly at home from acute asphyxia. A few days before death the patient complained an obvious palpable swelling on the left side of the neck. The autopsy showed an oval-shaped mass originating on the wall of the larynx and herniating into the extralaryngeal region. The critical reduction of the laryngeal lumen originated from an intense oedema of the laryngeal mucosa above the cyst, concurrent with an inflammatory process of the cystic wall, with probable associated glottis laryngospasm mediated by the superior laryngeal nerve. The rapid evolution of oedema was favoured by the extreme relaxation of the connective tissue of the laryngeal mucosa in the supraglottic and aryepiglottic regions which explains the sudden death. The case is useful for delineating the problems related to the possible evolution of laryngeal cysts, the mechanisms of asphyxial complications, the pathological diagnosis and the medico-forensic aspects.

EGFR polysomy in squamous cell carcinoma of the thyroid. Report of two cases and review of the literature.

AIMS AND BACKGROUND: Primary squamous cell carcinoma of the thyroid gland (PSCCT) is an uncommon malignancy characterized by a poor prognosis. A radical surgical approach combined with radiotherapy or chemotherapy is the generally accepted treatment for this tumor. The epidermal growth factor receptor (EGFR) is a transmembrane tyrosine kinase receptor modulating the cell proliferation and biological progression of many human epithelial tumors. The EGFR overexpression in PSCCT suggests an additional therapeutic option for the treatment of this tumor. METHODS AND STUDY DESIGN: The clinicopathological features and immunohistochemical profiles of two cases of primary squamous cell carcinoma of the thyroid in a 66-year-old and an 83-year-old woman are presented. EGFR status was valued in both cases. RESULTS: Overexpression of EGFR protein was detected in 50% and 75% of the tumor cell membranes. EGRF gene polysomy was detected in both tumors. CONCLUSIONS: Pharmaceuticals targeting EGFR may help to provide the rationale for an additional, novel therapeutic option for this rare tumor, especially when other therapeutic options have been exhausted.

Immediate anaphylactic death following antibiotics injection: splenic eosinophilia easily revealed by pagoda red stain.

The comparison of 4 cases of immediate anaphylactic death following the intramuscular injection of antibiotics (different types of penicillin or cephalosporins) with 4 cases of immediate non-anaphylactic death (induced by different causes) recognized splenic eosinophilia, as the main feature for the differential diagnosis, in agreement with isolated previous studies. The use of a stain (pagoda red) little known and seldom employed in Pathology and in Forensic Medicine, showed the concomitant massive presence (immunohistochemically confirmed) of mast cells and degranulated mast cells, the latter mainly located in splenic sinuses. The whole of our findings led us to consider the spleen as the possible shock organ in man. Waiting for further judgment on our hypothesis, we seized the opportunity to remark the employment of the pagoda red stain when the contemporary demonstration of eosinophils, mast cells and degranulated mast cells is required.