Métodos diagnósticos de la encefalopatía hepática en la atención primaria de salud: Revisión sistemática

La encefalopatía hepática consiste en la disfunción o deterioro cerebral, consecuente a afecciones como insuficiencia hepática e hipertensión portal, en el ámbito médico es catalogada como una grave complicación clínica asociada al daño hepático severo. Se llevó a cabo un estudio cualitativo de revisión sistemática aplicando la declaración PRISMA 2020, en donde se utilizó los documentos disponibles en las diferentes bases de datos y con la aplicación de los operadores booleanos para su búsqueda. De los documentos seleccionados se pudieron obtener 840 referencias de información en una primera búsqueda en las bases de datos y 8 registros de datos. Finalmente, para la investigación se consiguió un total de 16 fuentes bibliográficas. La encefalopatía hepática se compone de un síndrome neuro-psiquiátrico que incluye deterioro psicomotor y/o sensitivo, desorientación, incoordinación, alteración de la memoria, confusión, somnolencia, estupor y coma, existen diversas herramientas para el diagnóstico desde el primer nivel de atención, una de las principales es la anamnesis y la exploración física del paciente donde se espera encontrar hallazgos cognitivos y neuromusculares relacionados a la enfermedad hepática grave, entre los estudios complementarios se emplea principalmente exámenes de laboratorio, Criterios de West Haven, prueba psicométrica, prueba neurofisiológica y estudios de neuroimagen como resonancia magnética.

Hepatic encephalopathy consists of brain dysfunction or deterioration, consequent to conditions such as hepatic insufficiency and portal hypertension, and in the medical field it is cataloged as a serious clinical complication associated with severe liver damage. A qualitative study of systematic review was carried out applying the PRISMA 2020 statement, using the documents available in the different databases and Boolean operators for the search. From the selected documents it was possible to obtain 840 references of information in a first search in the databases and 8 data records. Finally, a total of 16 bibliographic sources were obtained for the research. Hepatic encephalopathy is composed of a neuropsychiatric syndrome that includes psychomotor and/or sensory impairment, disorientation, incoordination, memory alteration, confusion, somnolence, stupor and coma, there are several tools for diagnosis from the first level of care, One of the main ones is the anamnesis and physical examination of the patient where it is expected to find cognitive and neuromuscular findings related to severe liver disease, among the complementary studies are mainly used laboratory tests, West Haven Criteria, psychometric test, neurophysiological test and neuroimaging studies such as magnetic resonance imaging.

A encefalopatia hepática consiste na disfunção ou deterioração cerebral, consequente a condições como a insuficiência hepática e a hipertensão portal, e é classificada no domínio médico como uma complicação clínica grave associada a lesões hepáticas graves. Foi efectuado um estudo de revisão sistemática qualitativa aplicando a declaração PRISMA 2020, utilizando os documentos disponíveis nas diferentes bases de dados e operadores booleanos para a pesquisa. A partir dos documentos selecionados, foi possível obter 840 referências de informação numa primeira pesquisa nas bases de dados e 8 registros de dados. Por fim, obteve-se um total de 16 fontes bibliográficas para a investigação. A encefalopatia hepática é uma síndrome neuropsiquiátrica que inclui comprometimento psicomotor e/ou sensorial, desorientação, incoordenação, comprometimento da memória, confusão, sonolência, estupor e coma, e existem várias ferramentas para o diagnóstico no primeiro nível de cuidados, Um dos principais instrumentos é a anamnese e o exame físico do doente, onde se esperam encontrar achados cognitivos e neuromusculares relacionados com a doença hepática grave. Os estudos complementares incluem testes laboratoriais, os critérios de West Haven, testes psicométricos, testes neurofisiológicos e estudos de neuroimagem, como a ressonância magnética.

Síndromes epilépticos neonatales / Neonatal epileptic syndromes

Resumen Los síndromes epilépticos neonatales hacen parte de las epilepsias de origen genético y metabólico en este grupo edad y aunque no son la causa más frecuente de crisis neonatales, su reconocimiento temprano permite dirigir mejor su enfoque diagnóstico y tratamiento. Pue den clasificarse en síndromes neonatales autolimitados y encefalopatías epilépticas y del desarrollo infantil temprano (EIDEE). Aunque pueden mostrar semiología similar en algunos tipos de crisis, como las secuenciales, e incluso comparten alteraciones en genes comunes en su etiología, su evolución es muy diferente. En los sín dromes autolimitados, las crisis remiten en los primeros meses de vida alcanzando un desarrollo psicomotor nor mal, lo que da su nombre de autolimitado; sin embargo, el término benigno no debe utilizarse dado que algunos pueden presentar recurrencia de crisis, trastornos del movimiento o trastornos del aprendizaje. En las EIDEE las crisis suelen ser refractarias al tratamiento y se comprometen funciones cerebrales y el neurodesarrollo. En esta revisión describiremos el fenotipo electroclínico de los síndromes epilépticos neonatales, los genes más frecuentemente involucrados y su espectro clínico, su enfoque diagnóstico, así como los tratamientos reco mendados.

Abstract Neonatal epileptic syndromes are part of the genetic and metabolic epilepsies in this age group. Although they are not the most frequent cause of neonatal sei zures, their early recognition allows for better diagnostic and therapeutic approaches. These syndromes can be classified into self-limited neonatal syndromes and early infantile epileptic and developmental encephalopathies (EIDEE). While they may share semiology in some types of seizures, such as sequential, and even share altera tions in common genes in their etiology, their evolution is very different. In self-limited neonatal syndromes, seizures typically resolve within the first months of life with normal psychomotor development, giving rise to the term self-limited. However, the term benign should not be used as some may present recurrence of seizures, movement disorders, or learning disorders. In the case of EIDEE, seizures are usually refractory to treatment, affecting brain functions and neurodevelopment. In this review, our aim was to describe the electro clinical phenotype of neonatal epileptic syndromes, the most frequently involved genes and their clinical spectrum, their diagnostic approach, as well as the rec ommended treatments.

Hipotermia terapéutica: estudio descriptivo de una cohorte de 10 años en un hospital público de alta complejidad / Therapeutic hypothermia: A descriptive, cohort study conducted over 10 years at a tertiary care public hospital

Introducción. La hipotermia terapéutica (HT) reduce el riesgo de muerte o discapacidad en niños con encefalopatía hipóxico-isquémica (EHI) moderada-grave. Objetivo. Describir una población de pacientes con EHI que requirió HT y su evolución hasta el alta hospitalaria. Población y métodos. Estudio descriptivo de cohorte retrospectivo. Se analizaron todos los pacientes que ingresaron a HT entre 2013 y 2022. Se evaluaron datos epidemiológicos, clínicos, de monitoreo, tratamiento, estudios complementarios y condición al alta. Se compararon los factores de riesgo entre pacientes fallecidos y sobrevivientes, y de estos, los que requirieron necesidades especiales al alta (NEAS). Resultados. Se incluyeron 247 pacientes. Mortalidad: 11 %. Evento centinela más frecuente: período expulsivo prolongado (39 %). Inicio del tratamiento: mediana 5 horas de vida. Convulsiones: 57 %. Eritropoyetina intravenosa: 66,7 %. Patrón anormal de monitoreo de función cerebral: 52 %. Normalización del monitoreo: mediana 24 horas. Resonancia magnética patológica: 42 %. Variables predictoras de mortalidad: Sarnat y Sarnat grave, y ecografía patológica al ingreso. Conclusión. La mortalidad global fue del 11 %. Las derivaciones aumentaron en forma más evidente a partir del año 2018. El horario de inicio de HT fue más tardío que en reportes anteriores. Los signos neurológicos de gravedad según la escala de Sarnat y Sarnat y la ecografía cerebral basal patológica fueron predictores independientes de mortalidad al alta. Los pacientes con NEAS presentaron normalización del trazado del electroencefalograma de amplitud integrada más tardío. El hallazgo más frecuente en la resonancia fue la afectación de los ganglios basales. No se encontraron diferencias clínicas ni de complicaciones estadísticamente significativas entre los pacientes que recibieron eritropoyetina.

Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

The clinical, laboratory, etiological profile and outcome of acute necrotising encephalitis of childhood in tertiary care centre from western India

Acute necrotising encephalopathy of childhood (ANEC) is an encephalopathy that presents with viral prodrome accompanied by episodes of seizures and rapid alteration of consciousness. Many patients had a previous history of febrile illness before neurological worsening. Though there is no definite genetic cause, few genes are involved in familial forms of the disease. Geographically this disease is seen in East Asian countries involving infantile and childhood age. Radiological evaluation classically shows lesions involving thalami, cerebellum, brainstem, and white matter. We hereby report 4 cases hospitalized at a tertiary health care hospital with classical presentation, hallmark radiographic, and hematological picture. All four patients presented with varied neurological involvement including altered consciousness, status dystonicus, trismus, and status epilepticus following an acute febrile illness. Radiological involvement is classical in all with damage to the thalami, cerebellum, brainstem, and white matter, though the neurological presentation, duration, and outcome of all varied. All these 4 patients were thoroughly investigated and out of them 3 were managed with IVIG and MPS, the rest one with an immunosuppressive state managed symptomatically in a conservative manner, and all four were discharged with varied neurological morbidities. All of them offered symptomatic medical management, and physiotherapy from experts. ANEC is an acute deteriorating neurological disorder with a prior history of febrile illness. Neurological illness has hallmark clinical presentation with classical symmetrical brain involvement including thalami, cerebellum, brainstem, and white matter. Though having a varied clinical spectrum, it has responded well to immunotherapy by anti-inflammatory agents including IVIG and MPS.

A treatable early onset epileptic encephalopathy: pyridoxamine 5'-phosphate oxidase deficiency

Pyridox (am) ine 5'-phosphate oxidase (PNPO) deficiency is a rare epileptic encephalopathy condition due to mutations in PNPO gene. It is one of treatable metabolic epilepsies. It is unresponsive to antiseizure medications, but respond to pyridoxal-5-phosphate (PLP), active form of vitamin B6. It is characterized by refractory seizures from newborn or in utero, developmental delay. Based on refractory seizures, age of onset, negative biochemical profile and response to PLP, suspect PNPO deficiency. Next generation sequencing will help in the diagnosis. Early diagnosis and early initiation of PLP will help to cessation of seizures and better neurological outcome. Here we present a case of PNPO deficiency, which is diagnosed early and noticed good response with PLP.

Magnetic resonance imaging findings in acute febrile encephalopathy in children

Background: This prospective observational study aims to study magnetic resonance imaging (MRI) findings in the setting of acute febrile encephalopathy in children between 1 month to 18 year of age group.Methods: This study was conducted in patients of acute febrile encephalopathy admitted in pediatric intensive care unit (PICU) at tertiary care centre during January 2019 to December 2019 in age group one month to 18 years. 32 patients satisfied the inclusion criteria.Results: Of the 32 patients included in the study MRI was done in 28 patients. MRI brain was normal in 17 patients and abnormalities were found in 11 patients. Majority findings were cerebral enema and restricted diffusion 3 (10.5%). Other findings were T2 hyperintensity and FLAIR hyperintensity lesion in basal ganglia and thalami region 2 (7%), T2 and FLAIR hyperintensity hippocampal lesion in hippocampus 2 (7%), haemorrhagic lesion 1 (3.5%).Conclusions: Acute febrile encephalopathy is a life-threatening condition. It is important to identify the possible aetiology for directing specific treatment. Amongst others MRI is one modality that has the potential to identify possible aetiology. Paediatric intensive care physicians are not always updated regarding utility of MRI and its findings in acute febrile encephalopathy. The main reason being non-inclusion of this subject in curriculum. This study was intended to understand all the possible MRI findings in acute febrile encephalopathy, correlate it with clinical findings and ultimately aid in management of these cases.

Clinico-etiological profile of acute liver failure in children in a tertiary care hospital of northernmost India

Background: Acute liver failure is a life-threatening condition with sudden onset liver injury, decreased liver functions, hepatic encephalopathy, and coagulopathy in patients without preexisting liver disease. The objective of this study was to find out the clinical and etiological factors of acute liver failure in children.Methods: This study was a hospital based prospective observational study conducted from November 2017 to October 2019 at Pediatric Intensive Care Unit (PICU) of Postgraduate Department of Pediatrics, Government Medical College Srinagar, Kashmir. Fifty-one consecutive patients of ALF in the age group of 1 to 18 years were included in this study.Results: The most common clinical presentation in our study was jaundice which was present in all cases followed by anorexia (90.2%), vomiting (84.3%), fever (76.5%) and abdominal pain (64.7%). HE was present at admission in 54.9% cases and exaggerated DTR抯 was present in 49% cases. Of the other clinical manifestations, bleeding was present in 49% cases, ascites in 33.3% cases and edema in 5.9% cases. Infections (76.5%) were the most common cause of ALF in children followed by indeterminate (9.8%), autoimmune (5.9%), drug induced (3.9%), Wilson抯 disease (2%) and HLH (2%). In infectious etiology, the most common cause was Hepatitis A (66.7%) followed by Enteric fever (7.8%) and Hepatitis E (2%).Conclusions: The most common clinical manifestation of ALF in children is Jandice. Hepatitis A is the most common cause of ALF in children.

Screening of infants and young children with hyperbilirubinemia for sensorineural hearing impairment: an institutional study

Background: Jaundice is one of the most common problems occurring in newborns. Severe neonatal hyperbilirubinemia is a common cause of sensory neural hearing loss. It is important to identify and treat the jaundice early, to prevent complications like encephalopathy leading to hearing loss. Early detection of hearing loss is important for early intervention. The aim of the study was to evaluate the prevalence of sensorineural hearing loss (SNHL) in children with hyperbilirubinemia and to correlate the degree of hearing loss with degree of hyperbilirubinemia. Methods: The 50 cases including newborn and young children (<12 years of age) having history of hyperbilirubinemia and exchange transfusion were included in this study. After the approval and clearance from institutional ethical committee, this study was conducted from April 2021 to March 2022 in the department of ENT, govt. medical college Amritsar in co-ordination with department of pediatrics. Results: On comparing brain stem evoked response audiometry (BERA) and otoacoustic emissions (OAE) results, it was found that out of 50 patients BERA was abnormal in 8 patients while 42 had normal BERA. 18% (9) patients had abnormal OAE results out of which 7 had bilateral REFER result while 2 had unilateral REFER result. On comparing the OAE and BERA for sensitivity and specificity, the sensitivity was 92.9% in right ear while specificity was 62.5%, whereas in left ear sensitivity was 95.2% while specificity was 75%. Conclusions: According to our study the prevalence of sensorineural hearing impairment comes out to be 16% as per BERA. BERA is more sensitive and specific as compared to OAE. But still OAE can be used as screening test considering the cost factor and ease of conducting OAE test while BERA is a confirmatory test for SNHL.

Never Before Exposed: Borassus Flabellifer’s Shadow on Liver Health

The last stage of many hepatic diseases, including hepatitis, is cirrhosis. The liver's vital function in detoxifying xenobiotics—such as medications and toxic composites—is the subject of much research. Liver cirrhosis is the cause of alterations in the liver's architecture that mostly affect protein binding, blood circulation, and the enzymes that break down medicinal substances. The main reason why therapeutic metabolising enzymes disappear is because to liver towel loss. However, not all enzyme activity is decreased in tandem; some are only changed in one specific case. This case report focuses on the clinical features, diagnostic evaluation, and therapeutic concerns of a patient having liver cirrhosis. Further research and advancements in our comprehension of the pathogenesis and treatment of cirrhosis are necessary in order to enhance outcomes and minimise the burden of this illness on those who are impacted.

Falla hepática aguda fulminante secundaria a dengue severo en un niño: reporte de un caso / Fulminant acute liver failure secondary to severe dengue in a child: case report

RESUMEN El dengue es una enfermedad infecciosa frecuente en áreas tropicales como Perú. Este virus puede producir complicaciones poco reportadas y potencialmente fatales como la falla hepática aguda. Reportamos el caso de un niño de 7 años que presentó fiebre, cefalea y dolor abdominal. En la ecografía se encontró hepatomegalia y en los laboratorios se observó trombocitopenia severa y elevación de transaminasas. Durante la hospitalización fue diagnosticado como dengue severo y desarrolló falla hepática aguda, injuria renal y encefalopatía. A pesar del manejo de soporte y la ventilación asistida, desarrolló disfunción orgánica múltiple con refractariedad a fluidos y fuga capilar. La falla hepática aguda secundaria a dengue severo es una complicación rara con desenlace desfavorable.

ABSTRACT Dengue is a common infectious disease in tropical areas such as Peru. This virus can cause underreported and potentially fatal complications such as acute liver failure. We report the case of a 7-year-old boy who presented with fever, headache, and abdominal pain. On ultrasound, we found hepatomegaly and labs severe thrombocytopenia and elevated transaminases. During hospitalization he was diagnosed with severe dengue and developed acute liver failure, kidney injury, and encephalopathy. Although intensive care management and assisted ventilation, he developed multiple organ dysfunctions with fluid refractoriness and capillary leak. Acute liver failure secondary to severe dengue is a rare complication with an unfavorable outcome.

Dopamine Dynamics in the Amygdala Influence Emotional Changes in the Early Stage of Systemic Inflammatory Response Syndrome in Rats / La Dinámica de la Dopamina en la Amígdala Influye en los Cambios Emocionales en la Etapa Temprana del Síndrome de Respuesta Inflamatoria Sistémica en Ratas

SUMMARY: Systemic inflammatory response syndrome (SIRS) is a potentially fatal reaction to various forms of tissue damage and infections that cause damage to various organs. Furthermore, the brain is damaged earlier than other organs, resulting in diffuse brain dysfunction. The central clinical symptom of SIRS is delirium and emotional changes are involved in disease development. Although the amygdala is known to play a major role, the mechanisms underlying emotional changes in the early stages of SIRS have not been elucidated. Therefore, changes to dopamine levels in the amygdala were observed using an in vivo model of lipopolysaccharide (LPS)- induced SIRS to clarify the biochemical mechanisms activated in the early stages of SIRS. Extracellular dopamine was collected from the amygdala of free moving rats via microdialysis and then analyzed by high-performance liquid chromatography. In addition, emotional changes were assessed with the open field and sucrose preference tests. In the LPS group, dopamine release in the amygdala increased remarkably immediately after LPS administration, peaking at 120 min. Thereafter, dopamine release temporarily decreased, but then significantly increased again after 180 min. The present results suggest that diffuse brain dysfunction in the early stages of SIRS may involve altered dopamine levels in the amygdala.

El síndrome de respuesta inflamatoria sistémica (SRIS) es una reacción potencialmente fatal a diversas formas de daño tisular e infecciones que causan injuria a varios órganos. Además, el cerebro se daña antes que otros órganos, lo que provoca una disfunción cerebral difusa. El síntoma clínico central del SIRS es el delirio y los cambios emocionales están involucrados en el desarrollo de la enfermedad. Aunque se sabe que la amígdala desempeña un papel importante, no se han dilucidado los mecanismos que subyacen a los cambios emocionales en las primeras etapas del SRIS. Por lo tanto, en el estudio se provocaron cambios en los niveles de dopamina en la amígdala utilizando un modelo in vivo de SRIS inducido por lipopolisacáridos (LPS) para dilucidar los mecanismos bioquímicos activados en las primeras etapas del SRIS. La dopamina extracelular se recogió de la amígdala de ratas en movimiento libre mediante microdiálisis y luego se analizó mediante cromatografía líquida de alta resolución. Además, se evaluaron los cambios emocionales con las pruebas de campo abierto y de preferencia de sacarosa. En el grupo de LPS, la liberación de dopamina en la amígdala aumentó de manera notable inmediatamente después de la administración de LPS, alcanzando un máximo a los 120 minutos. A partir de entonces, la liberación de dopamina disminuyó temporalmente, pero luego volvió a aumentar significativamente después de 180 min. Los resultadosactuales sugieren que la disfunción cerebral difusa en las primeras etapas del SIRS puede implicar niveles alterados de dopamina en la amígdala.

Wernicke’s encephalopathy complicating hyperemesis gravidarum: a case series

Wernicke’s encephalopathy is an acute neuropsychiatric syndrome due to thiamine deficiency. In most cases, it is associated with alcoholism and malnutrition and rarely can be secondary to hyperemesis gravidarum and arise during the first trimester of pregnancy. The clinical signs are specific to this disorder. However, they are unknown by most clinicians, especially obstetricians, delaying treatment and leading to serious problems including maternal mortality. We report a case series of three patients diagnosed with Wernicke’s encephalopathy during the first trimester based on clinical symptoms and radiological signs in two cases and only on clinical findings in case 2. A high dose of thiamine was started intravenously in all patients and the majority of symptoms resolved. Unfortunately, case 3 died, probably to a delay of diagnosis. Given this severity even with rapid treatment, prevention measures with low doses of thiamine supplementation remain at present the best treatment and should be applied in any patient presenting with hyperemesis gravidarum.

A SYSTEMATIC MAPPING REVIEW OF IN-VITRO AND IN-VIVO EVIDENCES EXPLORING THE ROLE OF STRAIN-SPECIFIC PROBIOTIC BIFIDOBACTERIUM LONGUM W11

The gut microbiome has a significant role in overall well-being. Various probiotics are currently used for the improvement of the gut microbiome; the current scoping review aimed to critically examine the effectiveness of Bifidobacterium longum W11 in healthy and disease states. A thorough search of the literature was done in three scientific databases (PubMed, ScienceDirect, and Google Scholar) to identify and retrieve in-vitro, pre-clinical, and clinical evidence that evaluated the effect of B. longum W11 probiotic. Two independent reviewers identified and screened articles, published from 2000 to 2023 from the databases. Data from eligible studies were extracted, compiled, critically evaluated for scientific strength, and presented in this scoping review. Initially, 663 articles were identified and after a complete screening and evaluation process, twenty-one articles (eight in-vitro and animal studies; thirteen clinical studies) were included. Pre-clinical data suggest that B. longum W11 can withstand the severe gastrointestinal environment and colonize the intestinal epithelial cells to a significant degree. Due to the presence of a specific EPS cluster gene, B. longum W11 is capable of producing unique exopolysaccharides that might be responsible for the adhesion and functional capabilities of B. longum W11. Additionally, the specific mutation in the rpoB gene confers the B. longum W11 resistance to all rifamycin derivatives (including rifaximin). Clinical studies involving individuals with constipation and irritable bowel syndrome have shown that B. longum W11 supplementation significantly improves the overall quality of life and reduces the severity of symptoms. Furthermore, B. longum W11 was found to be effective in minimal hepatic encephalopathy and active celiac disease conditions. Due to the antibiotic resistance, the simultaneous use of rifaximin and B. longum W11 in patients with uncomplicated diverticular disease condition resulted in greater improvement in various symptoms compared to rifaximin supplementation alone. These data suggest that B. longum W11 is a potential probiotic that can be administered along with antibiotics in various gastrointestinal disease conditions. This evidence suggests that B. longum W11 is a promising probiotic with potential applications in various functional and inflammatory GI-related complications. Further clinical studies and stringent systematic reviews are needed to strengthen the outcomes of the current study.

Derangement of liver function tests in dengue patients

Background: Changes in the liver function test may serve as an early marker for timely diagnosis and identification of patients who may develop severe dengue. The purpose of this study was to examine the link between dengue fever severity and liver function test. Methods: This prospective observational study was conducted in the Department of General Medicine, Madhesh Institute of health sciences, provincial hospital, Janakpurdham in which we included dengue positive patients (aged 18 years or more) based on NS1 antigen or high titer on IgM/IgG testing from July 2023 till August 2023. We excluded patients with diseases like malaria, cirrhosis of liver, enteric fever, viral hepatitis or any other disease or taking any medication which can derange LFT. Results: We included 96 patients fulfilling the study criteria. Of these, 71% had DF, 22% had DHF and 7% had DSS. Among liver enzymes, mean AST of the patients was significantly higher in DSS group of patients (775.19�.65 U/l), as compared to those in the DF and DHF group of patients, p value <0.01. Similarly, mean ALT of the patients was significantly higher in DSS group of patients (387.8�.6 U/l), as compared to those in the DF and DHF group of patients, p value<0.01. On the contrary, mean alkaline phosphatase levels were similar between the three patient groups. Conclusions: Based on the results our study, we conclude that raised AST and ALT levels were significantly associated with severity of DSS and DHF. Patients with dengue infection should have a baseline liver function test and subsequent LFT monitoring to detect early hepatic impairment.

A study of the incidence of posterior reversible encephalopathy syndrome in patients with eclampsia and their fetomaternal outcome at a tertiary care centre in India

Background: Hypertensive disorders are one of the most crucial and still unsolved problems in obstetrics. Eclampsia is one of the most serious acute complications of pregnancy, and the risk of morbidity and mortality for both the mother and baby is very high. Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition associated with eclampsia that can have severe consequences if not promptly diagnosed and managed. It presents with altered consciousness, acute cortical blindness and convulsions. “Delivery is the ultimate cure of eclampsia” is a traditional belief but it does occur in the postpartum period too.Methods: A retrospective analysis of medical records was conducted for eclamptic patients admitted to the tertiary care center over a specified period. Patients diagnosed with PRES were identified and their clinical characteristics, diagnostic imaging findings, treatment modalities, and maternal and neonatal outcomes were reviewed.Results: This study sheds light on the incidence of posterior reversible encephalopathy syndrome in eclamptic patients at a tertiary care center in India. PRES was more common in primigravidas in the younger age group (20-30 years) and patients who presented with multiple seizures, resulting in higher number of cesarean sections.Conclusions: Early recognition and management of PRES are crucial for improving maternal outcomes. Further research is warranted to refine strategies for timely diagnosis and intervention, ultimately contributing to the reduction of maternal and neonatal morbidity and mortality associated with eclampsia and its complications.

Síndrome retroviral agudo manifestado como encefalitis y ataxia cerebelosa: reporte de caso y revisión de la literatura / Acute retroviral syndrome presenting as encephalitis and cerebellar ataxia: case report and literature review

RESUMEN El síndrome retroviral agudo (SRA) es uno de los escenarios clínicos posibles en los estadios tempranos de la infección por VIH, con presentaciones variables caracterizadas por alta carga viral y manifestaciones sintomáticas inespecíficas. Se describe el caso de un paciente varón de 21 años que presentó encefalitis aguda y ataxia cerebelosa, en cuyo estudio se diagnosticó infección por VIH y se identificó el cuadro de SRA.

ABSTRACT Acute retroviral syndrome (ARS) is one of the possible clinical configurations in the early stages of HIV infection, with varying presentations, characterized by high viral copies and nonspecific symptoms. We describe the case of a 21-year-old man who presented an acute onset encephalitis and cerebellar ataxia which led to the diagnosis of HIV infection and the identification of ARS.

Effect of L-carnitine combined with citicoline on the therapeutic effect of neonatal hypoxic-ischemic encephalopathy and serum NO and ET-1 / 国际检验医学杂志

Objective To explore the effects of L-carnitine combined with citicoline on the therapeutic effect of neonatal hypoxic-ischemic encephalopathy(NHIE)and serum nitric oxide(NO)and endothelin-1(ET-1).Methods A total of 95 children with HIE admitted to the hospital from April 2020 to January 2023 were selected and were divided into observation group(47 cases)and control group(48 cases)by random number table method.The control group was given citicoline,and the observation group was given citicoline combined with L-carnitine.The therapeutic effect was evaluated on 14 days after treatment,and the recovery time of original reflex,muscle tone and consciousness was calculated.The levels of oxidative stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD)]and vascular endothelial function indexes(NO,ET-1)were detected before treatment and 14 days after treatment.Neonatal neurobehavioral score(NBNA)was used to evaluate the neurological function of the children,and the safety of the treatment regimen was ob-served.Pearson correlation analysis was used to analyze the correlation between NBNA and vascular endothe-lial function indexes.Results The total effective rate in the observation group was 91.49％,which was higher than 72.92％in the control group(P＜0.05).The original reflex recovery time,muscle tone recovery time and consciousness recovery time of NHIE children in the observation group were shorter than those in the control group(P＜0.05).There was no significant difference in NBNA scores between the two groups before treatment(t=1.225,P=0.224).After treatment,the NBNA score in the observation group was higher than that in the control group(t=6.223,P＜0.001).After treatment,MDA level decreased and SOD level in-creased in two groups(P＜0.05).After treatment,the level of MDA in the observation group was lower than that in the control group,while the level of SOD was higher than that in the control group(P＜0.05).After treatment,the levels of NO and ET-1 were decreased in both groups(P＜0.05).The levels of NO and ET-1 in the observation group were lower than those in the control group after treatment(P＜0.05).The adverse drug reaction rates in observation group and control group were 17.02％and 8.33％,respectively,and there was no significant difference between two groups(P＞0.05).Pearson correlation analysis showed that serum NO,ET-1 and NBNA score in NHIE children were negatively correlated(r=-0.546,-0.608,P＜0.05).Conclusion L-carnitine combined with citicoline could improve the therapeutic effect of NHIE,shorten the re-covery time of clinical manifestations,and improve nerve function,oxidative stress and vascular endothelial function without increasing drugs and adverse reactions.In addition,vascular endothelial function indexes are negatively correlated with NBNA score,which could be used as auxiliary reference indexes for judging NHIE.

Network pharmacology analysis on Panacis Quinquefolii Radix- Acori Tatarinowii Rhizoma for diabetes encephalopathy and experimental verification of its anti-inflammatory mechanism / 国际中医中药杂志

Objective:To predict the mechanism of Panacis Quinquefolii Radix- Acori Tatarinowii Rhizoma (PQ-AT) in the treatment of diabetes encephalopathy (DE) using network pharmacology combined with molecular docking; To conduct experimental verification.Methods:The active components and targets of PQ and AT were screened by TCMSP database. The GeneCards and Disgenet were used to collect DE related target genes. String database and Cytoscape software were used to structure PPI network and perform visualization analysis. The common targets were imported into Metascape platform for GO annotation and KEGG enrichment analysis. Molecular docking was used to verify the binding ability of active components to core targets. Rats were randomly divided into a blank group, a model group, and a low-dose group of PQ-AT (1.08 g/kg), a high-dose group of PQ-AT (2.16 g/kg), and a metformin group (0.18 g/kg) using a random number table. To establish the rat model of diabetes encephalopathy, intraperitoneal injection of streptozotocin was used in addition to the blank group. After a 12-week drug intervention, TNF-α and Cyclooxygenase-2 (PTGS2) protein expression in the cerebral cortex of rats was detected using Western blot.Results:A total of 26 active components in PQ-AT and 107 related targets of DE were obtained, mainly including TNF, JUN, and PTSG2, which were mainly concentrated in TNF signaling pathway, cancer and other signal pathways. Molecular docking showed that the main active components of PQ-AT had relatively stable binding activity with TNF-α and PTGS2. Western blot results shows that compared with the model group, the expressions of PTGS2 and TNF-α significantly decreased in each administration group ( P<0.05 or P<0.01). Conclusion:PQ-AT can act on TNF, CASP3, JUN, STAT3, PTGS2 and other core targets to regulate signal pathways such as TNF, and inhibit inflammatory reaction to achieve the effect of treating DE.

Discussion on syndrome differentiation and treatment of acupuncture-moxibustion encephalopathy based on Shi's Xingnao Kaiqiao theory / 国际中医中药杂志

By exploring the core ideas of the "Xingnao Kaiqiao" theory, analyzing the relationship between the "Xingnao Kaiqiao" theory and the TCM encephalopathy, and exploring the necessity of acupuncture for the treatment of TCM encephalopathy, in order to clarify how to diagnose and treat brain diseases in acupuncture and moxibustion. The "Xingnao Kaiqiao" is the core of the theory of the "Tiaoshen", the acupuncture of "Xingnao Kaiqiao" was based on the principle of "Xingnao","Xingshen" and "Tiaoshen", the idea of the "Tiaoshen" was inseparable from the diagnosis and treatment of the TCM encephalopathy. Based on the special features of acupuncture therapy and complexity and particularity of TCM encephalopathy, acupuncture and moxibustion treatment of encephalopathy was supposed to have their own unique system of syndrome differentiation and treatment. During the practice of acupuncture, the diagnosis and treatment of TCM encephalopathy should be based on "brain", "Xingnao Tiaoshen" as a general rule, adding and subtracting from the main points of the "Xingnao Kaiqiao", and the different brain diseases are matched with appropriate treatments.

Targeted inhibition of GABAergic neuron's DRP1 in substantia nigra pars reticulata improves motor function in mice with hepatic encephalopathy / 神经解剖学杂志

Objective:To investigate the effect of mitochondrial division of GABAergic neurons in substantia nigra pars reticulata(SNr)on motor dysfunction in mice with acute hepatic encephalopathy(AHE).Methods:AHE mice model was established by intraperitoneal injection of thioacetamide(TAA).The changes of liver lobules in AHE mice were observed by hematoxylin-eosin(HE)staining.The changes of serum aspartate aminotransferase(AST),alanine aminotransferase(ALT)and blood ammonia in AHE mice were detected by biochemical detection kit.Then,the motor function of AHE mice was observed by rod fatigue test,elevated cross maze test and open field test.Furthermore,the changes of mitochondrial area,perimeter,roundness and other morphological indicators in SNr of AHE mice were ob-served and analyzed by transmission electron microscopy.The expression of mitochondrial division and fusion related molecules in SNr of AHE mice was observed by Western Blot.Then,the expression of mitochondrial dynamic related protein 1(DRP1)in SNr of AHE mice was targeted by AAV virus.The mitochondrial membrane potential(MMP),ATP and reactive oxygen species(ROS)in SNr were detected by fluorescence enzyme marker,and the changes of motor function of mice were observed.Results:Compared with the control group,the motor function of AHE mice was signifi-cantly decreased,the mitochondrial division of SNr was significantly enhanced,and the expression of mitochondrial divi-sion related proteins was significantly increased.The MMP in SNr of AHE mice was significantly decreased,the ATP of cells was decreased,and the ROS was increased.After targeted inhibition of DRP1 expression in SNr of AHE mice,the movement was improved;further observation found that after the mitochondrial division in SNr of AHE mice was inhibi-ted,the MMP was significantly increased,the ATP of cells was increased,and the ROS was decreased,which demon-strated that the mitochondrial function was significantly improved.Conclusion:Targeted inhibition of mitochondrial di-vision of GABAergic neurons in SNr of AHE mice can improve mitochondrial morphology and function,thus alleviating their movement disorders.