RESUMEN
A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.
RESUMEN
<b>Objective: </b>Elderly patients commonly experience adverse drug events (ADEs) owing to their poor drug metabolizing and excretion ability, and these often cause multiple organ dysfunction syndrome. Therefore, it is important that we identify the adverse drug events early on during prognosis. We searched for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.<br><b>Methods: </b>The objects under analysis were oral medicines that were registered in the Japanese Adverse Drug Event Report database (JADER). The associations between the elderly/non-elderly patients and exacerbation risk/non-exacerbation risk were analyzed by risk ratios (RR). The signal detection of exacerbation risk was defined as 95% confidence interval of lower limit of risk ratio>1 and χ<sup>2</sup>≥4.<br><b>Results: </b>The oral medicines that might markedly exacerbate the prognosis of ADEs in the elderly patients in comparison with the ADEs of young patients included 84 items, of which 63 have not been described as potentially inappropriate medicines in all guidelines for medical treatment of the elderly patients.<br><b>Conclusion: </b>In this study, while we could not search for oral medicines having a high risk of ADEs, we were able to search for oral medicines that might exacerbate the prognosis of ADEs in elderly patients. This result could contribute to the proper use of medicines in the elderly patients.
RESUMEN
<b>Objective: </b>Many of the elderly patients are suffering from constipation, are using the oral laxative. However the risk assessment of the oral laxative is not performed. Therefore, we used Japanese Adverse Drug Event Report database (JADER) and examined for the safety of the oral laxative in the elderly patients.<br><b>Methods: </b>Since the analysis target medicines; 12 oral laxatives and target ADEs; “digestive disorders” and “electrolyte abnormality,” the JADER database for April 2004 to January 2015 were analyzed in adults of age exceeds 60. We used the reporting odds ratio for a safety index of drugs, using reporting odds ratio, when the Lower bound of the 95% two-sided confidence interval exceeds 1, it is the signal detection of ADE.<br><b>Results: </b>The oral laxatives detected the signal of “digestive disorders” were three medicines, and “electrolyte abnormality” were five medicines. Especially, for electrolyte abnormalities not only increases the blood magnesium values as magnesium oxide, that there is also affect other electrolyte revealed.<br><b>Conclusion: </b>Some oral laxatives were also intended to signal detections of the adverse events that are not listed in the attached document, it is necessary to pay attention to the use of them for the elderly patients.