The effect of the COVID-19 pandemic on opioid prescribing for patients with pleuritic pain.

OBJECTIVE: We sought to understand opioid prescribing for COVID-19 positive and negative patients with pleuritic pain during the first wave of the pandemic. We hypothesized that patients without COVID-19 would be prescribed opioids more frequently intrapandemic compared to prepandemic and postulated that COVID-19 patients would be prescribed opioids more frequently and at greater quantity than their peers. DESIGN: A retrospective observational analysis of electronic health record data. SETTING: A quaternary academic hospital from February through April 2020. PARTICIPANTS: A total of 1,400 of 3,169 adult inpatient hospitalizations involving pleuritic pain were included. MAIN MEASURES: Frequency and average daily dose of opioid prescriptions were analyzed using logistic and linear regression. Opioid prescribing habits were compared pre- and intrapandemic. Hypotheses and primary outcome measures were formulated prior to data collection. KEY RESULTS: During the pandemic, COVID-19 patients were 15.77 absolute percentage points less likely to be prescribed opioids compared to patients without COVID-19 (95 percent confidence interval (CI): -8.98 to -22.56 percent). Patients without COVID-19 were equally likely to be prescribed opioids pre- and intrapandemic (95 percent CI: -9.37 to 2.42 percent). Odds ratio of opioid prescription for COVID-19 patients was 0.44 (95 percent CI: 0.08-0.80). Within those given opioids, COVID-19 patients were prescribed 3.0 percent greater morphine milligram equivalents (MMEs) (95 percent CI: 1.07-5.85 percent). CONCLUSION: During the first wave of the pandemic, COVID-19 patients with pleuritic pain were prescribed opioids less frequently than patients without COVID-19, while patients without COVID-19 were equally likely to be prescribed opioid pre- and intrapandemic. On the other hand, COVID-19 patients treated with opioids were given greater daily MMEs due to the greater utilization of opioid infusions.

Neuroleptic Malignant Syndrome: A Case Aimed at Raising Clinical Awareness.

A 60-year-old man with a history of bipolar disorder on risperidone, bupropion, and escitalopram was admitted for community acquired streptococcal pneumonia. Four days later, he developed persistent hyperthermia, dysautonomia, rigidity, hyporeflexia, and marked elevation of serum creatine phosphokinase. He was diagnosed with neuroleptic malignant syndrome (NMS) and improved with dantrolene, bromocriptine, and supportive therapy. This case emphasizes the importance of considering a broad differential diagnosis for fever in the ICU, carefully reviewing the medication list for all patients, and considering NMS in patients with fever and rigidity.

Electrical synapses formed by connexin36 regulate inhibition- and experience-dependent plasticity.

The mammalian brain constantly adapts to new experiences of the environment, and inhibitory circuits play a crucial role in this experience-dependent plasticity. A characteristic feature of inhibitory neurons is the establishment of electrical synapses, but the function of electrical coupling in plasticity is unclear. Here we show that elimination of electrical synapses formed by connexin36 altered inhibitory efficacy and caused frequency facilitation of inhibition consistent with a decreased GABA release in the inhibitory network. The altered inhibitory efficacy was paralleled by a failure of theta-burst long-term potentiation induction and by impaired ocular dominance plasticity in the visual cortex. Together, these data suggest a unique mechanism for regulating plasticity in the visual cortex involving synchronization of inhibitory networks via electrical synapses.