Background: Handgrip strength (HGS) is a widely used indicator of muscle strength and physical performance, and its recovery in rehabilitation reflects functional improvement. Although polypharmacy is common among older patients and associated with functional decline, its impact on muscle strength recovery during convalescent rehabilitation remains unclear. We investigated the association between polypharmacy and in-hospital HGS recovery and its modification by cognitive function. Methods: This retrospective observational study included patients aged ≥65 years admitted to a convalescent rehabilitation hospital between April 2017 and March 2024. Polypharmacy was defined as using six or more regular prescription medications at discharge. HGS recovery was calculated as the logarithmic ratio of discharge to admission HGS. Multivariate linear regression analyses were performed with stratification by cognitive status, and multivariate logistic regression analysis examined the association between polypharmacy and medications associated with muscle weakness. Results: Among 1,650 patients analyzed, 1,350 had low HGS and 300 had normal HGS at admission. In the low-HGS group, polypharmacy was independently associated with poorer HGS recovery (B=-0.064), corresponding to approximately 6% lower improvement. Stratified analyses showed that the association was significant in patients with cognitive impairment but not in patients without cognitive impairment. No significant association was found in patients with normal HGS. Polypharmacy was strongly associated with use of medications known to adversely affect muscle function. Conclusion Polypharmacy was associated with poorer HGS only in patients with low baseline HGS, and stratified analyses suggested a stronger association in those with cognitive impairment.

Background: This study aimed to reveal demographic data for care-dependent older adults receiving home medical care and to evaluate whether potentially inappropriate medication (PIM) prescriptions were associated with hospitalization and death. Methods: Data of healthcare and long-term care (LTC) insurance claims of older adults aged ≥65 years receiving home medical care in Kure city, Japan, in April 2017 were obtained. They included age, sex, recorded diagnosis on medical claims, level of LTC needs, and medication profile. Hospital admissions and deaths were identified between April 2017 and April 2019. Factors associated with hospitalization/death and PIM (≥1 PIM) defined by the Screening Tool of Older Persons' potentially inappropriate Prescriptions for Japanese were analyzed statistically. Results: A total of 2,052 participants (mean age 86.5±7.4 years, female 71.7%) were included. The mean number of prescribed medications was 6.6±4.3. PIM increased as LTC level became severe (8.7% for support level 1&2; 22.6% for care level 1&2; 26.0% for care level 3–5). Among PIM, H2 receptor antagonists were the most common medication (29.0%), followed by antiplatelet agents (22.6%), magnesium oxide (19.4%), non-benzodiazepine sedatives (17.7%), and benzodiazepines (16.8%). On logistic regression analysis, the number of medications, PIM, and care level 1&2 were associated with a higher likelihood of hospital admission. There was no significant correlation between each PIM and hospital admissions. Regarding death, while age was associated with a higher likelihood, female sex and severe level of disability were associated with a lower likelihood. Conclusion PIM was prevalent among homebound older adults, suggesting that careful medication review should be conducted, especially in those with disability.

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

Tuberculous spondylitis, or so-called Pott's disease, seems to be overlooked because of a lack of severe inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever, weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between Pott's disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory process in Pott's disease tends to spare the disk space, while that of pyogenic infection typically affects the area. Herein, we present a patient with Pott's disease who showed the characteristic clinical and radiological findings.