ABSTRACT
UNLABELLED: In Romania, minimal hepatic encephalopathy (MHE) is underdiagnosed and undertreated in patients with liver cirrhosis. The psychometric hepatic encephalopathy score (PHES) is recommended as the first-line tool for the diagnosis of MHE. AIM: To use PHES in a group of Romanian cirrhotic patients and highlight the relationships between demographic and biological factors and tests results. MATERIALS AND METHODS: Of the 148 patients with liver cirrhosis admitted to the Iasi Institute of Gastroenterology and Hepatology between August 2014 and February 2015 only 80 who met the eligibility criteria were enrolled and completed the study. Blood samples for routine tests and serum ammonia were collected from all patients on the day of PHES evaluation. RESULTS: In the study group (n = 80) mean age was 57.7 ± 8.5 years, and the average number of years of education was 11.2 ± 2.7. The main causes of cirrhosis were alcohol consumption (31 patients--38.8%), hepatitis C virus infection (29 patients--36.3%) and hepatitis B virus infection (17 patients--21.3%). Age, number of years of education, severity of liver disease (measured by using Child-Pugh and MELD scores) and some biological constants (albumin, bilirubin, International Normalized Ratio-INR) were significantly correlated (p < 0.05) with most psychometric tests. CONCLUSIONS: PHES is a practical, objective and useful method for the diagnosis of MHE. Demographic and biological factors correlated with the results of the psychometric test. The PHES requires standardization before applying it in Romanian cirrhotic patients.
Subject(s)
Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/psychology , Liver Cirrhosis/complications , Neuropsychological Tests , Adolescent , Adult , Aged , Aged, 80 and over , Female , Hepatic Encephalopathy/blood , Hepatic Encephalopathy/epidemiology , Hepatic Encephalopathy/etiology , Humans , Inflammation Mediators/blood , Liver Cirrhosis/psychology , Male , Middle Aged , Predictive Value of Tests , Psychometrics , Reproducibility of Results , Retrospective Studies , Risk Factors , Romania/epidemiology , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
Minimal hepatic encephalopathy (MHE) defines the presence of neurocognitive impairments in patients with cirrhosis or portal-systemic shunting that show a normal neurologic and psychiatric status on clinical examination. Although ammonia has the central role in MHE pathogenesis, factors such as infection, oxidative stress, manganese or intestinal bacterial overgrowth contribute to the development of the neurocognitive deficits associated with this disease. Many methods have proven useful in identifying MHE but because of the major drawbacks (standardization requirements, high price, sophisticated equipment, and limited access) a gold-standard test is still missing. Although beneficial, the treatment of MHE is not routinely recommended and should be taken into consideration in patients at risk for accidents and in those with cognitive complaints or decline in work performance.
Subject(s)
Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/etiology , Liver Cirrhosis/complications , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Gastrointestinal Tract/microbiology , Hepatic Encephalopathy/complications , Hepatic Encephalopathy/prevention & control , Hepatic Encephalopathy/psychology , Humans , Oxidative Stress , Quality of Life , Risk Factors , Severity of Illness IndexABSTRACT
The effect of a 27.12 MHz pulsed electromagnetic field (Diapulse) on microbial growth is investigated. A strain of K 12 E. coli grown in complete Pennassay medium is subjected to Diapulse action for 30 min, at 8 hrs and 12 hrs of growth. In this experimental set-up, designed to be closed to the physiological conditions of open wounds, the Diapulse action does not promote any increase of cell population, indicating the safety of this type of therapy for wound healing process. The same K 12 E. coli strain grown in Pennassay medium for 2 hours is inoculated into a minimal growth medium and the lagless exponential growth thus obtained is followed by a spectrophotometric method. Diapulse field is applied to this lagless phase of cellular cultures at 30, 60, and 90 minutes after inoculation. A slight increase in the number of cells was observed at 2 and 4 hours after the Diapulse application, when the cultures were previously subjected to Diapulse action between the period of 60 and 90 minutes of their growth. A possible molecular mechanism for these effects is discussed.
