Commonwealth Medical College

Background The FRAIL questionnaire is a validated screening tool for frailty in geriatric trauma patients that has been associated with functional outcomes and mortality. It includes five components: Fatigue, Resistance, Aerobic, Illness, and Weight Loss. This study aims to determine whether a single component is a better predictor than others of in predicting frailty. Methods A retrospective chart review was conducted on 613 geriatric trauma patients admitted between June and November 2023. Patient demographics, injury severity scores (ISS), and FRAIL questionnaire responses were obtained from electronic health records. Spearman’s rank correlation coefficient (ρ) was used to assess the relationship between each FRAIL component and total FRAIL score. A bootstrap 95% confidence interval (CI) was calculated using 10,000 replicates to evaluate statistical significance. Results All FRAIL components showed significant positive correlations with FRAIL score. Resistance (ability to climb a flight of stairs) had the strongest correlation (ρ = 0.69, 95% CI: 0.65–0.73), followed by Fatigue (ρ = 0.65, 95% CI: 0.61–0.69), Aerobic (ρ = 0.55, 95% CI: 0.50–0.60), Illness (ρ = 0.40, 95% CI: 0.35–0.45), and Weight Loss (ρ = 0.29, 95% CI: 0.24–0.34). Conclusions Resistance, specifically the ability to climb a flight of stairs, is the strongest correlate of frailty in geriatric trauma patients. Its strong correlation with frailty-related outcomes suggests its potential as a simple, rapid, and reliable bedside screening tool to improve risk

Bipolar disorder (BD) is a complex mental disorder that has multiple modes of causality. In this brief review, we used PubMed and Google Scholar databases to conduct an analysis that focuses on the epidemiology, genetics, aberrant developmental processes, environmental influences, and diagnostic criteria of BD. Diagnosis of BD is often associated with several psychiatric disorders. SNPs located in genes, such as CACNA1C and ODZ4 identified by several studies are potential contributors to the etiology of BD. Aberrant neurodevelopmental processes, such as the brain sulcation are shown to be different between the subtypes of BD. Environmental influences including life stressors, substance misuse, smoking, influenza, and the current COVID-19 pandemic have also played a substantial role in individuals developing BD. The goal of this manuscript is to educate the public on current research of possible etiologies and casual factors of BD. This study can be used by others in the science community as a guide for the signs, symptoms, causes, and therapeutic care of BD.

Background: Fentanyl and its derivatives are highly utilized opioid-based analgesics provided to patients in various formulations. The evolving opioid crisis over the past decade has increased pressure on the health care industry to monitor opioid production. Different policies and procedures implemented to contain the crisis from a controlled substance standpoint have changed the utilization patterns of some opioids. A prior report identified 3-fold differences between states in fentanyl use. This study explored fentanyl distribution patterns from 2010 and 2019. Methods: The amount of fentanyl base distributed from 2010 to 2019 was obtained from the Drug Enforcement Administration. Sufentanil, alfentanil, and remifentanil were also analyzed from 2010 to 2017, the most recent year reported. Prescriptions, units, and reimbursement for 2010 and 2019 were obtained from Medicaid and fentanyl prescriber specialty from Medicare Part D. Results: There was a 65.5% decrease in the milligrams of fentanyl per person distributed when correcting for population. From a regional perspective, Ohio had the greatest decrease (-79.3%) while Mississippi saw the smallest (-44.5%). There was a 6.8-fold regional difference in the quantity of fentanyl distributed in 2019 from hospitals (South Dakota = 775.2, Alabama = 113.2 ug/person). The regional difference was also sizeable for pharmacies (6.2-fold, Mississippi = 1,025.3, Washington, D.C. = 165.6). Medicaid reimbursement in 2019 was $165 million for over eight hundred-thousand prescriptions with the majority for generic (99.7%) and injectable (77.6%) formulations. Interventional pain management and anesthesia were overrepresented, and hematology/oncology significantly underrepresented for fentanyl in Medicare. Conclusion: The production and distribution of fentanyl-based substances decreased, although not uniformly, in the United States over the last decade. Additionally, the most prescribed formulations of fentanyl have transitioned away from transdermal, potentially in an effort to regulate its availability. Although impactful, overdose deaths attributed to synthetic opioid deaths continue to increase, highlighting the need for targeted public health interventions beyond the pharmaceutical and medical communities.

Background:Type 1 clinoidal meningiomas (ClinMens) grow from the inferior part of the clinoid process and are closely associated with the internal carotid artery (ICA) and optic apparatus. Surgical challenges stem from the intimal relation with the vascular adventitia and perineurium. Their intimate relationship with vascular and neural structures poses significant challenges for safe resection. This technical note illustrates the feasibility and microsurgical anatomy of a minimally invasive extradural route - the mini-pretemporal approach - applied to a representative case of complex ClinMen. Methods:We describe the surgical management of a 41-year-old female presenting with subacute visual decline due to a large type 1 ClinMen with extensive vascular encasement. Through a limited mini-pterional craniotomy with extradural dissection of the middle fossa and anterior clinoidectomy, access to the paraclinoid region was achieved while minimizing brain retraction. Results:Sequential extradural middle cranial fossa peeling, anterior clinoidectomy, and circumferential sharp dissection of key neurovascular structures were technically feasible and facilitated gross-total resection with visual improvement. Conclusion:The mini-pretemporal approach represents an adaptation of established skull base techniques rather than a new procedure. By combining minimized craniotomy, extradural exposure, and early devascularization, it may facilitate safe and effective resection in selected ClinMens. Further experience in larger cohorts will be necessary to confirm its reproducibility, safety, and comparative advantages over traditional approaches.

Idiopathic hypersomnia is a chronic neurologic sleep disorder that manifests as excessive daytime sleepiness despite normal or prolonged sleep times for age. Frequently, idiopathic hypersomnia is clinically characterized by marked sleep inertia, long and unrefreshing naps, and a high sleep efficiency. Since the initial description, there has been an ongoing evolution of its nomenclature, approach to diagnosis, characterization of symptoms, and determination of the burden of disease. In addition, an increased attention to and study of its epidemiology, neurobiology, and potential therapeutic strategies has begun to contribute to a better approach to identifying and treating it. At present, idiopathic hypersomnia is considered an orphan disease with unknown frequency and the cause is unknown; however, there is evidence to suggest circadian and sleep structure differences, structural brain changes, and neurochemical changes may contribute to the development and expression of this disease. The approach to treatment can be challenging owing to a limited number of approved treatments (calcium, magnesium, potassium, and sodium oxybates) in idiopathic hypersomnia. However, consideration of therapies shown to improve excessive daytime sleepiness in other disorders is frequently employed. Future directions require a clear consensus on the defining characteristics of idiopathic hypersomnia to enhance the opportunity for improved recognition, diagnosis, and treatment strategies to be established. This article provides a historical review of the evolving diagnostic classification of idiopathic hypersomnia, potential insights to the underlying pathophysiology, and a summary of proposed approaches for diagnosis and therapeutic intervention.