Sodium Valproate Use in Japanese Patients with Schizophrenia and Coronavirus Disease Is Associated with an Increased Risk of Pneumonia.

Schizophrenia is a known risk factor for coronavirus disease (COVID-19) infection and severity, and certain psychotropic drugs have been linked to increased mortality in infected patients with schizophrenia. However, little evidence exists regarding this risk. We retrospectively examined the association between mood stabilizers and the risk of pneumonia in patients with schizophrenia. This study included 99 patients with schizophrenia or schizoaffective disorder who were infected with COVID-19 in 2022 and met the inclusion criteria. After conducting propensity score matching to align patient backgrounds and concomitant medications, we assessed the impact of mood stabilizers, specifically sodium valproate, on the risk of pneumonia development. Univariate analysis revealed that patients with schizophrenia and COVID-19 who developed pneumonia were more likely to be older (64.5 [14.2] vs. 57.4 [11.5] years, p = 0.008) and using sodium valproate (44.4% vs. 16.7%, p = 0.004). Even after propensity score matching, patients who developed pneumonia were still more likely to be receiving sodium valproate than not (58.8% vs. 20.0%, p = 0.003). Sodium valproate use may be a risk factor for the development of pneumonia in patients with chronic schizophrenia who are infected with COVID-19 during long-term hospitalization.

Hemorrhagic rectal ulcer caused by a deformity of the coccyx complicated by normal delivery.

A 25-year-old woman delivered her first-born child weighing 3400 g by full-term normal delivery. Bloody stool developed 3 days after delivery. Colonoscopic examination revealed two linear ulcers parallel to the anal column on the posterior side of the rectal ampulla about 5 cm from the anal ring. Coagulated blood was detected at the ulcer bottom, suggesting the site of hemorrhage. Bowel rest in the absence of oral intake resulted in the disappearance of bloody stool. Three days later colonoscopic examination revealed improvement in the ulcer. There was no sign of constipation. A lateral pelvic radiograph showed that the apex of the coccyx was flexed anteriorly. The parturient canal may have physically pressed the rectum against the apex of the coccyx during delivery, causing mucosal injury. Only a few studies have reported the complication of a rectal ulcer due to injury during delivery. Furthermore, none of the previous studies has reported a rectal ulcer caused by deformity of the coccyx.