Encephalopathy score

The encephalopathy score gives an indication of how severe the liver impairment is. A score of 1 shows early signs of liver decompensation a score of 4 implies end-stage Uver failure with very little function remaining. 

Population PK screening in Phase II and Phase III is useful in assessing the impact of altered hepatic function (as a covariate) in PKs, if those patients are not excluded from Phase II and III trials, and if there is sufficient PK information collected about the patients to characterize them reasonably well. If a population PK approach is used, patients in Phase II and III studies are assessed for encephalopathy, ascites, serum bilirubin, serum albumin, and prothrombin time (which are components of the Child-Pugh score) or a similar group of measures of hepatic function. The population PK study, then, would include the following features ... 

Additional in vitro models and assays for eye irritation testing have been proposed in the past. An example is the porcine-based corneal opacity and permeability (PCOP) assay to predict eye irritation of water-soluble cosmetic ingredients [99]. Porcine corneas were chosen due to their advantages in comparison to the bovine corneas such as no concerns about encephalopathy diseases, regular supply of eyes with an acceptable level of quality from a slaughterhouse, more closely related to the human cornea, and their use in ophthalmic research. Using a modified holder and adapted experimental procedures 50 cosmetic ingredients were tested and compared to the in vivo Draize MAS scores. Based on their results, the study concluded that the PCOP could better predict the irritation classes than the BCOP assay. 

The literature suggests that children, compared with adults, may have greater sensitivity to aluminum and greater susceptibility to cognitive decline from oral aluminum exposure from food, containers, and utensils. Treatment of children with chronic renal failure with oral aluminum resulted in an encephalopathy similar to DD (Baluarte et al. 1977 Griswold et al. 1983 Nathan and Pedersen 1980 Sedman et al. 1984). One study of aluminum in water consumed by children found no association with psychological test scores (McMillan et al. 1993). 

Karp inski FE, Rieders F, Girsh LS Calcium disodium versenate in the therapy of lead encephalopathy. J Pediatr 42 687-699, 1953 Kirkconnell SC, Hicks LE Residual effects of lead poisoning on Denver Developmental Screening Test scores. J Abnorm Child Psychol 8 257-267, 1980 Kotok D Development of children with elevated blood lead levels a controlled study. J Pediatr 80 57-61, 1972... 

Prognosis of acute liver failure depends on several factors like etiology of liver disease, age, grade of liver disease, grade of encephalopathy, presence or absence of systemic inflammatory response syndrome, etc. Currently available prognostic scoring systems do not adequately predict outcomes or determine candidacy for liver transplantation (Poison and Lee, 2005). In the smdy of Bhatia et al. (2006), however, three variables were found to be significantly predictive of death arterial ph > 7.40, presence of clinical cerebral edema, and arterial ammonia levels > 124 [imol/1. 

Ammonia metabolism within the muscle may be improved by the administration of L-omithine-L- aspartate (LOLA). Controlled trials suggest that enteral and parenteral formulations of ornithine aspartate significantly reduce blood ammonia levels and have useful therapeutic effects in patients with cirrhosis and encephalopathy (Kircheis et al., 1997 Stauch et al., 1998). Poo et al. (2006) recently showed in a randomized, lactulose-controlled study of oral ornithine-aspartate in 20 patients with clinically overt HE that LOLA in contrast to lactulose significantly improved parameters of mental status, number connection test scores, asterixis scores and EEG. Both lactulose and LOLA reduced serum ammonia levels and improved quaUty of life scores. Since only 20 patients were included in this study the results cannot be considered proof for the superiority of LOLA compared to lactulose, while the data underscore the effect of both agents. Ornithine aspartate is well tolerated in general. From a theoretical point of view the combination of disaccharides and ornithine aspartate may be useful in patients with insufficient efficacy of only one of the two drugs. 

Flumazenil has been used as a non-specific treatment in patients with hepatic encephalopathy [88, 89. However, it was effective in only some subjects in a double-blind, placebo-con-trolled, crossover study in 527patients with cirrhosis and hepatic encephalopathy grade III and IVa, of whom 265 received flumazenil and 262 received placebo [90 ]. There was improvement of the neurological score in 18% of the patients with grade III encephalopathy and in 15% of those with grade IVa compared with 3.8% and 2.7% respectively of those who received placebo electroencephalography improved in 28% and 22% compared with... 

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