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J Obstet Gynecol Neonatal Nurs 2021 Jun 8. Epub 2021 Jun 8.

Objective: To critically review and summarize current knowledge regarding the assessment of newborns with neonatal abstinence syndrome (NAS).

Data Sources: We searched the following databases for articles on the assessment of newborns with NAS that were published in English between January 2014 and June 2020: PubMed, CINAHL, and PsycINFO. Keywords and Medical Subject Heading terms used to identify relevant research articles included neonatal abstinence syndrome; Finnegan Scale; eat, sleep, console; epigenetics; genetics; pharmacokinetics; and measurement. Read More

J Biol Chem 2021 Jun 8:100862. Epub 2021 Jun 8.

Stowers Institute for Medical Research, Kansas City, MO 64110; Department of Biochemistry & Molecular Biology, University of Kansas Medical Center. Electronic address:

The Elongin complex was originally identified as an RNA polymerase II (RNAPII) elongation factor and subsequently as the substrate recognition component of a Cullin-RING E3 ubiquitin ligase. More recent evidence indicates the Elongin ubiquitin ligase assembles with the Cockayne syndrome B helicase (CSB) in response to DNA damage and can target stalled polymerases for ubiquitylation and removal from the genome. In this report, we present evidence that the CSB-Elongin ubiquitin ligase pathway has roles beyond the DNA damage response in the activation of RNAPII-mediated transcription. Read More

Prim Care Companion CNS Disord 2021 Jun 10;23(3). Epub 2021 Jun 10.

Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.

To compare outcomes among newborns of opioid-using and nonopioid drug-using mothers with those of control mothers who did not report substance use.

Using the Rochester Epidemiology Project, newborns diagnosed with drug withdrawal syndrome (per or codes) from January 2010 through June 2017 were identified. For mothers, data collected included age, race, drug use, number of prenatal visits, and results of the urinary drug abuse survey, meconium test, and self-report survey. Read More

Clin Exp Nephrol 2021 Jun 11. Epub 2021 Jun 11.

Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan.

Background: Inhibitors of vascular endothelial growth factor (VEGF)-VEGF receptor 2 (VEGFR2) signaling, such as bevacizumab (Bmab), are used for the treatment of various advanced cancers. However, these inhibitors induce renal thrombotic microangiopathy (TMA). Recently, two European cohort studies showed a distinctive histopathological pseudothrombotic pattern different from TMA in Bmab-treated patients. Read More

Medicine (Baltimore) 2021 Jun;100(23):e26324

Faculdades Pequeno Principe.

Rationale: Human parvovirus B19 (B19) infection can produce a spectrum of clinical syndromes, including neurological manifestations, most notably encephalitis. Although symptoms suggestive of autoimmune disease in patients with B19 infection have been previously described, a clear association of autoimmune encephalitis with B19 infection has yet to be established.

Patient Concerns: We describe the case of a 6-year-old boy who was hospitalized due to status epilepticus, which evolved to super-refractory status epilepticus that was only mildly responsive to anticonvulsant drugs. Read More

Medicine (Baltimore) 2021 Jun;100(23):e26313

Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.

Rationale: In coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome refractory to optimal conventional management, we should consider the indication for veno-venous extracorporeal membrane oxygenation (V-V ECMO). Growing evidence indicates that COVID-19 frequently causes coagulopathy, presenting as hypercoagulation and incidental thrombosis. For these reasons, a multifactorial approach with several anticoagulant markers should be considered in the management of anticoagulation using heparin in COVID-19 patients on V-V ECMO. Read More

Ther Clin Risk Manag 2021 4;17:589-599. Epub 2021 Jun 4.

Department of Urology, Albert Einstein College of Medicine, Ardsley, NY, USA.

A need exists for local (ie, bladder-specific) interventions to treat overactive bladder (OAB) with low risk of unwanted postprocedural outcomes. Gene therapy targeted to leverage endogenous physiology in bladder cells may assist in restoring normal cell and organ function. Herein, we review the potential promise of gene therapy for treating OAB, focusing on gene transfer of URO-902, a non-viral naked plasmid DNA expressing the big potassium (BK) channel. Read More

Eur Heart J Case Rep 2021 May 10;5(5):ytab181. Epub 2021 May 10.

Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, U K.

Background: Coronary stent avulsion is a rare, infrequently reported complication of percutaneous coronary intervention (PCI) with no consensus on management options.

Case Summary: This case series presents three descriptions of iatrogenic coronary stent avulsions, and three different bailout management strategies. All patients presented with acute coronary syndrome and required PCI. Read More

Cureus 2021 May 4;13(5):e14835. Epub 2021 May 4.

Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA.

The intrathecal drug delivery system (IDDS) is successfully utilized for the treatment of chronic pain conditions; however, they are associated with complications related to human error and system failure. A case report is presented of a patient with opioid withdrawal (OW) secondary to assumed catheter microfracture. Interrogation of the IDDS allowed for the collection of pre- and post-treatment/stabilization cerebrospinal fluid (CSF), which is used to investigate the possible physiological determinants of OW. Read More

Int J Nurs Stud 2021 May 10;120:103975. Epub 2021 May 10.

Department of Heart Disease, Bellvitge University Hospital, IDIBELL, Barcelona, Spain. Electronic address:

Background: The ageing of the population is leading to an increase in the number of elderly patients with acute myocardial infarction. These patients are at higher risk for complications and poor medication adherence, which in turn are associated with higher healthcare resource expenditures. Nursing programmes might help to improve adherence in these complex patients. Read More

Addiction 2021 Jun 7. Epub 2021 Jun 7.

RAND Corporation, Pittsburgh, PA.

Aims: To estimate the association between punitive policies for women with substance use during pregnancy and odds of neonatal abstinence syndrome (NAS) diagnosis among Medicaid-insured infants, and to estimate this association controlling for the presence of four other policies related to substance use in pregnancy.

Design, Setting, And Participants: Analysis of live births in Medicaid claims data from 39 US states in varying years between 2006 and 2014 using weighted generalized linear models with clustered standard errors and state and year fixed effects.

Measurements: NAS rates in states without punitive policies were compared with rates in states with policies before and after policy enactment using logistic regression models adjusted for individual and county-level factors and including state and year fixed effects. Read More

Cardiol J 2021 Jun 7. Epub 2021 Jun 7.

Department of Cardiology, Center for Heart Diseases, Military Hospital, Wroclaw, Poland.

The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Read More

Front Immunol 2021 19;12:667430. Epub 2021 May 19.

Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.

Background: Autoinflammatory phospholipase Cγ2 (PLCγ2)-associated antibody deficiency and immune dysregulation (APLAID) is a rare autoinflammatory disease caused by gain-of-function mutations in the gene. Here we report a rare case of APLAID patient carrying a novel heterozygous missense I169V mutation with gangrenous pyoderma and concomitant high serum immunoglobulin (Ig) E level.

Methods: The patient was diagnosed as APLAID and has been treated in our department. Read More

Front Neurol 2021 20;12:673135. Epub 2021 May 20.

Pediatric Neurology and Epileptology Unit, Brotzu Hospital Trust, Cagliari, Italy.

Purified cannabidiol (CBD) was administered to highly refractory patients with Dravet (DS) or Lennox-Gastaut (LGS) syndromes in an ongoing expanded access program (EAP). Herein, we report interim results on CBD safety and seizure outcomes in patients treated for a 12-month period. Thirty centers were enrolled from December 2018 to December 2019 within the open-label prospective EAP up to a maximum of 25 mg/kg per day. Read More

J Clin Exp Hepatol 2021 May 31. Epub 2021 May 31.

Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain.

Background & Aims: The evidence suggests that most vulnerable subjects to COVID-19 infection suffer from patients with comorbidities or immunosuppression, including liver transplant recipients. Liver graft dysfunction may be a rare complication. Some patients complain about the post-COVID-19 syndrome. Read More

Gut 2021 Mar 18. Epub 2021 Mar 18.

Gastroenterology and Hepatology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands

Objective: Despite regular colonoscopy surveillance, colorectal cancers still occur in patients with Lynch syndrome. Thus, detection of all relevant precancerous lesions remains very important. The present study investigates Linked Colour imaging (LCI), an image-enhancing technique, as compared with high-definition white light endoscopy (HD-WLE) for the detection of polyps in this patient group. Read More

PLoS One 2021 3;16(6):e0248476. Epub 2021 Jun 3.

Southwest Health Equity Research Collaborative, Northern Arizona University, Flagstaff, Arizona, United States of America.

In this paper, we describe a population of mothers who are opioid dependent at the time of giving birth and neonates exposed to opioids in utero who experience withdrawal following birth. While there have been studies of national trends in this population, there remains a gap in studies of regional trends. Using data from the Arizona Department of Health Services Hospital Discharge Database, this study aimed to characterize the population of neonates with neonatal opioid withdrawal syndrome (NOWS) and mothers who were opioid dependent at the time of giving birth, in Arizona. Read More

Clin Transl Sci 2021 Jun 3. Epub 2021 Jun 3.

Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia.

Results from BBORN, a previous phase III trial in infants with neonatal opioid withdrawal syndrome (NOWS), demonstrated that sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than the comparator, oral morphine. Objectives of BPHORE, a new trial with buprenorphine in a similar population were to 1) optimize initial dose, up-titration to achieve symptom control and weaning steps of pharmacologic treatment and 2) investigate safety of the revised regimen. A pharmacodynamic model linked buprenorphine exposure to NOWS symptom scores. Read More

J Bone Miner Res 2021 Jun 2. Epub 2021 Jun 2.

Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands.

Denosumab (Dmab) treatment can benefit patients with fibrous dysplasia/McCune-Albright syndrome (FD/MAS) by suppressing the receptor activator of nuclear factor κB ligand (RANKL)-mediated increased bone resorption. However, limited data of two pediatric cases indicate that a rebound phenomenon may occur after withdrawal. Therefore we studied the safety of Dmab discontinuation in FD/MAS. Read More

Infect Dis Rep 2021 May 24;13(2):448-453. Epub 2021 May 24.

Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.

Tenofovir disoproxil fumarate (TDF) is used worldwide to treat and prevent Human Immunodeficiency Virus (HIV) infection. Fanconi syndrome is a complication of TDF use and is characterized by inadequate reabsorption of glucose, phosphate and protein in the proximal tubule of the kidney which may eventually lead to osteomalacia manifested by symptoms of pain, muscular weakness and difficulty ambulating. We present a patient with severe osteomalacia due to progressive and unrecognized Fanconi's syndrome, who responded rapidly to TDF withdrawal, oral phosphate repletion and calcitriol. Read More

J Clin Med 2021 May 26;10(11). Epub 2021 May 26.

Medical Center, Department of Psychiatry, Radboud University, 6525 GA Nijmegen, The Netherlands.

The gamma-hydroxybutyric acid (GHB) withdrawal syndrome can have a fulminant course, complicated by severe complications such as delirium or seizures. Detoxification by tapering with pharmaceutical GHB is a safe way to manage GHB withdrawal. However, a detailed description of the course of the GHB withdrawal syndrome is currently lacking. Read More

Molecules 2021 May 28;26(11). Epub 2021 May 28.

Department of Pharmaceutical Chemistry, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria.

Opioids are the most effective analgesics, with most clinically available opioids being agonists to the µ-opioid receptor (MOR). The MOR is also responsible for their unwanted effects, including reward and opioid misuse leading to the current public health crisis. The imperative need for safer, non-addictive pain therapies drives the search for novel leads and new treatment strategies. Read More

Addiction 2021 May 31. Epub 2021 May 31.

Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center.

Background And Aims: Increased alcohol consumption has been proposed as a potential consequence of the coronavirus disease 2019 (COVID-19) pandemic. There has been little scrutiny of alcohol use behaviors resulting in hospital visits, which is essential to guide pandemic public policy. We aimed to determine whether COVID-19 peak restrictions were associated with increased hospital visits for alcohol use or withdrawal. Read More

Seizure 2021 May 24;91:5-8. Epub 2021 May 24.

Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Box 29, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK.

We describe real-world experience with cannabidiol (CBD) in adults with Dravet Syndrome (DS) via GW Pharma early access programme at two UK neurology centres. Adults with genetically-confirmed DS had CBD added to existing therapy, titrated up to 20 mg/kg, as tolerated. The primary outcome measure was percentage reduction in convulsive seizures. Read More

Psychiatry Res 2021 May 20;302:114023. Epub 2021 May 20.

School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. Electronic address:

Burnout is currently operationalised as comprising of exhaustion, depersonalization and reduced personal accomplishment. However, questions have been raised as to whether this three-factor model accurately characterises the syndrome. We therefore sought to re-examine burnout's key symptoms and to develop a new model of the syndrome. Read More

J Pediatr 2021 May 27. Epub 2021 May 27.

Rady Children's Hospital and University of California San Diego, San Diego, CA.

Objective: To investigate the efficacy and safety of sildenafil added to inhaled nitric oxide (iNO) for newborn infants with persistent pulmonary hypertension of newborn (PPHN) or hypoxic respiratory failure (HRF) at risk of PPHN.

Study Design: Part A of a multinational, randomized, double-blind, placebo-controlled trial. Infants ≤96hrs-old, >34 weeks of gestation, receiving iNO (10-20ppm on ≥50% FiO) for PPHN or HRF at risk of PPHN, and oxygen index >15-<60, were randomized (1:1) to IV sildenafil (loading: 0. Read More

J Addict Med 2021 May 26. Epub 2021 May 26.

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (ABC, NC); Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada (TC, NC).

Alcohol use disorder and gastric bypass surgery are highly comorbid. Alcohol withdrawal syndrome (AWS) is a common and potentially life-threatening event, requiring nuanced and individually tailored management depending on various clinical factors including patient history, alcohol consumption, comorbidities, and timeline of use. Although increasingly common, the literature for managing alcohol withdrawal in the gastric bypass population is quite limited. Read More

Clin Gastroenterol Hepatol 2021 May 25. Epub 2021 May 25.

University of Michigan Health System, Ann Arbor, Michigan.

Background And Aims: Tegaserod is a 5-HT receptor agonist approved for irritable bowel syndrome with constipation in women <65 years of age without a history of cardiovascular ischemic events. Safety data are presented from 2 external adjudications from the 2018 Gastrointestinal Drugs Advisory Committee meeting supporting tegaserod's reintroduction after its voluntary 2007 withdrawal. Withdrawal was based on an internal adjudication using pooled placebo-controlled tegaserod data to identify potential cardiovascular ischemic signals. Read More

J Med Case Rep 2021 May 26;15(1):287. Epub 2021 May 26.

Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.

Background: The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. Read More

BMC Med Inform Decis Mak 2021 05 20;21(1):162. Epub 2021 May 20.

BlackThorn Therapeutics, 780 Brannan St., San Francisco, CA, 94103, USA.

Background: Heterogeneity among patients' responses to treatment is prevalent in psychiatric disorders. Personalized medicine approaches-which involve parsing patients into subgroups better indicated for a particular treatment-could therefore improve patient outcomes and serve as a powerful tool in patient selection within clinical trials. Machine learning approaches can identify patient subgroups but are often not "explainable" due to the use of complex algorithms that do not mirror clinicians' natural decision-making processes. Read More