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Covert encephalopathy

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https://www.readbyqxmd.com/read/29750368/using-digital-interventions-to-support-individuals-with-alcohol-use-disorder-and-advanced-liver-disease-a-bridge-over-troubled-waters
#1
Brian Suffoletto, Steve Scaglione
Alcohol abstinence is the most important therapeutic goal for individuals with advanced liver disease (ALD), but commonly co-occurring alcohol use disorders (AUD) make it difficult to achieve (DiMartini et a, 2004). This challenge is perhaps best documented in the pre- and post-liver transplant period: around 30% of patients on a liver transplant list relapse with alcohol (Carboneau et al., 2010), and up to 50% can relapse in the first 10 years post-transplant (DiMartini et al., 2010). Tools to assist patients with ALD and AUD in initiating and maintaining abstinence have been limited: safe, tolerable, and effective pharmacotherapies for AUD are not widely used and treatment is often complicated by medical issues including malnourishment, physically debility, covert or overt hepatic encephalopathy, sleep and fatigue disorders, comorbid depression, and anxiety disorders...
May 11, 2018: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/29606895/hepatic-encephalopathy-current-challenges-and-future-prospects
#2
REVIEW
Mirashini Swaminathan, Mark Alexander Ellul, Timothy Js Cross
Hepatic encephalopathy (HE) is a common complication of liver dysfunction, including acute liver failure and liver cirrhosis. HE presents as a spectrum of neuropsychiatric symptoms ranging from subtle fluctuating cognitive impairment to coma. It is a significant contributor of morbidity in patients with liver disease. HE is observed in acute liver failure, liver bypass procedures, for example, shunt surgry and transjugular intrahepatic portosystemic shunt, and cirrhosis. These are classified as Type A, B and C HE, respectively...
2018: Hepatic Medicine: Evidence and Research
https://www.readbyqxmd.com/read/29545765/clinical-characteristics-and-etiology-of-bilateral-vestibular-loss-in-a-cohort-from-central-illinois
#3
Jorge C Kattah
Background: Previous series of bilateral vestibular loss (BVL) identified numerous etiologies, but surprisingly, a cause in a significant number of cases remains unknown. In an effort to understand possible etiology and management strategies, a global effort is currently in progress. Here, I contribute my 10-year experience with both acute and chronic BVL during the 2007-2017 decade. Methods: This is a retrospective review of the charts and EMR of patients diagnosed with BVL in the last 10 years...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29533396/diagnosis-of-minimal-hepatic-encephalopathy-a-systematic-review-of-point-of-care-diagnostic-tests
#4
REVIEW
Elliot B Tapper, Neehar D Parikh, Akbar K Waljee, Michael Volk, Noelle E Carlozzi, Anna S-F Lok
OBJECTIVES: Minimal hepatic encephalopathy (HE) is common, characterized by deficits in reaction time and executive function, and strongly associated with disability and mortality. Point-of-care diagnostics performed without specialized skills or equipment are now available, albeit with limited data regarding their generalizability. METHODS: We systematically reviewed MEDLINE, EMBASE, Cochrane Library, and Scopus for diagnostic studies of MHE using broad search terms including HE and minimal, covert, or the names of published diagnostic modalities...
April 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29411990/diagnosis-and-management-of-hepatic-encephalopathy
#5
Debbie L Shawcross
Overt and covert hepatic encephalopathy (HE) are debilitating complications of cirrhosis. HE results in a poor quality of life for patients and their caregivers and, unless there is access to liver transplantation, the prognosis is poor. The development of overt HE is often unpredictable, and its management, particularly in the ward, remains challenging. There is an urgent need for novel approaches to treat HE. Until recently, therapies for this complication were disappointing, with frequently intolerable side effects such as diarrhoea and faecal incontinence...
February 7, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29341039/covert-hepatic-encephalopathy-leads-to-distinct-alterations-in-the-emotional-state-independently-of-meld-score
#6
Robin Greinert, Cristina Ripoll, Alexander Zipprich
BACKGROUND AND AIMS:  Covert hepatic encephalopathy impairs many aspects of quality of life, although its impact on the emotional state has not been evaluated. This study aims to evaluate the impact of covert hepatic encephalopathy on the emotional state and which factors are associated with changes in the emotional state in patients with cirrhosis. METHODS:  This single-center study included all patients with cirrhosis who underwent the portosystemic encephalopathy syndrome (PSE) test, critical flicker frequency, and emotional state assessment with the Eigenschaftswörterliste 60-S in 2011...
January 16, 2018: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/29313245/effect-of-post-traumatic-stress-disorder-on-cognitive-function-and-covert-hepatic-encephalopathy-diagnosis-in-cirrhotic-veterans
#7
Thomas K Burroughs, James B Wade, Michael S Ellwood, Andrew Fagan, Douglas M Heuman, Michael Fuchs, Jasmohan S Bajaj
BACKGROUND: In veterans, post-traumatic stress disorder (PTSD) is often associated with substance abuse, which in turn can lead to cirrhosis. Cirrhotic patients are prone to cognitive impairment, which is typically due to covert hepatic encephalopathy (CHE), but can also be affected by PTSD. The aim was to define the impact of PTSD on cognitive performance and the diagnosis of CHE in cirrhotic patients. METHODS: Outpatient veterans with cirrhosis underwent two separate modalities for CHE cognitive testing [Psychometric Hepatic Encephalopathy Scale (PHES) and Inhibitory Control Test (ICT)]...
February 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29201772/managing-encephalopathy-in-the-outpatient-setting
#8
REVIEW
Tarana Gupta, Sahaj Rathi, Radha K Dhiman
In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination...
January 2017: Euroasian journal of hepato-gastroenterology
https://www.readbyqxmd.com/read/28974899/natural-history-of-covert-hepatic-encephalopathy-an-observational-study-of-366-cirrhotic-patients
#9
An-Jiang Wang, A-Ping Peng, Bi-Min Li, Na Gan, Li Pei, Xue-Lian Zheng, Jun-Bo Hong, Hai-Ying Xiao, Jia-Wei Zhong, Xuan Zhu
AIM: To explore the natural history of covert hepatic encephalopathy (CHE) in absence of medication intervention. METHODS: Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE (OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients...
September 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28749453/mindfulness-based-stress-reduction-therapy-improves-patient-and-caregiver-reported-outcomes-in-cirrhosis
#10
Jasmohan S Bajaj, Michael Ellwood, Timothy Ainger, Thomas Burroughs, Andrew Fagan, Edith A Gavis, Douglas M Heuman, Michael Fuchs, Binu John, James B Wade
OBJECTIVES: Patient-reported outcomes such as health-related quality of life (HRQOL) are impaired in cirrhosis due to under-treated mood and sleep disorders, which can adversely impact their caregivers. Mindfulness-based stress reduction (MBSR) can improve patient-reported outcomes (PRO) in non-cirrhotic patients but their impact in cirrhosis is unclear. To evaluate the effect of MBSR and supportive group therapy on mood, sleep and HRQOL in cirrhotic patients and their caregivers. METHODS: Cirrhotic outpatients with mild depression (Beck Depression Inventory (BDI)>14) on screening with an adult caregiver were enrolled...
July 27, 2017: Clinical and Translational Gastroenterology
https://www.readbyqxmd.com/read/28588751/protein-tolerance-to-standard-and-high-protein-meals-in-patients-with-liver-cirrhosis
#11
Octavio Campollo, Dirk Sprengers, Gitte Dam, Hendrik Vilstrup, Neil McIntyre
AIM: To investigate the plasma amino acid response and tolerance to normal or high protein meals in patients with cirrhosis. METHODS: The plasma amino acid response to a 20 g mixed protein meal was compared in 8 biopsy-proven compensated cirrhotic patients and 6 healthy subjects. In addition the response to a high protein meal (1 g/kg body weight) was studied in 6 decompensated biopsy-proven cirrhotics in order to evaluate their protein tolerance and the likelihood of developing hepatic encephalopathy (HE) following a porto-caval shunt procedure...
May 18, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28523351/severity-specific-alterations-in-cbf-oef-and-cmro2-in-cirrhotic-patients-with-hepatic-encephalopathy
#12
Gang Zheng, Hanzhang Lu, Wenkui Yu, Song Luo, Ya Liu, Wei Liu, Hui Liu, Long Wu, Lijuan Zheng, Xiang Kong, Long Jiang Zhang, Guang Ming Lu
OBJECTIVES: To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia. METHODS: The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI...
November 2017: European Radiology
https://www.readbyqxmd.com/read/28383566/adventures-in-developing-an-app-for-covert-hepatic-encephalopathy
#13
Jasmohan S Bajaj
Patient-reported outcomes (PRO) are critical to understand the spectrum of disease in chronic conditions but are often ignored in clinical practice. Cirrhosis, one of the leading causes of morbidity, is associated with severely impaired PROs likely due to covert hepatic encephalopathy (CHE). The clinical relevance and logistic barriers to routine CHE testing led us to develop the "EncephalApp Stroop App", which is now being used to diagnose CHE. The Primer discusses this example which can potentially be applied to other diseases...
April 6, 2017: Clinical and Translational Gastroenterology
https://www.readbyqxmd.com/read/28370089/grading-the-range-of-hepatic-encephalopathy-from-overt-to-covert-animals-to-the-rescue
#14
EDITORIAL
German Soriano, Jasmohan S Bajaj
No abstract text is available yet for this article.
July 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28104319/the-mexican-consensus-on-probiotics-in-gastroenterology
#15
M A Valdovinos, E Montijo, A T Abreu, S Heller, A González-Garay, D Bacarreza, M Bielsa-Fernández, M C Bojórquez-Ramos, F Bosques-Padilla, A I Burguete-García, R Carmona-Sánchez, A Consuelo-Sánchez, E Coss-Adame, J A Chávez-Barrera, M de Ariño, J Flores-Calderón, O Gómez-Escudero, M S González-Huezo, M E Icaza-Chávez, A Larrosa-Haro, M Morales-Arámbula, C Murata, J A Ramírez-Mayans, J M Remes-Troche, T Rizo-Robles, M Peláez-Luna, E M Toro-Monjaraz, A Torre, M E Urquidi-Rivera, R Vázquez, J K Yamamoto-Furusho, F Guarner
INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology...
April 2017: Revista de Gastroenterología de México
https://www.readbyqxmd.com/read/28066966/updating-the-neuropsychological-test-system-in-japan-for-the-elderly-and-in-a-modern-touch-screen-tablet-society-by-resetting-the-cut-off-values
#16
Takumi Kawaguchi, Mika Konishi, Akinobu Kato, Motoichiro Kato, Yohei Kooka, Kei Sawara, Ryujin Endo, Takuji Torimura, Kazuyuki Suzuki, Yasuhiro Takikawa
AIM: Covert hepatic encephalopathy is frequently seen in cirrhotic patients. This condition can be diagnosed by a computerized neuropsychological test system (NPT); however, NPT has not been updated for approximately two decades in Japan. The aim of this study is to update the NPT to be more suitable for both the elderly and modern society by resetting of cut-off values. METHODS: We enrolled 367 healthy subjects aged between 40 and 79 years old between 2003 and 2010...
November 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28027071/covert-hepatic-encephalopathy-can-my-patient-drive
#17
REVIEW
Jawaid Shaw, Jasmohan S Bajaj
Liver cirrhosis is a public health problem and hepatic encephalopathy is one of its main complications, which can be either overt meaning thereby evident and readily diagnosed, or covert/minimal (covert hepatic encephalopathy-CHE) needing psychometric testing for diagnosis. Patients with CHE hepatic encephalopathy have deficits in multiple domains including visuospatial assessment, attention, response inhibition, working memory, along with psychomotor speed to name a few areas. These patients have poor navigational skills, get fatigued easily, and demonstrate poor insight into their driving deficits...
February 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28018114/low-phase-angle-is-associated-with-the-development-of-hepatic-encephalopathy-in-patients-with-cirrhosis
#18
Astrid Ruiz-Margáin, Ricardo Ulises Macías-Rodríguez, Javier Ampuero, Francisco Javier Cubero, Luis Chi-Cervera, Silvia L Ríos-Torres, Andrés Duarte-Rojo, Ángeles Espinosa-Cuevas, Manuel Romero-Gómez, Aldo Torre
AIM: Evaluate the association between phase angle and the development of hepatic encephalopathy in the long-term follow-up of cirrhotic patients. METHODS: This was a prospective cohort study. Clinical, nutritional and biochemical evaluations were performed. Mann-Whitney's U and χ(2) tests were used as appropriate. Kaplan-Meier curves and Cox proportional Hazards analysis were used to evaluate the prediction and incidence of hepatic encephalopathy. RESULTS: Two hundred and twenty were included; the most frequent etiology of cirrhosis was hepatitis C infection, 52% of the patients developed hepatic encephalopathy (18...
December 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27977668/magnetic-resonance-spectroscopy-for-evaluating-portal-systemic-encephalopathy-in-patients-with-chronic-hepatic-schistosomiasis-japonicum
#19
Ying Li, Lihong Mei, Jinwei Qiang, Shuai Ju, Shuhui Zhao
Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients...
December 2016: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/27958279/brain-training-with-video-games-in-covert-hepatic-encephalopathy
#20
Jasmohan S Bajaj, Vishwadeep Ahluwalia, Leroy R Thacker, Andrew Fagan, Edith A Gavis, Michael Lennon, Douglas M Heuman, Michael Fuchs, James B Wade
Despite the associated adverse outcomes, pharmacologic intervention for covert hepatic encephalopathy (CHE) is not the standard of care. We hypothesized that a video game-based rehabilitation program would improve white matter integrity and brain connectivity in the visuospatial network on brain magnetic resonance imaging (MRI), resulting in improved cognitive function in CHE subjects on measures consistent with the cognitive skill set emphasized by the two video games (e.g., IQ Boost-visual working memory, and Aim and Fire Challenge-psychomotor speed), but also generalize to thinking skills beyond the focus of the cognitive training (Hopkins verbal learning test (HVLT)-verbal learning/memory) and improve their health-related quality of life (HRQOL)...
February 2017: American Journal of Gastroenterology
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