Evidence to Support the Use of S-Adenosylmethionine for Treatment of Post-Concussive Sequelae in the Military.

INTRODUCTION: Since the year 2000, over 413,000 service members have sustained traumatic brain injury (TBI) and may present with post-concussive sequelae including headaches, fatigue, irritability, cognitive problems, depression, insomnia, and chronic pain. Although the focus of the article is on military TBI, the usefulness of S-adenosylmethionine (SAMe) would extend to both civilian and military populations. This narrative review examines the preclinical and clinical literature of SAMe's metabolism and alterations seen in disease states such as depressive disorders, pain disorders, fatigue, cognition, dementia, use in pregnancy and peripartum, children, adolescents, and adults, to the elderly with and without dementia, stroke, and neurodegeneration, in order to highlight its potential benefit in post-concussive sequelae after TBI. MATERIALS AND METHODS: A MEDLINE/PubMed and Cochrane Database search was conducted between May 3, 2018 and July 30, 2019 by combining search terms for SAMe with terms for relevant disease states including depression, brain injury, dementia, Alzheimer's disease, Parkinson's disease, cognition, fatigue, and pain. This search retrieved a total of 676 references. 439 were excluded for being over a 10-year publication date, except where clinically relevant. After additional removal of repeated articles, the number of articles were totaled 197. An additional 59 articles were excluded: 10 not in English, 4 duplicates, 4 not original investigations, and 41 outside the scope of this article. The remaining 138 articles were used in this review and included 25 clinical studies, 46 preclinical studies, 63 reviews, and 4 case reports. RESULTS: This narrative review examined the preclinical and clinical literature of SAMe's metabolism and alterations seen in MDD, pain disorders, fatigue, cognition and memory, dementia, and other disorders to highlight the potential benefit of SAMe in post-concussive sequelae in mTBI. The literature showed potential for improvement, safety, and tolerability in these symptom clusters commonly seen in military mild TBI (mTBI). CONCLUSION: There is evidence of a potential benefit of SAMe as an intervention to help with symptoms across the range of post-concussive sequelae and syndromes commonly seen in military mTBI. Since the discovery of SAMe in 1952, this pleiotropic molecule has shown the significance of its involvement in several metabolic cascades in such disparate systems as epigenetics, bioenergetics, DNA methylation, neurotransmitter systems, and potential usefulness in military TBI. Significant limitations include disparate presentations seen in patients with mild TBI, those with post-concussive syndrome, as well as those with comorbid depression and posttraumatic stress disorder. Also, over-the-counter medications are not regulated and SAMe products may vary widely in price and quality. Given the potential for mania in patients with bipolar disorder, evaluation and recommendations should be made by a physician able to evaluate the underlying bipolar diathesis. Furthermore, this narrative review serves as the rationale for future open-label and double-blind placebo-controlled trials in military mTBI and SAMe.

The Orthodox Church and the Mental Health Burden of a Pandemic: A Narrative Mini-Review.

The mental health burden of the recent COVID19 pandemic will be extensive and pervasive likely for many years to come. The stress and anxiety of this event will undoubtedly impact Orthodox communities regardless of location after the world has met the crisis and resumed some sense of normalcy. The assessment of mental health needs among Orthodox Christians remains a largely unstudied phenomenon. A small narrative review was conducted to ascertain ways in which other faith-based organizations have studied mental health in their own communities. While studies that address many minority and immigrant-based faith-based organizations exist, these are limited in scope. Given similarities that exist between minority and immigrant-based faith-based populations and Orthodox communities, a planning framework is suggested to improve an Orthodox response post-pandemic.

The Evolution of the Medical School Deanship: From Patriarch to CEO to System Dean.

Medical school deanship in the US has evolved during the past 200 years as the complexity of the US health care system has evolved. With the introduction of Medicare and Medicaid and the growth of the National Institutes of Health, the 19th-century and first half of the 20th-century role of the medical school dean as guild master transformed into that of resource allocator as faculty practice plans grew in scope and grew as an important source of medical school and university revenue. By 2000, the role of the medical school dean had transformed into that of CEO, with the dean having control over school mission and strategy, faculty practice plans, education, research dollars, and philanthropy. An alternative path to the Dean/CEO model has developed-the System Dean, who functions as a team player within a broader health system that determines the mission for the medical school and the related clinical enterprise. In this paper, the authors discuss the evolution of the medical school dean with respect to scope of authority and role within the health care system.

Financial implications of increasing medical school class size: does tuition cover cost?

INTRODUCTION: In 2006, the Association of American Medical Colleges (AAMC) issued a recommendation that medical schools increase the supply of physicians by 30% to meet the patient needs of the new millennium. OBJECTIVE: To provide financial analysis of the cost of increasing class size. METHODS: To determine the financial consequences of increasing medical student enrollment and in the absence of nationally published cost data for medical schools, adjusted secondary revenue data was analyzed using AAMC and Liaison Committee on Medical Education (LCME) financial data from 2009. Linear regression analysis was used to determine average fixed costs and variable cost per student in USD. RESULTS: In USD, $62,877 represents the best point estimate of the annual variable cost of educating a medical student. CONCLUSION: Comparing this cost to current tuitions and fees of LCME-accredited medical schools suggests that revenues other than tuition are needed to cover increases in class size. Tuition and fees revenue from increasing enrollment will not increase overall revenue to medical schools.

Healing and hope in the midst of devastation: reflections on Katrina in the aftermath of September 11.

This article reflects on Hurricane Katrina within the background and context of 9/11. Included are other tragedies experienced in the School of Medicine when, combined with 9/11, laid the foundation for our continued working through Katrina.

The medical school curate: an examination of student need.

The intense and encompassing nature of medical education can be overwhelming at times. The impact that this effect has on a student can be mitigated if adequately trained, spiritually focused advisors are available and present within the campus setting. This article presents real case examples of, and recommendations for, the role of medical school chaplaincies and why those chaplaincies should be a part of the culture of medical education.