Normalisation of the psychometric encephalopathy score within the Cameroonian population

Background Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. Results A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was − 0.08 ± 1.28 and the cut-off between normal and pathological values was set at − 3 points. PHES of the cirrhotic patients was − 7.66 ± 5.62 points and significantly lower than that of volunteers (p < 0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE. Conclusion PHES cut-off value in Cameroonians is − 3, with MHE prevalence of 74% among cirrhotic patients.

Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

Background: Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. Aim: To standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods: This was a prospective, multicentric study from December 1st, 2018 to July 31st, 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the Number Connection Test-A (NCT-A), Number Connection Test-B (NCT-B), Serial Dotting Test (SDT), Line Tracing Test (LTT) were expressed in seconds and those of the Digit Symbol Test (DST) in points. Results: A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3±15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62±3,9 years in cirrhotic patients. The PHES of the healthy volunteer group was -0.08 ± 1.28 and the cut-off between normal and pathological values was set at −3 points. PHES of the cirrhotic patients was -7.66 ± 5.62 points and significantly lower than that of volunteers (p <0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE.Conclusion: PHES cut-off value in Cameroonians is -3, with MHE prevalence of 74% among cirrhotic patients.

Neurologic Safety of Etomidate-Based Sedation during Upper Endoscopy in Patients with Liver Cirrhosis Compared with Propofol: A Double-Blind, Randomized Controlled Trial

(1) Background: Although etomidate-based sedation is an effective and safe protocol in endoscopic procedures, there is a lack of evidence regarding the safety of etomidate in patients with liver cirrhosis (LC). This study aimed to compare the neurologic safety and efficacy of etomidate and propofol for endoscopic sedation in patients with LC. (2) Methods: From December 2017 to December 2019, consecutive cirrhotic patients who underwent sedative endoscopy using either etomidate or propofol were randomly recruited. The primary endpoint was the number connection test (NCT), and the secondary endpoints included factors for the safety of sedatives during endoscopy. (3) Results: 63 patients were enrolled in each of the etomidate and propofol groups. The NCT times were significantly lower in the etomidate group than in the propofol group. Furthermore, severe or very severe degree of encephalopathy was higher in the propofol group but was not significantly different. Pharmacological properties and the overall incidence of respiratory and cardiovascular events did not differ significantly between the groups. (4) Conclusion: Etomidate-based sedation exacerbates neither subclinical nor overt hepatic encephalopathy. It guarantees efficacies similar to those of propofol regarding rapid sedation, fast recovery, and early discharge, with no increased risk of adverse respiratory or cardiovascular events in patients with LC.

Effect of l-ornithine-l-aspartate therapy on the hyperammonemia level and results of the number connection test of patients suffering from nonalcoholic fatty liver disease

The aim was to study the hyperammonemia level and the duration of implementation of the number connection test (NCT) for patients with nonalcoholic fatty liver disease (NAFLD) in the pre-cirrhosis stage, including effect of the oral administration of L-ornithine-L-aspartate (LOLA) on these indices, and NCT correlation with body chemistry values. Material and methods: the research covered 103 patients with NAFLD to study the hyperammonemia level and other relevant blood chemistry values; we performed NCT before and after the LOLA treatment. The aim was to study the hyperammonemia level and the duration of implementation of the number connection test (NCT) for patients with nonalcoholic fatty liver disease (NAFLD) in the pre-cirrhosis stage, including effect of the oral administration of L-ornithine-L-aspartate (LOLA) on these indices, and NCT correlation with body chemistry values. Material and methods: the research covered 103 patients with NAFLD to study the hyperammonemia level and other relevant blood chemistry values; we performed NCT before and after the LOLA treatment.

Prevalence of Covert Hepatic Encephalopathy in A Tertiary Care Centre

Introduction: Among patients with Hepatic Encephalopathy, prevalence of Minimal HE variesbetween 30-50%. Identifying patients with MHE has been shown to improve with medications anddelay development of Overt HE, however only limited clinicians screen for MHE in patients due totime consuming neuropsychological and neurophysiological tests. The Number Connection Test isan easy way to evaluate patients to diagnose MHE. The aim of this study is to find out the prevalenceof covert hepatic encephalopathy. Methods: The descriptive cross-sectional study was done to find out the prevalence of covert hepaticencephalopathy among patients with chronic liver disease. To diagnose Covert HE which includedMHE as well, NCT was used in Devanagari script. Results: The prevalence of covert hepatic encephalopathy is found to be 56 (58.3%) at 90% confidenceinterval (58.23-58.37%). A total of 96 patients (71.9% male) were diagnosed as HE, with mean age of49.6+11.8 years. The cause of CLD in 85 (88.5%) of these patients was alcohol, of which 76 (79.2%)consumed locally brewed alcohol. Of these 96 patients with HE, only 40 (41.7%) had overt HE.Among all these, maximum patients had MHE (37.5%). Conclusions: Our study showed that although the prevalence of minimal HE is quite high amongcirrhotics, they are usually missed in clinical practice due to absence of symptoms. Active screeningwith easy-to-administer tests, like Number Connection tests, can help identify patients with minimalHE and hence treat them early.

LASER THERAPY FOR MANAGEMENT OF CEREBRAL DYSFUNCTION IN CASES OF ACUTE SEVERE PANCREATITIS

Background.A persistently high mortality rate of patients with pancreatitis is the result of multiple organ failure which is in many aspects associated with developing endogenous intoxication. Pancreatic encephalopathy is one of particular manifestations of this syndrome.Aim of study: to determine severity of cerebral dysfunction in cases of acute destructive pancreatitis, to assess the efficacy of laser therapy for this disease.Material and methods: The research is based on the results of clinical studies, carried out at the Republican Clinical Hospital No.3. Clinical laboratory analysis of 60 patients was conducted. The patients were randomly split into two equal groups: the comparison group (standard therapy) and the basic group (standard therapy and laser therapy). The patients were examined upon admission to hospital and in dynamics (day 1, 3, 5, and 7). The severity of cerebral dysfunction was assessed within controlled terms with the help of RASS and psychometric tests: number connection tests (A and B), “Point in circle”, “Labyrinth”, test of symbols and numbers. The level of endogenous intoxication was evaluated by the amount of hydrophilic (middle molecules) and hydrophobic (common and effective albumin concentration) component.Results. Acute severe pancreatitis led to a marked endogenous intoxication, which manifested itself as an increase in medium molecular weight peptides, decrease in common and effective albumin concentration, growth of toxicity index with regard to normal indices. During all research period the basic group (laser therapy) there was a decrease in medium molecular weight peptides, significant increase in common and effective albumin concentration and a decrease in index toxicity. Psychometric tests revealed a number of deviations from normal indices. At the beginning of the research, a reliable prolongation of time interval during examination tests (the number connection test B, “point in circle”, “Labyrinth”) was noted, and less cells were filled during symbol and number test with regard to normal indices. The subsequent analysis of psychometric tests of patients from the basic group revealed a shortening of time interval during number connection test block B, “Point in circle” and “Labyrinth”. More filled cells during symbol and numbers test were also observed.Conclusion. Results of psychometric tests confirmed latent encephalopathy during endogenous intoxication, associated with acute severe pancreatitis. The laser therapy as a component of complex treatment promotes to decrease severity of endogenous intoxication and manifestation of encephalopathy.

Role of probiotics in the treatment of minimal hepatic encephalopathy in patients with HBV-induced liver cirrhosis

Objective This study was performed to investigate the role of probiotics ( Clostridium butyricum combined with Bifidobacterium infantis) in the treatment of minimal hepatic encephalopathy (MHE) in patients with hepatitis B virus (HBV)-induced liver cirrhosis. Methods Sixty-seven consecutive patients with HBV-induced cirrhosis without overt hepatic encephalopathy were screened using the number connection test and digit symbol test. The patients were randomized to receive probiotics (n = 30) or no probiotics (n = 37) for 3 months. At the end of the trial, changes in cognition, intestinal microbiota, venous ammonia, and intestinal mucosal barriers were analyzed using recommended systems biology techniques. Results The patients’ cognition was significantly improved after probiotic treatment. The predominant bacteria ( Clostridium cluster I and Bifidobacterium) were significantly enriched in the probiotics-treated group, while Enterococcus and Enterobacteriaceae were significantly decreased. Probiotic treatment was also associated with an obvious reduction in venous ammonia. Additionally, the parameters of the intestinal mucosal barrier were obviously improved after probiotic treatment, which might have contributed to the improved cognition and the decreased ammonia levels. Conclusion Treatment with probiotics containing C. butyricum and B. infantis represents a new adjuvant therapy for the management of MHE in patients with HBV-induced cirrhosis.