Background:Amid healthcare workforce shortages and an aging population, families are increasingly performing informal caregiving tasks, equipping them with skills unique to their older relative's medications. Yet, despite high rates of medication errors during transitions of care, family members' expertise is rarely solicited by healthcare professionals in hospital. Purpose:To understand how families are engaged in older adults' medication management, and to explore strategies for improving medication management during transitions of care. Methods:A qualitative exploratory study was conducted between October 2024 and January 2025. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using the Framework Method. Inductive themes were conceptualized from the data and deductively mapped to the Patient and Family Engagement Framework. Results:In total, 66 semi-structured interviews were conducted. Eight inductive themes were generated from the data and deductively mapped to three levels of engagement comprising consultation, involvement, and partnership and shared leadership. Four themes mapped onto consultation, with family members mainly receiving and transferring medication information between healthcare professionals. Three themes reflected involvement, where healthcare professionals considered family members' preferences when determining the treatment options. At this level of engagement, responsibility for managing medications was delegated between families and healthcare professionals. The last theme aligned with partnership and shared leadership, where families initiated medication changes and negotiated treatment plans with healthcare professionals. An application or QR code was proposed as a strategy to improve medication information transfer. Family members also believed that being offered alternative treatments and a list of possible medication questions to ask would enhance collaborative decision-making. Conclusion:Families rarely received an invitation to participate in medication decision-making, highlighting how preferences for active engagement are difficult to address under current practices. Policymakers should consider strategies that promote shared decision-making, such as mandating that alternative treatment options are provided where clinically appropriate. Registration:Registered in ANZCTR (ACTRN12624000901505) on the 24th of July 2024.
Background:Adverse drug reactions (ADRs) represent a significant challenge in pharmacovigilance, particularly for patients with chronic conditions like diabetes. Traditional reporting methods are often cumbersome and suffer from substantial underreporting. Mobile health applications with gamification elements offer a promising approach to enhance ADR reporting engagement. Objective:This study aimed to design, develop, and evaluate a gamified mobile application (RxFeedback) for ADR reporting among diabetic patients and healthcare professionals in Iran, with gamification mechanics (points, leaderboards, challenges) as the core engagement strategy. Methods:This analytical cross-sectional pilot study employed a user-centered design methodology in three phases: 1) Requirements gathering through literature review and stakeholder surveys (5 patients, 4 professionals); 2) Application development using Flutter framework with Dart programming language for Android platform; 3) Evaluation using Mobile Application Rating Scale (MARS) by 5 experts and Questionnaire for User Interaction Satisfaction (QUIS) by 20 patients. Results:The RxFeedback application incorporated comprehensive ADR reporting features, medication management, and gamification elements (points system, leaderboards, challenges). Expert evaluation yielded a mean MARS score of 3.65/5, with highest scores in functionality (4.05) and lowest in aesthetics (3.40). Patient satisfaction assessment showed an overall QUIS score of 6.14/10, with highest satisfaction in application features (6.8) and lowest in terminology (5.7), though the limited sample size (n=20 patients, n=5 experts) and focus on usability should be noted as preliminary study constraints. Conclusion:RxFeedback demonstrated acceptable usability and quality (MARS: 3.65/5; QUIS: 6.14/10) in this pilot study. However, effectiveness in improving actual ADR reporting rates was not assessed. These findings establish preliminary acceptability as a foundation for future experimental studies.
Introduction:Calcium channel blockers (CCBs) show notable interindividual variability in antihypertensive response. This study evaluated the association of a pharmacogenomics (PGx)-guided antihypertensive strategy incorporating CACNA1C rs2238032 and CYP3A5 rs776746 with short-term blood pressure (BP) outcomes among Chinese patients with hypertension receiving CCB-containing regimens. Methods:This secondary exploratory analysis included patients receiving CCB-containing regimens from two previously completed multicenter randomized cohorts conducted in Hunan and Fujian provinces, China. The Hunan cohort assessed a 4-week PGx-guided strategy combined with structured management, while the Fujian cohort evaluated genotype-guided treatment during 4-8 weeks after an initial standardized management phase. The primary endpoint was BP control at the last follow-up; secondary endpoints included changes in systolic BP (SBP) and diastolic BP (DBP), medication use, and short-term safety outcomes. Multivariable regression models were used to adjust for prespecified clinical covariates. Results:A total of 4608 patients in Hunan and 418 patients in Fujian were included. In the Hunan cohort, the genotype-guided group had higher 4‑week BP control (81.83% vs 25.07%; adjusted OR = 14.56, P < 0.001) and greater SBP/DBP decreases. In the Fujian cohort, genotype-guided therapy was associated with higher 8‑week BP control (81.74% vs 77.39%; adjusted OR = 2.43, P = 0.003) and greater DBP decrease. Associations were stronger among patients whose BP remained uncontrolled after standardized management. No short-term safety concerns were identified. Conclusion:A genotype-guided antihypertensive strategy incorporating CCB-related PGx information, including CACNA1C rs2238032 and CYP3A5 rs776746, was associated with improved short-term BP control among Chinese patients with hypertension receiving CCB-containing regimens, without an apparent short-term safety disadvantage. However, these findings should be interpreted as exploratory associations rather than proof of causal benefit. Further prospective randomized studies are needed to confirm these findings.
Background:Venous thromboembolism (VTE) is a major cardiovascular disorder associated with high morbidity and mortality. Several epidemiological studies have reported seasonal variations in VTE, with higher rates during winter. However, it remains unclear whether reports of VTE adverse events in spontaneous reporting systems exhibit similar seasonal patterns. Material and Methods:A retrospective pharmacovigilance study was conducted using data from the Japanese Adverse Drug Event Report (JADER) database. Reports of VTE, including deep vein thrombosis and pulmonary embolism, were identified from the adverse event records of the JADER database. Monthly reporting rates were calculated by dividing the number of VTE reports by the total number of adverse event reports. Seasonal variations were evaluated using negative binomial regression models with monthly indicator variables and harmonic seasonal terms. The association between monthly VTE reporting rates and the mean monthly temperature in Tokyo was assessed using Pearson's correlation analysis. Results:VTE adverse event reports showed a clear seasonal pattern. In the harmonic seasonal model, the estimated peak occurred in December and the nadir in July, with a peak-to-nadir rate ratio of 1.29. The harmonic seasonal model showed a better fit than the monthly indicator model (Akaike information criterion: 1696.8 vs 1712.6). Monthly VTE reporting rates were inversely correlated with mean monthly temperature in Tokyo (Pearson's r = -0.769, p = 0.003). Conclusion:VTE adverse event reports in the JADER database showed a clear seasonal pattern, with higher and lower reporting rates in winter and summer, respectively. Seasonal and environmental factors may be associated with seasonal variation in VTE reporting. It should be noted, however, that spontaneous reporting data cannot be used to estimate the absolute incidence of VTE or to establish causal relationships between drugs and adverse events. Further studies using complementary data sources are required to confirm these findings.
Background:Adverse events related to use of medicinal products are among the significant causes of morbidity and mortality. Quality of adverse event reports is essential for safety risk management. We therefore analyzed trends, timeliness and completeness of individual case safety reports (ICSRs) at a regional pharmacovigilance (PV) centre in Malawi. Methods:This was a cross-sectional study involving data extraction from ICSR reports that were submitted from 2017 to 2024. The data included patient demographics, adverse events, suspected products and reporter details. ICSR completeness was assessed using the vigiGrade® tool. Results:The PV centre received a total of 1,057 ICSRs during the targeted period. These included 940 (88.9%) ADR and 117 (11.1%) AEFI cases. Most of the ADRs were serious (56.1%, n=527) while most of the AEFIs were not serious (58.1%, n=68), p<0.001. Highest reporting rates were recorded in 2022. Most of the ADR cases were related to Isoniazid (16.6%, n=156), followed by tenofovir/lamivudine/dolutegravir (14.5%, n=136). For the AEFIs, most cases were related to pneumococcal conjugate (22.2%, n=26), followed by pentavalent vaccine (21.4%, n=25). The median vigiGrade score for the ADRs was 0.7 (95% CI: 0.7-0.9; IQR: 0.57-1). This was significantly lower (P<0.001) as compared to the AEFIs with a median score of 1 (95% CI: 1-1; IQR: 0.7 -1). There was no significant difference in transmission time between ADR and AEFI reports, p=0.106. The median duration for transmission of ADR reports was 19.5 days (95% CI: 17-21 days; IQR: 6-56 days), while the median time AEFI report transmission was 8 days (95% CI: 3-30.9 days; IQR: 1-156 days). Conclusion:The study highlights poor quality and delayed reporting of adverse events. This may hinder safety signal detection, proper regulatory decision making and compromise patient safety. Strengthening digital reporting mechanisms would enhance quality reporting and streamline timely data flow.
Stanley Mwita Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaCorrespondence: Stanley Mwita, Email stanleymwita@gmail.com
Introduction: The association between metoclopramide and pheochromocytoma crisis has been documented in literature. However, evidence has primarily relied on case reports and small-scale experimental studies rather than rigorous causal assessments. Therefore, this study aimed to assess the causal relationship between metoclopramide use and the occurrence of pheochromocytoma crisis by analyzing data from the literature and World Health Organization (WHO) global pharmacovigilance database. Methods: This study was a descriptive analysis and causality assessment of metoclopramide and pheochromocytoma crisis. Data were retrieved from published literature and the WHO global pharmacovigilance database (VigiBase) on February 13, 2025. In addition to the causality results extracted from VigiBase, causality assessment at the individual level for published case reports was conducted using the Naranjo Adverse Drug Reaction Probability Scale. Causality assessment at the population level was conducted using the Austin Bradford-Hill causality assessment framework. Results: A total of 62 de-duplicate cases were found in VigiBase and the literature. Almost all cases were classified as serious with 12 fatalities. In many instances, the drug-induced crisis served as the first clinical indication of an undiagnosed (occult) tumor. A causality assessment using the Naranjo algorithm conducted by the current authors classified the 18 published cases as "probable" (13) and "possible" (5). In VigiBase, causality assessment at the individual level was reported for 10 cases, with possible (6), probable (2), and reasonable possibilities (2). The results of the causality assessment at the population level using Hill's criteria revealed compelling evidence across all nine criteria. Conclusion: A reasonable causal relationship exists between metoclopramide and pheochromocytoma crisis, supporting its contraindication in patients with known or suspected pheochromocytoma. Clinicians should monitor patients, consider underlying pheochromocytoma, and be aware of this risk. Further international casecontrol studies are recommended to confirm this causal association.
Paracetamol (acetaminophen) is widely used for pain and fever management in children under five; however, accidental overdose is an increasing public health concern in low-resource settings such as Somalia. This narrative review highlights key risk factors, clinical consequences, and prevention strategies relevant to the Somali context based on published literature. Misconceptions about dosing, reliance on age rather than weight, and unrestricted access contribute to inappropriate administration and increased risk of hepatotoxicity and acute liver failure. While metabolic pathways in young children differ from adults, increased vulnerability in this setting is more strongly associated with malnutrition, dosing errors, and delayed access to healthcare. Toxicity results from accumulation of N-acetyl-p-benzoquinone imine (NAPQI), leading to oxidative stress and liver injury. Early treatment with N-acetylcysteine (NAC) is essential, yet delayed presentation and limited availability of antidotes in Somalia worsen outcomes. There is currently limited published data on the incidence of paracetamol overdose and NAC availability in Somalia. Strengthening caregiver education, pharmacy-based counseling, access to essential antidotes, and national poison surveillance systems is critical to reducing preventable pediatric liver injury in Somalia.
Introduction:Opioids carry an inherent high risk of adverse drug events (ADEs), although these are generally predictable and avoidable through proper management and monitoring. Naloxone, an opioid antagonist, is used to counteract severe opioid overdoses. Aim:This study aimed to estimate the incidence of iatrogenic opioid overdoses and describe prescribing patterns before, during and after them. Methods:We conducted a ten-year retrospective case series analysis of naloxone use among inpatients at a large, multisite university hospital in Switzerland from January 2014 to December 2023. Cases were included if an adult patient had received naloxone after opioid administration and overdose. We excluded patients who received naloxone during surgery or in intensive care units. Results:Of the 671 uses of naloxone identified, 121 (18.0%) met our inclusion criteria. Yearly naloxone use incidence was 11.0 per 10,000 inpatients, increasing slightly from 2014 to 2023. The median daily opioid dose requiring naloxone was 73 morphine milligram equivalents (MME). According to the Schumock and Thornton scale criteria, we considered 82 (67.8%) of the 121 opioid overdoses to have been potentially preventable The median opioid doses received before hospital admission (29.4 MME) were higher than at discharge (15.0 MME). Nevertheless, 71 (68.3%) of 104 discharged patients were still prescribed at least one opioid. Conclusion:This study found that iatrogenic opioid overdoses were relatively uncommon. However, the considerable number of preventable opioid overdoses estimated leads us to conclude that opioid stewardship programmes should be recommended across Switzerland.
Livedoid vasculitis is a vascular autoimmune disorder affecting the skin. It most commonly occurs in young women. The occurrence of this condition after the coronavirus 2019 (COVID-19) vaccination is rare. The available literature suggests limited use of exosomes in the treatment of livedoid vasculitis. We present the case of a 65-year-old Chinese man who developed livedoid vasculitis after COVID-19 vaccination. We posit that the etiology in this case may be either COVID-19 vaccine-induced immune stimulation or activation of the condition by a rare vaccine component. This case is unique, with no previously reported precedents. The patient was treated intravenously for 1 month with stem cell-derived exosome therapy, using stem cells derived from exfoliated human deciduous teeth. This resulted in improvement in the livedoid vasculitis, with no reemergence of symptoms. This case highlights the therapeutic benefits of exosome treatment for livedoid vasculitis after COVID-19 vaccination. However, large-scale studies are needed before this outcome can be generalized.
Computed tomography (CT) contributes substantially to medical radiation exposure, making diagnostic reference levels (DRLs) essential for dose optimization and patient protection. This narrative review summarizes international CT DRL practices and examines the current status of DRL development in Jordan. Published studies and key guidance documents addressing adult and pediatric CT DRLs, including CTDIvol, dose-length product (DLP), and size-specific dose estimate (SSDE) where available, were reviewed to identify common implementation approaches, frequently used dose metrics, and evidence gaps relevant to Jordan. The reviewed literature shows marked inter-country variation in DRL methodology, updating cycles, and regulatory integration. In Jordan, available studies demonstrate useful local and multicenter data, but routine CT practice still lacks a unified national DRL framework. Reported Jordanian values also show inter-institutional variability, highlighting the need for standardized data collection, regular auditing, and coordinated national oversight. Establishing national DRLs based on transparent methodology and periodic revision would strengthen radiation protection, improve protocol consistency, and support safer CT practice in Jordan.
A 12-year-old patient was hospitalized with suspected recurrent Stevens-Johnson syndrome (SJS) caused by ibuprofen. The patient presented with aphthous lesions on the lips and oral mucosa, accompanied by fever and cough. Further examination revealed more severe symptoms. The exact classification of his skin reaction and the underlying cause were challenging due to the coexistence of multiple potential triggers. The diagnostic overlap among various skin reactions requires careful evaluation of the clinical presentation and histopathological findings in relation to potential drug exposure and/or infectious triggers. Cutaneous reactions such as SJS and fixed drug exanthema are predominantly associated with drug exposure, whereas Erythema multiforme (EM) and Mycoplasma pneumoniae rash and mucositis (MIRM) are mainly linked to infectious triggers. The diagnosis of a skin reaction and its trigger is highly relevant for therapy and prevention of further episodes. In this patient, administration of ibuprofen, as well as infections with Herpes simplex virus (HSV) and Mycoplasma pneumoniae (M. pneumoniae) were considered potential triggers, highlighting the complexity of this case. The patient recovered following extensive therapy and was discharged after two weeks.
Introduction:Constant supervision is required in a hospital setting because medication errors are a common occurrence and can be potentially harmful to patients. Objective:To examine patterns in medication error rates, types, and departmental distributions at tertiary hospitals from 2013 to 2023. Methods:In this cross-sectional research, the internal hospital medication error database was utilized, collecting data on dosage errors which included Wrong Dose, Drug Omission, Timing Error, and the departments assignment of errors include ICU, General Ward, Pharmacy, Emergency Department for a continuous duration of 11 years. Results:The reports for medication errors at tertiary hospitals for the years 2013-2023 altogether displayed fairly consistent behavior. Maximum error count was in the year 2019 with 6108 errors while the minimum was in the year 2015 with errors summing up to 725. The results showed fallen in medication errors to 1279 errors by 2023. Important types of errors were wrong/unclear dose prescriptions that used to peak in 2019 with 1307 and also duplication of medication errors increased with 297 additional errors between 2013 to 2023. The changes between types of errors made (χ2 = 1297.75, p-value < 0.001), hospital centers (χ2 = 1668.97, p-value < 0.001) and sections of the hospital in which they were carried out (χ2 = 3086.19, p-value < 0.001) proved vital through chi-square tests done and thus showcasing the shifting control of medication error detection and reporting brought by electronic health record (EHRs) system and training. Conclusion:Medication errors showed variability with peaks, troughs, and fluctuations, demonstrating the inter-year coping mechanisms of EHRs system and personnel. Decision makers need to improve the system alongside staff education and some focused departmental attention. Although there has been some improvement in reporting errors, reporting new emerging errors, such as duplication of procedures, necessitates further vigilance in the dispensation of services to patients.
Background: Evidence on bleeding events associated with oral anticoagulants in real-world settings is limited. Thus, we compared the incidence rate of oral anticoagulant-associated bleeding between warfarin and direct oral anticoagulants (DOACs). Methods: This is a retrospective observational study using the Japanese Adverse Drug Event Report Database (JADER) and the nationwide health insurance claims database. We investigated the number of case reports with "bleeding" or "hemorrhage" using the JADER. The drugs of interest included warfarin, dabigatran, edoxaban, rivaroxaban, or apixaban. Main outcome measures included the number of case reports of bleeding and the estimated annual incidence rate of oral anticoagulant-associated bleeding using the Japanese Adverse Drug Event Report (JADER) and the nationwide estimated number of patients with prescriptions. Results: In JADER, we found 16,125 oral anticoagulant-associated bleeding in 15,970 case reports of patients between April 1, 2004, and March 31, 2024. The most common suspected oral anticoagulant administered to patients was apixaban (33.4%), followed by rivaroxaban (26.0%), warfarin (16.6%), edoxaban (13.3%), and dabigatran (10.7%). The incidence rates of anticoagulant-associated bleeding in patients who were prescribed dabigatran, edoxaban, rivaroxaban, and apixaban were higher compared to those in patients who were prescribed warfarin. The estimated annual incidence rate was remarkably high in patients who received apixaban, reaching 1976.90 per 1,000,000 patients. Conclusion: Compared with warfarin, the incidence rates of oral anticoagulant-associated bleeding were higher with dabigatran, edoxaban, rivaroxaban, or apixaban. In a real-world setting in Japan, the risk of oral anticoagulant-associated bleeding appears to be higher with DOACs than with warfarin.
Akina Takami,1 Gen Terashima,2 Takumi Tajima,2 Koki Yamashita,3 Ataru Igarashi1 1Department of Health Policy and Public Health, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Tokyo, Japan; 2JMDC, Inc., Tokyo, Japan; 3Maxwell International, Inc., Chiba, JapanCorrespondence: Akina Takami, Department of Health Policy and Public Health, Graduate School of Pharmaceutical Sciences, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, Tel +81 3-5841-4828, Fax +81 3-5841-4829, Email mariechanmail@g.ecc.u-tokyo.ac.jpBackground: Evidence on bleeding events associated with oral anticoagulants in real-world settings is limited. Thus, we compared the incidence rate of oral anticoagulant-associated bleeding between warfarin and direct oral anticoagulants (DOACs).Methods: This is a retrospective observational study using the Japanese Adverse Drug Event Report Database (JADER) and the nationwide health insurance claims database. We investigated the number of case reports with “bleeding” or “hemorrhage” using the JADER. The drugs of interest included warfarin, dabigatran, edoxaban, rivaroxaban, or apixaban. Main outcome measures included the number of case reports of bleeding and the estimated annual incidence rate of oral anticoagulant-associated bleeding using the Japanese Adverse Drug Event Report (JADER) and the nationwide estimated number of patients with prescriptions.Results: In JADER, we found 16,125 oral anticoagulant-associated bleeding in 15,970 case reports of patients between April 1, 2004, and March 31, 2024. The most common suspected oral anticoagulant administered to patients was apixaban (33.4%), followed by rivaroxaban (26.0%), warfarin (16.6%), edoxaban (13.3%), and dabigatran (10.7%). The incidence rates of anticoagulant-associated bleeding in patients who were prescribed dabigatran, edoxaban, rivaroxaban, and apixaban were higher compared to those in patients who were prescribed warfarin. The estimated annual incidence rate was remarkably high in patients who received apixaban, reaching 1976.90 per 1,000,000 patients.Conclusion: Compared with warfarin, the incidence rates of oral anticoagulant-associated bleeding were higher with dabigatran, edoxaban, rivaroxaban, or apixaban. In a real-world setting in Japan, the risk of oral anticoagulant-associated bleeding appears to be higher with DOACs than with warfarin.Keywords: oral anticoagulants, direct oral anticoagulants (DOACs), Japanese adverse drug event report (JADER), drug safety, bleeding
Ashraf A’aqoulah,1,2 Malak Alqahtani,1,3 Dalal F Bin Dayel,3 Bandar Zarbah,3 Farah Kalmey,2,4 Ghassan Shattat,2,5 Raghib Abusaris2,6 1Health Systems Management Department, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; 3Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia; 4Department of English Language, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Basic Sciences, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 6Epidemiology and Biostatistics Department, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCorrespondence: Ashraf A’aqoulah, Email aqoulaha@ksau-hs.edu.saIntroduction: Constant supervision is required in a hospital setting because medication errors are a common occurrence and can be potentially harmful to patients.Objective: To examine patterns in medication error rates, types, and departmental distributions at tertiary hospitals from 2013 to 2023.Methods: In this cross-sectional research, the internal hospital medication error database was utilized, collecting data on dosage errors which included Wrong Dose, Drug Omission, Timing Error, and the departments assignment of errors include ICU, General Ward, Pharmacy, Emergency Department for a continuous duration of 11 years.Results: The reports for medication errors at tertiary hospitals for the years 2013– 2023 altogether displayed fairly consistent behavior. Maximum error count was in the year 2019 with 6108 errors while the minimum was in the year 2015 with errors summing up to 725. The results showed fallen in medication errors to 1279 errors by 2023. Important types of errors were wrong/unclear dose prescriptions that used to peak in 2019 with 1307 and also duplication of medication errors increased with 297 additional errors between 2013 to 2023. The changes between types of errors made (χ2 = 1297.75, p-value < 0.001), hospital centers (χ2 = 1668.97, p-value < 0.001) and sections of the hospital in which they were carried out (χ2 = 3086.19, p-value < 0.001) proved vital through chi-square tests done and thus showcasing the shifting control of medication error detection and reporting brought by electronic health record (EHRs) system and training.Conclusion: Medication errors showed variability with peaks, troughs, and fluctuations, demonstrating the inter-year coping mechanisms of EHRs system and personnel. Decision makers need to improve the system alongside staff education and some focused departmental attention. Although there has been some improvement in reporting errors, reporting new emerging errors, such as duplication of procedures, necessitates further vigilance in the dispensation of services to patients.Keywords: medication errors, medical error reports, electronic health records, hospital databases, medical error trends
This study asked the questions: what is known and what is not known about medication burden in adults with an intellectual disability. We used a rapid mapping review methodology to collate, describe and catalog the wide variety of evidence in this area. Ninety-one studies were included. Study characteristics, indicators of medication burden and sub-populations at increased risk were catalogued in a table and tabulated as tree maps. The authors concluded that there is evidence of a high medication burden in this population, and that the burden is highest in older adults with an ID, those living in supervised housing and those with diagnosed comorbidities and multi-morbidities. Areas that need further exploration are the total burden of medications used, including the age at which medications are first prescribed and the duration of medication use; the long-term effects of a high medication burden; and the long-term effects of anticholinergic burden. In addition, there is little information on the effects of demographic factors such as race and income.
Purpose:Calcium channel blockers (CCBs) are widely used as first-line therapy for hypertension, but concerns remain regarding their long-term safety and effectiveness. This review aims to systematically summarize the existing evidence on the long-term safety and effectiveness of CCBs in patients with hypertension. Methods:A systematic review was conducted using the PubMed database to identify randomized controlled trials (RCTs), cohort studies, and case-control studies assessing the long-term use (≥1 year) of CCBs in adult hypertensive populations. Eligible studies compared CCBs with other antihypertensive agents or placebo and reported outcomes related to systemic safety and effectiveness. The quality of each study was assessed using the Jadad and Newcastle-Ottawa Scales. Evidence was synthesized descriptively and stratified by organ system and clinical outcome. Results:In total, 29 studies met the inclusion criteria, encompassing both RCTs and observational studies. Long-term CCB use was generally safe, with manageable risks. Renal protective effects were less consistent, while several studies reported a marginal increase in the incidence of new-onset diabetes. Associations with breast cancer remained inconclusive, and the risk of bone fractures appeared modestly reduced. Other systemic effects, including metabolic and reproductive changes, were generally mild. In terms of effectiveness, CCBs consistently reduced stroke incidence, although evidence regarding other cardiovascular outcomes, such as infarction, heart failure, and transient ischemic events, was inconsistent across studies. Conclusion:Overall, CCBs are safe for long-term use and show sustained effectiveness in stroke and angina, although evidence for heart failure, myocardial infarction, and transient ischemic attack remains inconsistent.
Background:Hypersensitivity reaction to hyaluronidase, though rare, can occur following regional anesthesia in ophthalmic surgery and may mimic serious conditions such as orbital cellulitis. Prompt recognition is critical to avoid misdiagnosis and unnecessary interventions. Case Presentation:We report two cases of hypersensitivity reaction following hyaluronidase-augmented peribulbar anesthesia for cataract surgery. Case 1: A 90-year-old female with no prior allergy history developed progressive periorbital edema extending to the ipsilateral face and neck within 7 hours after surgery. Infection and hemorrhage were excluded via ultrasound. The reaction resolved promptly with antihistamines and systemic corticosteroids. Case 2: A 69-year-old female developed progressive bilateral periorbital edema extending to the forehead, accompanied by moderate pain within 7 hours postoperatively. While her C-reactive protein (CRP) level was within normal limits on the day of surgery, it rose significantly to 33.92 mg/L on postoperative day 1. Given this clinical and laboratory progression, an empirical and prophylactic therapeutic protocol was initiated, including a short course of systemic antibiotics alongside intensified anti-inflammatory treatment. All bacterial and fungal cultures returned negative, confirming a non-infectious etiology. Both patients achieved complete resolution of symptoms with uneventful recoveries maintained at both the one-week and one-month postoperative follow-up visits. Conclusion:These cases illustrate that hyaluronidase hypersensitivity, though uncommon, should be considered in the differential diagnosis of acute postoperative periorbital inflammation. A combination of clinical vigilance, targeted imaging, and judicious use of laboratory tests is key to distinguishing this condition from infectious complications. Early diagnosis and a structured management approach are crucial to ensure patient safety and optimal outcomes.
