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Shiv Kumar Sarin - One of the best experts on this subject based on the ideXlab platform.
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Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis.
Journal of gastroenterology and hepatology, 2012Co-Authors: Amit Agrawal, P Sharma, Barjesh Chander Sharma, Rajiv Uppal, Shiv Kumar SarinAbstract:Background and Aim People with cirrhosis are at increased risk of development of complications related to sedation. The aim of the present study was to compare the effects of sedation for upper gastrointestinal endoscopy (UGIE) with propofol and midazolam on psychometric tests and critical flicker frequency (CFF) in people with cirrhosis. Methods A total of 127 people with cirrhosis were randomized into three groups: propofol group (n = 40), midazolam group (n = 42) and no sedation (n = 45). All patients underwent CFF test and combination of Psychometry (number connection test-A and B [NCT-A,B]; digit symbol test [DST], line tracing test [LTT] and serial dotting test [SDT]) at baseline and at 2 h post-endoscopy. CFF was done at 30 min and repeated every 30 min for 2 h. Results In the propofol group there was no deterioration in Psychometry (NCT-A [55.6 ± 18.7 vs 56.4 ± 19.0 s], NCT-B [98.2 ± 35.1 vs 97.8 ± 34.6 s], DST [26.7 ± 5.7 vs 26.3 ± 5.3], LTT [112.9 ± 35.7 vs 113.7 ± 36.6 s], SDT [94.6 ± 34.1 vs 95.2 ± 34.5 s]). Significant deterioration from baseline (39.8 ± 2.9 Hz) was seen in CFF at 30 min (38.8 ± 2.3 Hz) and 1 h (39.2 ± 2.4 Hz), P = 0.01 but no difference thereafter. In the midazolam group, significant deterioration was observed on Psychometry (NCT-A [56.0 ± 18.5 vs 60.4 ± 19.8 s], NCT-B [99.9 ± 29.1 vs 105.9.6 ± 30.3 s], DST [26.1 ± 4.7 vs 25.2 ± 4.3], LTT [129.1 ± 34.5 vs 132.9 ± 35.4 s], SDT [95.6 ± 34.2]). No deterioration was observed in Psychometry and CFF in people with cirrhosis without sedation. Conclusions Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.
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Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2010Co-Authors: P Sharma, Barjesh Chander Sharma, Shiv Kumar SarinAbstract:BACKGROUND: Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients. Diagnosis of MHE requires cumbersome tests. Lactulose is effective in the treatment of MHE. This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment. METHODS: One hundred and ten patients were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B), P300 auditory event related potential (P300ERP), venous ammonia, and CFF for MHE. MHE was diagnosed by abnormal Psychometry (＞2SD age matched controls) and P300ERP. MHE patients were treated with lactulose for one month. Response was defined by normalization (＜2SD of matched controls) of both Psychometry and P300ERP. RESULTS: Of the 110 patients [Child Turcott Pugh score ABC 39:42:29, (age 41.6±11.6 years, M:F 82:28)1, 75 (68%) had abnormal results of psychometric tests, and 74 (67%) had prolonged P300ERP. Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP. Thus sixty (54.5%) patients were diagnosed as having MHE. After treatment for one month, 34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests. CFF was＜39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment. CFF sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the assessment of recovery of MHE were 65%, 91%, 85%, 77% and 80%, respectively. CONCLUSION: CFF is a simple, relatively reliable, and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE.
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Secondary Prophylaxis of Hepatic Encephalopathy: An Open-Label Randomized Controlled Trial of Lactulose Versus Placebo
Gastroenterology, 2009Co-Authors: Barjesh Chander Sharma, P Sharma, Amit Agrawal, Shiv Kumar SarinAbstract:Background & Aims Hepatic encephalopathy (HE) is associated with a poor prognosis. Lactulose is used for the treatment of HE. There is no study on the prevention of recurrence of HE using lactulose. Methods Consecutive cirrhotic patients who recovered from HE were randomized to receive lactulose (HE-L group) or placebo (HE-NL group). All patients were assessed by Psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], and object assembly test [OAT]), critical flicker frequency test, and blood ammonia at inclusion. Primary end point was development of overt HE. Results Of 300 patients with HE who recovered, 140 (46.6%) met the inclusion criteria and were included. There was a high prevalence of abnormal Psychometry test results (NCT-A, 67.5%; NCT-B, 62.5%; DST, 70%; and OAT, 80%), and FCT-A and B were abnormal in 10 of 14 patients. Critical flicker frequency was P = .001) developed HE over a median follow-up of 14 months (range, 1–20 months). Readmission rate due to causes other than HE (HE-L vs HE-NL, 9:6; P = NS) and deaths (HE-L vs HE-NL, 5:11; P = .18) in 2 groups were similar. Recurrence of overt HE was significantly associated with 2 or more abnormal psychometric tests after the recovery of an episode of HE ( r = 0.369, P = .02). Conclusions Lactulose is effective for prevention of recurrence of HE in patients with cirrhosis.
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minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction
The American Journal of Gastroenterology, 2008Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:BACKGROUND AND AIMS Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal Psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), Psychometry in 9 (26.4%), both P300ERP and Psychometry in 8 (23.5%), and CFF <38 Hz in 7 (21%) patients. Six (67%) patients with abnormal Psychometry and 7 (64%) with abnormal P300ERP had CFF below 38 Hz. CFF had sensitivity (75%), specificity (96%), positive predictive value (86%), negative predictive value (93%), and diagnosis accuracy of 91% when compared to patients with both abnormal Psychometry and P300ERP. The venous ammonia level was higher in patients with MHE (83.1 +/- 29.7 vs 44.7 +/- 16.1 micromol/L, P < 0.001) compared to patients without MHE. Spontaneous shunts were present in 67% of patients with MHE compared to 14% of non-MHE patients. MHE was more common in patients with spontaneous shunts (72.7%vs 17.4%, P= 0.001) than without spontaneous shunts. CONCLUSIONS Prevalence of MHE in EHPVO patients is 35.3%, and CFF alone can reliably diagnose 88% of MHE patients with both abnormal Psychometry and P300ERP. However, in view of the relatively low number of patients with MHE, the usefulness of CFF in this setting awaits confirmatory studies.
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Minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction.
The American journal of gastroenterology, 2008Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:BACKGROUND AND AIMS Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal Psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), Psychometry in 9 (26.4%), both P300ERP and Psychometry in 8 (23.5%), and CFF
P Sharma - One of the best experts on this subject based on the ideXlab platform.
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Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis.
Journal of gastroenterology and hepatology, 2012Co-Authors: Amit Agrawal, P Sharma, Barjesh Chander Sharma, Rajiv Uppal, Shiv Kumar SarinAbstract:Background and Aim People with cirrhosis are at increased risk of development of complications related to sedation. The aim of the present study was to compare the effects of sedation for upper gastrointestinal endoscopy (UGIE) with propofol and midazolam on psychometric tests and critical flicker frequency (CFF) in people with cirrhosis. Methods A total of 127 people with cirrhosis were randomized into three groups: propofol group (n = 40), midazolam group (n = 42) and no sedation (n = 45). All patients underwent CFF test and combination of Psychometry (number connection test-A and B [NCT-A,B]; digit symbol test [DST], line tracing test [LTT] and serial dotting test [SDT]) at baseline and at 2 h post-endoscopy. CFF was done at 30 min and repeated every 30 min for 2 h. Results In the propofol group there was no deterioration in Psychometry (NCT-A [55.6 ± 18.7 vs 56.4 ± 19.0 s], NCT-B [98.2 ± 35.1 vs 97.8 ± 34.6 s], DST [26.7 ± 5.7 vs 26.3 ± 5.3], LTT [112.9 ± 35.7 vs 113.7 ± 36.6 s], SDT [94.6 ± 34.1 vs 95.2 ± 34.5 s]). Significant deterioration from baseline (39.8 ± 2.9 Hz) was seen in CFF at 30 min (38.8 ± 2.3 Hz) and 1 h (39.2 ± 2.4 Hz), P = 0.01 but no difference thereafter. In the midazolam group, significant deterioration was observed on Psychometry (NCT-A [56.0 ± 18.5 vs 60.4 ± 19.8 s], NCT-B [99.9 ± 29.1 vs 105.9.6 ± 30.3 s], DST [26.1 ± 4.7 vs 25.2 ± 4.3], LTT [129.1 ± 34.5 vs 132.9 ± 35.4 s], SDT [95.6 ± 34.2]). No deterioration was observed in Psychometry and CFF in people with cirrhosis without sedation. Conclusions Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.
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Predictors of minimal hepatic encephalopathy in patients with cirrhosis
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2010Co-Authors: P Sharma, Barjesh Chander SharmaAbstract:Background/Aim: Minimal hepatic encephalopathy (MHE) impairs patient's daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated. Patients and Methods: A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by Psychometry, P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). MHE was diagnosed by abnormal Psychometry (>2 S.D.) and P300ERP (>2.5 S.D.). Univariate and multivariate logistic regression analyses were performed to determine the predictors of MHE. Results: Eighty-two (41%) patients were diagnosed to have MHE - 26/74 (35%) in Child A, 26/72 (36%) in Child B and 30/54 (56%) in Child C. Ninety-seven (48.5%) patients had abnormal psychometric tests, and 96 (48%) had prolonged P300ERP (>358 ms). Sixteen (16.5%) patients with abnormal Psychometry had P300ERP 358 ms. One hundred and three patients had CFF value 15.5, 115 (57.5%) had CTP score > 7.5, while 93 (46.5%) had venous ammonia > 84.5 μmol/L. On univariate analysis, MELD (8.52 [95% CI, 4.46-16.26; P = 0.001]), CFF (17.34 [95% CI, 8.16-36.85; P = 0.001]) and venous ammonia (7.80 [95% CI, 4.11-14.81; P = 0.003]) were associated with MHE; while CTP score (1.51 [95% CI, 0.85-2.69; P = 0.30]) was not significant. On multivariate analysis, MELD, CFF and venous ammonia were predictive of MHE. Conclusion: Prevalence of MHE in this study was 41%; and MELD > 15.5, CFF 84.5 μmol/L were predictive of MHE.
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Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2010Co-Authors: P Sharma, Barjesh Chander Sharma, Shiv Kumar SarinAbstract:BACKGROUND: Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients. Diagnosis of MHE requires cumbersome tests. Lactulose is effective in the treatment of MHE. This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment. METHODS: One hundred and ten patients were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B), P300 auditory event related potential (P300ERP), venous ammonia, and CFF for MHE. MHE was diagnosed by abnormal Psychometry (＞2SD age matched controls) and P300ERP. MHE patients were treated with lactulose for one month. Response was defined by normalization (＜2SD of matched controls) of both Psychometry and P300ERP. RESULTS: Of the 110 patients [Child Turcott Pugh score ABC 39:42:29, (age 41.6±11.6 years, M:F 82:28)1, 75 (68%) had abnormal results of psychometric tests, and 74 (67%) had prolonged P300ERP. Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP. Thus sixty (54.5%) patients were diagnosed as having MHE. After treatment for one month, 34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests. CFF was＜39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment. CFF sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the assessment of recovery of MHE were 65%, 91%, 85%, 77% and 80%, respectively. CONCLUSION: CFF is a simple, relatively reliable, and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE.
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Secondary Prophylaxis of Hepatic Encephalopathy: An Open-Label Randomized Controlled Trial of Lactulose Versus Placebo
Gastroenterology, 2009Co-Authors: Barjesh Chander Sharma, P Sharma, Amit Agrawal, Shiv Kumar SarinAbstract:Background & Aims Hepatic encephalopathy (HE) is associated with a poor prognosis. Lactulose is used for the treatment of HE. There is no study on the prevention of recurrence of HE using lactulose. Methods Consecutive cirrhotic patients who recovered from HE were randomized to receive lactulose (HE-L group) or placebo (HE-NL group). All patients were assessed by Psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], and object assembly test [OAT]), critical flicker frequency test, and blood ammonia at inclusion. Primary end point was development of overt HE. Results Of 300 patients with HE who recovered, 140 (46.6%) met the inclusion criteria and were included. There was a high prevalence of abnormal Psychometry test results (NCT-A, 67.5%; NCT-B, 62.5%; DST, 70%; and OAT, 80%), and FCT-A and B were abnormal in 10 of 14 patients. Critical flicker frequency was P = .001) developed HE over a median follow-up of 14 months (range, 1–20 months). Readmission rate due to causes other than HE (HE-L vs HE-NL, 9:6; P = NS) and deaths (HE-L vs HE-NL, 5:11; P = .18) in 2 groups were similar. Recurrence of overt HE was significantly associated with 2 or more abnormal psychometric tests after the recovery of an episode of HE ( r = 0.369, P = .02). Conclusions Lactulose is effective for prevention of recurrence of HE in patients with cirrhosis.
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minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction
The American Journal of Gastroenterology, 2008Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:BACKGROUND AND AIMS Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal Psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), Psychometry in 9 (26.4%), both P300ERP and Psychometry in 8 (23.5%), and CFF <38 Hz in 7 (21%) patients. Six (67%) patients with abnormal Psychometry and 7 (64%) with abnormal P300ERP had CFF below 38 Hz. CFF had sensitivity (75%), specificity (96%), positive predictive value (86%), negative predictive value (93%), and diagnosis accuracy of 91% when compared to patients with both abnormal Psychometry and P300ERP. The venous ammonia level was higher in patients with MHE (83.1 +/- 29.7 vs 44.7 +/- 16.1 micromol/L, P < 0.001) compared to patients without MHE. Spontaneous shunts were present in 67% of patients with MHE compared to 14% of non-MHE patients. MHE was more common in patients with spontaneous shunts (72.7%vs 17.4%, P= 0.001) than without spontaneous shunts. CONCLUSIONS Prevalence of MHE in EHPVO patients is 35.3%, and CFF alone can reliably diagnose 88% of MHE patients with both abnormal Psychometry and P300ERP. However, in view of the relatively low number of patients with MHE, the usefulness of CFF in this setting awaits confirmatory studies.
Barjesh Chander Sharma - One of the best experts on this subject based on the ideXlab platform.
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Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis.
Journal of gastroenterology and hepatology, 2012Co-Authors: Amit Agrawal, P Sharma, Barjesh Chander Sharma, Rajiv Uppal, Shiv Kumar SarinAbstract:Background and Aim People with cirrhosis are at increased risk of development of complications related to sedation. The aim of the present study was to compare the effects of sedation for upper gastrointestinal endoscopy (UGIE) with propofol and midazolam on psychometric tests and critical flicker frequency (CFF) in people with cirrhosis. Methods A total of 127 people with cirrhosis were randomized into three groups: propofol group (n = 40), midazolam group (n = 42) and no sedation (n = 45). All patients underwent CFF test and combination of Psychometry (number connection test-A and B [NCT-A,B]; digit symbol test [DST], line tracing test [LTT] and serial dotting test [SDT]) at baseline and at 2 h post-endoscopy. CFF was done at 30 min and repeated every 30 min for 2 h. Results In the propofol group there was no deterioration in Psychometry (NCT-A [55.6 ± 18.7 vs 56.4 ± 19.0 s], NCT-B [98.2 ± 35.1 vs 97.8 ± 34.6 s], DST [26.7 ± 5.7 vs 26.3 ± 5.3], LTT [112.9 ± 35.7 vs 113.7 ± 36.6 s], SDT [94.6 ± 34.1 vs 95.2 ± 34.5 s]). Significant deterioration from baseline (39.8 ± 2.9 Hz) was seen in CFF at 30 min (38.8 ± 2.3 Hz) and 1 h (39.2 ± 2.4 Hz), P = 0.01 but no difference thereafter. In the midazolam group, significant deterioration was observed on Psychometry (NCT-A [56.0 ± 18.5 vs 60.4 ± 19.8 s], NCT-B [99.9 ± 29.1 vs 105.9.6 ± 30.3 s], DST [26.1 ± 4.7 vs 25.2 ± 4.3], LTT [129.1 ± 34.5 vs 132.9 ± 35.4 s], SDT [95.6 ± 34.2]). No deterioration was observed in Psychometry and CFF in people with cirrhosis without sedation. Conclusions Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.
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Predictors of minimal hepatic encephalopathy in patients with cirrhosis
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2010Co-Authors: P Sharma, Barjesh Chander SharmaAbstract:Background/Aim: Minimal hepatic encephalopathy (MHE) impairs patient's daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated. Patients and Methods: A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by Psychometry, P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). MHE was diagnosed by abnormal Psychometry (>2 S.D.) and P300ERP (>2.5 S.D.). Univariate and multivariate logistic regression analyses were performed to determine the predictors of MHE. Results: Eighty-two (41%) patients were diagnosed to have MHE - 26/74 (35%) in Child A, 26/72 (36%) in Child B and 30/54 (56%) in Child C. Ninety-seven (48.5%) patients had abnormal psychometric tests, and 96 (48%) had prolonged P300ERP (>358 ms). Sixteen (16.5%) patients with abnormal Psychometry had P300ERP 358 ms. One hundred and three patients had CFF value 15.5, 115 (57.5%) had CTP score > 7.5, while 93 (46.5%) had venous ammonia > 84.5 μmol/L. On univariate analysis, MELD (8.52 [95% CI, 4.46-16.26; P = 0.001]), CFF (17.34 [95% CI, 8.16-36.85; P = 0.001]) and venous ammonia (7.80 [95% CI, 4.11-14.81; P = 0.003]) were associated with MHE; while CTP score (1.51 [95% CI, 0.85-2.69; P = 0.30]) was not significant. On multivariate analysis, MELD, CFF and venous ammonia were predictive of MHE. Conclusion: Prevalence of MHE in this study was 41%; and MELD > 15.5, CFF 84.5 μmol/L were predictive of MHE.
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Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2010Co-Authors: P Sharma, Barjesh Chander Sharma, Shiv Kumar SarinAbstract:BACKGROUND: Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients. Diagnosis of MHE requires cumbersome tests. Lactulose is effective in the treatment of MHE. This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment. METHODS: One hundred and ten patients were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B), P300 auditory event related potential (P300ERP), venous ammonia, and CFF for MHE. MHE was diagnosed by abnormal Psychometry (＞2SD age matched controls) and P300ERP. MHE patients were treated with lactulose for one month. Response was defined by normalization (＜2SD of matched controls) of both Psychometry and P300ERP. RESULTS: Of the 110 patients [Child Turcott Pugh score ABC 39:42:29, (age 41.6±11.6 years, M:F 82:28)1, 75 (68%) had abnormal results of psychometric tests, and 74 (67%) had prolonged P300ERP. Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP. Thus sixty (54.5%) patients were diagnosed as having MHE. After treatment for one month, 34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests. CFF was＜39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment. CFF sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the assessment of recovery of MHE were 65%, 91%, 85%, 77% and 80%, respectively. CONCLUSION: CFF is a simple, relatively reliable, and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE.
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Secondary Prophylaxis of Hepatic Encephalopathy: An Open-Label Randomized Controlled Trial of Lactulose Versus Placebo
Gastroenterology, 2009Co-Authors: Barjesh Chander Sharma, P Sharma, Amit Agrawal, Shiv Kumar SarinAbstract:Background & Aims Hepatic encephalopathy (HE) is associated with a poor prognosis. Lactulose is used for the treatment of HE. There is no study on the prevention of recurrence of HE using lactulose. Methods Consecutive cirrhotic patients who recovered from HE were randomized to receive lactulose (HE-L group) or placebo (HE-NL group). All patients were assessed by Psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], and object assembly test [OAT]), critical flicker frequency test, and blood ammonia at inclusion. Primary end point was development of overt HE. Results Of 300 patients with HE who recovered, 140 (46.6%) met the inclusion criteria and were included. There was a high prevalence of abnormal Psychometry test results (NCT-A, 67.5%; NCT-B, 62.5%; DST, 70%; and OAT, 80%), and FCT-A and B were abnormal in 10 of 14 patients. Critical flicker frequency was P = .001) developed HE over a median follow-up of 14 months (range, 1–20 months). Readmission rate due to causes other than HE (HE-L vs HE-NL, 9:6; P = NS) and deaths (HE-L vs HE-NL, 5:11; P = .18) in 2 groups were similar. Recurrence of overt HE was significantly associated with 2 or more abnormal psychometric tests after the recovery of an episode of HE ( r = 0.369, P = .02). Conclusions Lactulose is effective for prevention of recurrence of HE in patients with cirrhosis.
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minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction
The American Journal of Gastroenterology, 2008Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:BACKGROUND AND AIMS Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal Psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), Psychometry in 9 (26.4%), both P300ERP and Psychometry in 8 (23.5%), and CFF <38 Hz in 7 (21%) patients. Six (67%) patients with abnormal Psychometry and 7 (64%) with abnormal P300ERP had CFF below 38 Hz. CFF had sensitivity (75%), specificity (96%), positive predictive value (86%), negative predictive value (93%), and diagnosis accuracy of 91% when compared to patients with both abnormal Psychometry and P300ERP. The venous ammonia level was higher in patients with MHE (83.1 +/- 29.7 vs 44.7 +/- 16.1 micromol/L, P < 0.001) compared to patients without MHE. Spontaneous shunts were present in 67% of patients with MHE compared to 14% of non-MHE patients. MHE was more common in patients with spontaneous shunts (72.7%vs 17.4%, P= 0.001) than without spontaneous shunts. CONCLUSIONS Prevalence of MHE in EHPVO patients is 35.3%, and CFF alone can reliably diagnose 88% of MHE patients with both abnormal Psychometry and P300ERP. However, in view of the relatively low number of patients with MHE, the usefulness of CFF in this setting awaits confirmatory studies.
Vinod Puri - One of the best experts on this subject based on the ideXlab platform.
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minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction
The American Journal of Gastroenterology, 2008Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:BACKGROUND AND AIMS Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal Psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), Psychometry in 9 (26.4%), both P300ERP and Psychometry in 8 (23.5%), and CFF <38 Hz in 7 (21%) patients. Six (67%) patients with abnormal Psychometry and 7 (64%) with abnormal P300ERP had CFF below 38 Hz. CFF had sensitivity (75%), specificity (96%), positive predictive value (86%), negative predictive value (93%), and diagnosis accuracy of 91% when compared to patients with both abnormal Psychometry and P300ERP. The venous ammonia level was higher in patients with MHE (83.1 +/- 29.7 vs 44.7 +/- 16.1 micromol/L, P < 0.001) compared to patients without MHE. Spontaneous shunts were present in 67% of patients with MHE compared to 14% of non-MHE patients. MHE was more common in patients with spontaneous shunts (72.7%vs 17.4%, P= 0.001) than without spontaneous shunts. CONCLUSIONS Prevalence of MHE in EHPVO patients is 35.3%, and CFF alone can reliably diagnose 88% of MHE patients with both abnormal Psychometry and P300ERP. However, in view of the relatively low number of patients with MHE, the usefulness of CFF in this setting awaits confirmatory studies.
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Minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction.
The American journal of gastroenterology, 2008Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:BACKGROUND AND AIMS Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by Psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal Psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), Psychometry in 9 (26.4%), both P300ERP and Psychometry in 8 (23.5%), and CFF
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critical flicker frequency diagnostic tool for minimal hepatic encephalopathy
Journal of Hepatology, 2007Co-Authors: P Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:Background/Aims Minimal hepatic encephalopathy (MHE) is associated with poorer quality of life and increased work disability. Diagnosis requires cumbersome psychometric and neurophysiological tests. We evaluated critical flicker frequency (CFF) to diagnose MHE. Methods 156 cirrhotic patients (age 41±12.5yr) without overt encephalopathy (Child A 63, Child B 56, Child C 37) were evaluated by psychometric (number connection tests A, B or figure connection tests A, B), P300 auditory event related potential (ERP) and CFF. MHE was diagnosed by abnormal psychometric and/or P300 auditory event related potential. Results Prevalence of MHE was 53% with 27 (43%) in Child's A, 33 (59%) in Child's B and 23 (62%) in Child's C cirrhosis ( p =NS). Of 83 patients, 72 (87%) had abnormal Psychometry, 64 (77%) had abnormal P300 auditory event related potential (ERP) (380.6±28.8ms) and in 66 (80%) CFF was below 39Hz. 60 (83%) patients with abnormal Psychometry and 51 (80%) with abnormal P300 auditory event related potential had CFF below 39Hz. CFF sensitivity (96%), specificity (77%) and positive predictive value (68%), negative predictive value (98%) and diagnosis accuracy was 83.3% when compared to patients with both abnormal Psychometry and P300ERP. Conclusions Critical flicker frequency is a simple, reliable and accurate test without any age or literacy dependence for the diagnosis of MHE.
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Searching for South Asian Intelligence: Psychometry in British India, 1919–1940
Journal of the history of the behavioral sciences, 2014Co-Authors: Shivrang SetlurAbstract:This paper describes the introduction and development of intelligence testing in British India. Between 1919 and 1940 experimenters such as C. Herbert Rice, Prasanta Chandra Mahalanobis, and Venkatrao Vithal Kamat imported a number of intelligence tests, adapting them to suit a variety of South Asian languages and contexts. Charting South Asian Psychometry's gradual move from American missionary efforts toward the state, this paper argues that political reforms in the 1920s and 1930s affected how Psychometry was "indigenized" in South Asia. Describing how approaches to race and caste shifted across instruments and over time, this paper charts the gradual recession, within South Asian Psychometry, of a "race" theory of caste. Describing some of the ways in which this "late colonial" period affected the postcolonial landscape, the paper concludes by suggesting potential lines for further inquiry into the later career of intelligence testing in India and Pakistan.
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searching for south asian intelligence Psychometry in british india 1919 1940
Journal of The History of The Behavioral Sciences, 2014Co-Authors: Shivrang SetlurAbstract:This paper describes the introduction and development of intelligence testing in British India. Between 1919 and 1940 experimenters such as C. Herbert Rice, Prasanta Chandra Mahalanobis, and Venkatrao Vithal Kamat imported a number of intelligence tests, adapting them to suit a variety of South Asian languages and contexts. Charting South Asian Psychometry's gradual move from American missionary efforts toward the state, this paper argues that political reforms in the 1920s and 1930s affected how Psychometry was "indigenized" in South Asia. Describing how approaches to race and caste shifted across instruments and over time, this paper charts the gradual recession, within South Asian Psychometry, of a "race" theory of caste. Describing some of the ways in which this "late colonial" period affected the postcolonial landscape, the paper concludes by suggesting potential lines for further inquiry into the later career of intelligence testing in India and Pakistan.
