[Purpose] This study, which was performed in a Japanese university hospital, sought to identify predictors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR positivity and to determine which medical patients need SARS-CoV-2 PCR testing. [Methods] This retrospective cross-sectional survey was conducted in the Juntendo University Nerima Hospital, Tokyo, Japan. The study population included all outpatients from whom SARS-CoV-2 PCR samples were collected. Clinical information was extracted from medical charts, and factors potentially predictive of the SARS-CoV-2 PCR results were analysed using Studentʼs t-test or the Chi-squared test and the Chi-Squared Automatic Interaction Detector (CHAID) Decision Tree Analysis Model. [Results] A total of 336 patients (male：female = 159：177；mean ± SD age, 44.64 ± 19.04 years) were included in this study, 76 (22.6%) of whom had positive SARS-CoV-2 PCR results. CHAID decision tree analysis showed that close contact history plus ground-glass opacity (GGO) in peripheral areas on CT indicated a quite-high-risk group. Moreover, non-close contact history plus GGO in peripheral areas on CT and non-enforcement CT plus close contact history plus age over 34 years were seen more frequently in the high-risk groups. [Conclusions] These results emphasize the importance of performing SARS-CoV-2 PCR testing in quite-high and high-risk groups,

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[Introduction] Hodgkin lymphoma (HL) is a common cancer affecting the adolescent and young adult (AYA) population. Because AYA patients with HL present to their primary care physicians with a variety of complaints, an understanding of the clinical characteristics of these patients is important to prevent diagnostic or referral delay. Thus, we investigated the clinical characteristics present in the AYA population at the time of their HL visit. [Methods] In our exploratory single-center retrospective study, 21 AYAs (15-39 years) were compared with 45 middle-aged and older (MAO) patients (＞ 39 years), all with HL, who were diagnosed and treated at the Department of Hematology and Oncology, Toho University Medical Center Omori Hospital, between 2003 and 2018. [Results] Lymphadenopathy was the most common physical finding in both age groups. Fever was more frequent in the AYA group than in the MAO group on their first visit (57.1% vs. 28.9%, p = 0.028). Only AYA patients were referred for an evaluation of mediastinal masses on chest radiographs (4 vs. 0, p = 0.003). [Conclusions] Our study revealed that fever and mediastinal masses were prevalent in AYA patients. Fever and mediastinal masses may be clues of early diagnosis of HL in the AYA population.

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[Background] Coronavirus disease 2019 (COVID-19) is spreading globally and has brought psychological stress to the general population. This study aimed to evaluate the depressive state of non-affected patients in a general medicine outpatient unit before and during the COVID-19 outbreak in Japan. [Methods] This was a database study. A total of 454 patients who visited the general medicine department at one university hospital between January 2019 and January 2021 were enrolled. Depressive symptoms were assessed using the Self-rating Depression Scale (SDS). Dichotomous and continuous scores were compared before and during the COVID-19 period, with adjustments applied for age and sex. [Results] SDS scores were significantly higher for women and aged patients during the COVID19 period as compared to before. The logistic regression analysis showed that depressive state was correlated with visiting the hospital during the COVID-19 period (odds ratio and 95% confidence interval：1.56 [1.02 to 2.39]), with a SDS score increase of 2.39 (0.39 to 4.40). [Conclusions] Our study indicated that being in a depressive state was common to COVID-19- negative general medicine patients during the COVID-19 period.

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[Case] A 28-year-old man presented with fatigue, headache, bilateral shoulder pain, chills, and diarrhea. Although he was healthy, his symptoms appeared on the day after vaccination with his second dose of the Pfizer-BioNTech vaccine. He visited our outpatient clinic for Kampo medicine treatment on day 10. Based on the clinical course, the patient was considered to have vaccine- induced side effects, and keishito was prescribed according to the Eastern medicine findings. On day 13, his sweating disappeared, and headache and chills showed improvement;however, shoulder pain and fatigue persisted. On day 27, purple spots on the tongue were considered blood stasis, so the patient was prescribed tsudosan, which improved his shoulder pain. On day 52, the numeric rating scale score was 1 point, indicating a trend toward improvement. [Discussion] Side effects are typically common following vaccination as the body is building immunity to antigens;however, they usually subside within a few days. Western medicine alone cannot maintain the quality of life of patients experiencing prolonged symptoms. [Conclusions] Kampo medicine can be used to develop complementary medical treatments, even in clinical areas where evidence is yet to be accumulated.

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We report a case of emphysematous osteomyelitis of the spine secondary to methicillin- susceptible Staphylococcus aureus (MSSA) bacteremia. A 70-year-old man with type 2 diabetes and diabetic renal failure presented with fever and swelling of the right lower extremity. He was admitted to the hospital after being diagnosed with acute cellulitis originating from an ulcer on the right thumb. MSSA was detected in blood culture, and cefazolin was administered. On the 12th hospitalization day, the patient complained of lumbar pain. Physical examination revealed tenderness of the lumbar spinous process. Plain computed tomography (CT) revealed gas around the fifth lumbar vertebral body (L5) and epidural area. Magnetic resonance imaging (MRI) showed edematous changes in the vertebral bodies and surrounding soft tissues at the L5/S1 level. The patient was diagnosed with emphysematous osteomyelitis of the spine. Antibiotic therapy was continued, and CT after almost 4 months of treatment revealed the disappearance of emphysema. Subsequently, the treatment was terminated. Emphysematous osteomyelitis of the spine has a presentation similar to pyogenic spondylitis;however, it has a high mortality rate and requires prompt diagnosis. Diagnosing emphysematous osteomyelitis might require both CT and MRI. In addition to gram-negative rods and anaerobes, MSSA may also be a causative agent.

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