A woman in her 50s presented to the hospital with a chief complaint of headache and nausea. Graves' disease was diagnosed based on positive blood test results for thyrotoxicosis and TSH receptor antibody and ultrasonographic thyroid gland findings. The patient was hospitalized and started treatment with thiamazole; however, after hospitalization, psychiatric symptoms, such as visual and auditory hallucinations, appeared, and she fulfilled the diagnostic criteria for thyroid crisis. We increased the dose of thiamazole and added potassium iodide. Thyroid function improved; however, the patient experienced reemergence of psychiatric symptoms. Blood tests revealed pseudohyperchloremia, which led to the discovery of abuse of over-the-counter analgesics containing bromwarelyl urea. The psychiatric symptoms were suspected to be due to withdrawal from chronic bromine intoxication. After starting psychotropic drugs, the patient's psychiatric symptoms became mild, her thyroid function continued to improve steadily, and she was discharged from the hospital. Thyroid crisis is a condition that should be suspected and treated at an early stage; however, the diagnostic criteria for thyroid crisis can be false-positive if the thyroid disease is accompanied by other conditions that cause psychiatric symptoms.

Introduction: This study assessed the changes in outpatient visits during the COVID-19 pandemic.Methods: Subjects were patients who visited the outpatient clinic of the Family Medicine Centre at Kanai Hospital between April and May in 2019 and 2020. We compared the number of outpatients, their age, and their reasons for encounter (RFEs) classified according to the International Classification of Primary Care, 2nd Edition between 2019 and 2020.Results: A total of 1159 patients in 2019 and 859 patients in 2020 were evaluated. There were 553 male patients in 2019 and 452 in 2020 (P =0.029). The mean age of the patients was 48.4 years in 2019 and 52.4 years in 2020 (P =0.010). The mean number of patients per day was 25.2 in 2019 and 17.9 in 2020 (P < 0.001), with a significant reduction in patients aged 0-4 years in 2020 relative to 2019 (3.64 in 2019 vs.1.02 in 2020; P < 0.001). On evaluation of RFEs classified by organic system, the proportion of respiratory RFEs decreased from 45.3% in 2019 to 31.6% in 2020 (P =0.026), and gastrointestinal RFEs decreased from 17.9% to 5.3% (P =0.003) among children. Among adults, the proportion of respiratory RFEs decreased from 22.6% in 2019 to 15.6% in 2020 (P < 0.001) and skin RFEs decreased from 20.1% in 2019 to 15.3% in 2020 (P =0.011).Conclusion: The number of outpatients decreased during the COVID-19 pandemic. There were differences in the proportion of RFEs between the two periods.

Objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.529 (Omicron) was first detected in Japan in November 2021. In Osaka, public health centres subsequently increased active case finding and encouraged self-isolation. This study investigated the effectiveness of these countermeasures. Methods: Cases targeted for analysis were persons who had neither recently travelled abroad nor had contact with foreign tourists but tested positive for SARS-CoV-2 between 24 November 2021 and 4 January 2022 and were suspected or confirmed to have the Omicron variant. We performed a descriptive analysis and calculated the reproduction number (R) for each generation using the branching process method. Genomic sequencing data were analysed to plot a haplotype network. Results: A total of 251 cases were analysed. The median age was 30 years, and 46% (115/251) were in their 20s or younger. The first Omicron case in Osaka was detected on 21 December 2021. Local public health centres conducted health monitoring and contact tracing. We analysed R, using information from six clusters, including 42 pairs with a clear relationship between the case and the infected contact (infector–infectee pairs); the clusters had 19, 21 and 2 cases in each subsequent generation. The basic R (t = 0) was estimated to be 3.2, and subsequent generations (t = 1, 2) of R decreased to 1.1 and 0.1, respectively. The haplotype network showed that these cases constituted a monophyletic group with others detected around Osaka, indicating that these case-related clusters had been contained and were not involved in the nationwide Omicron waves. Discussion: Active case finding and self-isolation were found to be effective in limiting the spread of an emerging novel variant.