Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis

Minimal hepatic encephalopathy [MHE] represents a part of the spectrum of hepatic encephalopathy [HE]. It can have a far-reaching impact on quality and ability to function in daily life and may progress to overt HE. This study was designed to screen for MHE in drivers with liver cirrhosis in Mansoura, a city in the Nile delta in Egypt. A total of 174 consecutive drivers with positive serology for viral markers and cirrhosis were screened for MHE. Questionnaires and standard psychometric tests and well-informed consent were performed at the same setting. The diagnosis of MHE was made when one or both symbol digit test [SDT] and number connection test [NCT] appeared abnormal. Beck's inventory and Mini Mental State Examination questionnaires were performed for those diagnosed as MHE. After overnight fasting, venous blood samples were taken for haematologic tests and routine liver function tests by conventional methods. Arterial ammonia was also measured. A total of 66 patients showed evidence for MHE out of 139 patients who fulfilled the inclusion criteria. No significant differences were present, apart from a significantly elevated arterial ammonia level [p-value <0.001] and a bad self-reported driving history [p < 0.05] in the MHE-positive group when compared with the MHE-negative group. Multivariate logistic regression revealed that advanced Child-Pugh grade [p < 0.001], hepatitis B virus [HBV]-related a etiology [p < 0.001] and smoking are significant risk factors for MHE. MHE is significantly commoner among Child-Pugh C patients [p < 0.05] when compared with the other Child-Pugh grades. Our data revealed a high prevalence of MHE [47%] among Egyptian drivers with liver cirrhosis. It is hence recommended to include the driving history as well as regular pencil-paper standard psychometric testing in evaluating those at risk, especially in the outpatient setting, for early detection and proper management

Subclinical neurological affection in patients with chronic renal failure

Chronic renal insufficiency is associated with neurological derangements that involve both central and peripheral nervous systems. Subclinical involvement of the nervous system in uremic adults has been detected by certain neurophysiological techniques. The electrical monitoring of the central nervous system has allowed the early detection of uremic neural injury and the evaluation of various treatments employed. Similar studies concerning Egyptian patients are lacking. Therefore, the aim of the present study was to assess subclinical involvement of the central nervous system in Egyptian patients with different degrees of chronic renal dysfunction. A prospective controlled study was carried out. The study included a patient group and a control group. The patient group consisted of 45 chronic renal failure patients [age ranged from 18 to 67 years]. The patient group was primarily designed to include 3 equal groups according to the degree of chronic renal failure. The control group included 15 healthy volunteers. Both patient and control groups were subjected to a clinical, laboratory and electrophysiological assessment. Cognitive function was assessed using the bedside Mini-Mental State Examination [MMSE]. Electrophysiological assessment included Visual Evoked Potentials [VEPs]. Brainstem Auditory Evoked Potentials [BAEPs] and Event-related Potentials [P300]. The whole patient group as well as the three patient groups were comparable to the control group regarding age and sex. MMSE score and P300 amplitude were significantly lower while P300 latency and reaction time were significantly higher in the whole patient group compared to the control group [p=0.03, <0.001. 0.001 and 0.018. respectively]. Various parameters of VEPs and PAEPs were significantly affected in the whole patient group. Furthermore, significant differences were noted among the three patient groups. A significant positive correlation was found between each of serum creatinine, potassium, calcium and phosphorus and each of VEPs and PAEPs. In conclusion. MMSE, P300 VEPs and PAEPs are simple, non-invasive and reliable tools for detection of subclinical involvement of central nervous system in patients with chronic renal failure. Additionally, the more severe the degree of renal Impairment, the more the affected evoked potential parameters. Further more, some of these tools are more sensitive than others detection of early nervous system affection