S-100ß in chronic subdural haematoma: Prospective cohort study.

Chronic subdural haematoma (CSDH) is invariably classified as 'neurotrauma'. However, whilst a history of trauma/fall is frequent, it is usually distant, mild or even absent. Serum S-100ß > 1.38 µg/L is associated with a 100% specificity for mortality/poor outcome acutely after moderate-severe neurotrauma. Serum S-100ß > 0.10 µg/L is used to screen mild neurotrauma cases for emergent neuro-imaging. Serum S-100 in controls is 0.057 µg/L. S-100ß in serum or CSDH fluid (CSDHf) has not been studied. No normal 'subdural fluid' exists to compare CSDHf. We measured serum and CSDHf S-100ß at surgical drainage in a novel prospective single-centre cohort. Of n = 86/86 (100%, M65, age 73 ±â€¯13yrs), n = 66 (76%) reported mild trauma/fall 31 ±â€¯23 days previously. N = 54 (63%) presented with good clinical Markwalder Grade (MG: 0-1). Paired serum and CSDHf S-100ß samples were obtained in n = 45. CSDHf S-100ß (n = 80) was elevated (0.9 ±â€¯0.6 µg/L), was significantly higher than serum S-100ß (n = 51) (0.33 ±â€¯0.05 µg/L, P = 0.002), and was significantly correlated with midline-shift (r = 0.43, P = 0.005) and CSDH volume (r = 0.225, P = 0.046). CSDHf S-100ß was not significantly associated with any demographic factor, co-morbidity or outcome measure. CONCLUSIONS: Despite expectations, S-100ß was elevated in serum CSDH, but was significantly higher in CSDHf. Indeed, CSDHf S-100ß approached serum levels associated with a poor prognosis after acute-neurotrauma. However, CSDHf S-100ß did not represent a biomarker for trauma nor functional outcome. Whilst the non-traumatic source for on-going S-100ß release could not be determined, prolonged compression of an atrophic brain, subsequent CSF leakage, or 'subdural-space' meningeal disruption/proliferation, represent theoretical possibilities. Elevated S-100ß may therefore not be specific for mild-moderate-severe acute neurotrauma. Alternative non-traumatic intra-cranial mechanisms evidently also exist.

Long-term health outcomes in survivors after chronic subdural haematoma.

Chronic subdural haematoma (CSDH) is the most common neurosurgical presentation among the elderly. Although initially considered a non-threatening event, recent studies have highlighted poor long-term survival post-CSDH. Currently, there is a paucity of information regarding long-term health outcome in survivors after CSDH post-intervention. The objective of this research was to assess long-term functional, cognitive, and mental health outcome after CSDH. CSDH patients were administered a telephone-based assessment including a Demographic Questionnaire, Functional Activities Questionnaire (FAQ), Cognitive Telephone Screening Instrument (COGTEL), Mental Health Continuum-Short Form (MHC-SF), and the Geriatric Depression Scale (GDS). Results were obtained in n = 51 patients. CSDH patients were assessed at 5.5 + 2.1 years after CSDH and results were compared to age/gender matched controls (n = 52). Comorbidities were significantly greater in CSDH patients at the time of assessment (χ2 = 35.47, P < .01). CSDH patients demonstrated a significant reduction in functional independence (FAQ, P < .001) and Verbal Short-Term Memory (COGTEL, P = .048). Potential negative trends were observed for Verbal Long-Term Memory (P = .06) and Inductive Reasoning (P = .07). CSDH patients also demonstrated significantly poorer emotional, psychological and social well-being (MHC-SF: Emotional, P = .003; Psychological, P = .001; and Social, P < .001), with increased depressive symptomatology (GDS, P < .001). In addition to known decreased long-term survival, CSDH survivors demonstrated poorer long-term functional, cognitive and mental health outcomes than controls. Pre-existent comorbidities were also more prevalent. CSDH is therefore a sentinel health event: survivors represent a vulnerable group who require long-term, comprehensive, person-centred care. This is the first study of long term CSDH health outcomes.

Ignorance Is Not Bliss: If We Don't Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It? Commentary.

BACKGROUND: Female sexual dysfunction (FSD) affects as many as 1 in every 3 women, with a significant portion of these with hypoactive sexual desire disorder (HSDD). These figures alone present significant psychological and pharmacologic challenges. Partly in response to this situation, in 2015 the US Food and Drug Administration approved flibanserin for the treatment of HSDD. This approval has drawn criticism on the grounds of efficacy and necessity. AIM: To better inform potential consumers about FSD, flibanserin and other interventions for the treatment of HSDD, the importance of understanding the mechanism of FSD, and the efficacy of flibanserin and to review existing relevant knowledge. METHODS: A literature review of extant clinic studies and theoretical discussion articles was performed. OUTCOMES: Efficacy of flibanserin for addressing symptoms associated with HSDD in premenopausal women. RESULTS: Extant literature and empirical evidence suggest that the efficacy of flibanserin for the treatment of HSDD in premenopausal women is at least questionable. CLINICAL TRANSLATION: Clinicians considering the prescription of flibanserin would be well advised to appreciate some of the controversies concerning the efficacy of the drug. STRENGTHS AND LIMITATIONS: The prohibitive usage guidelines, tenuous risk-benefit profile, and considerable cost of use of flibanserin are each worthy of consideration. Flibanserin thus far has been trialed in only a narrow patient range: premenopausal women in long-term relationships with acquired or generalized HSDD. CONCLUSIONS: Although we acknowledge that the discovery and use of flibanserin constitute a compelling narrative, we conclude by questioning the specific efficacy and necessity of flibanserin in providing a treatment for HSDD in women. Anderson R, Moffatt CE. Ignorance Is Not Bliss: If We Don't Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It? COMMENTARY: J Sex Med 2018;15:273-283.