A. Trifan

The multimedia informed consent: A usefull tool in ERCP

Background: Evaluating patients satisfaction after endoscopic retrograde cholangiopancreatography (ERCP) isnt yet one of the professional state of the art practices. The multimedia informed consent may be a way in which to improve communication with the patient and therefore overall patient satisfaction. The aim of our study was to evaluate patients satisfaction and to establish a link to patients adherence related to the multimedia informed consent. Methods: A questionnaire was issued: first phase applied after giving the informed consent, the second one applied 24 hours after ERCP. 48 patients were involved in the study over 10 months. Subsequently, patients were divided in two groups: one receiving multimedia informed consent, the other receiving regular informed consent forms. Adherence was evaluated by registration of active participation to follow-up. Results: 100% patients with overall level A satisfaction complied to follow-up. Nevertheless, more patients from the multimedia informed consent group showed level A and B satisfaction, but with a difference not statistically significant. Conclusions: Adherence to follow-up showed to be proportional mainly with the level of satisfaction evaluated before and after ERCP.

Chronic hepatitis C virus infection: a new modifiable cardio-metabolic risk factor ?

Chronic hepatitis C infection is a systemic disease that leads to a high risk of cirrhosis and hepatic carcinoma, as well as extrahepatic related disorders, immune–related and metabolic alterations such as glucose metabolism impairment and steatosis, thus being a new cardio-metabolic risk factor. It has been shown that, due to chronic inflammation, HCV infection has a direct effect on the arterial wall, initiating endothelial dysfunction which is the first step in atherosclerotic processes with proatherogenic effects and numerous cardiovascular events. The recent data emphasize that HCV infection can induce insulin resistance in the liver and peripheral tissues through multiple mechanisms which interfere with insulin signaling, inducing the production of several proinflammatory cytokines, and modify the lipid metabolism with the result of hepatic steatosis, which is more pronounced in patients with HCV. The emergence of new direct acting, interferon-free antiviral treatment, leading to HCV cure in most cases with a satisfactory safety profile is, according to numerous studies, improving the glucose metabolism disorders and lowering the number of cardiovascular events in patients who obtained sustained viral response, thiugh further studies are needed to clarify definitively the role of HCV infection in cardiovascular and metabolic alterations, as well as the impact of viral eradication on cardiovascular outcomes.

Liver cirrhosis and the anticoagulant treatment - from guided indications to daily practice - case report

This is the case of a 64-year old hypertensive, diabetic patient, known to have liver cirrhosis, with a history of pulmonary thromboembolism, with permanent electrical cardiac stimulation, who was hospitalized for a newly diagnosed giant popliteal hematoma. The patient is currently discharged and following oral anticoagulant treatment.

203 ORAL GLUTAMINE CHALLENGE – DOES IT IMPROVE REVEALING MINIMAL HEPATIC ENCEPHALOPATHY IN CIRRHOSIS?

Background and Aims: Minimal hepatic encephalopathy (MHE) is a prevalent asymptomatic condition, whose diagnosis is difficult due to the lack of a gold standard test. Oral glutamine challenge (OGC) has been found to increase blood ammonia in patients with cirrhosis which could lead to significant cognitive impairment. The aim of our study was to evaluate the value of OGC in improving the performance of psychometric tests and arterial blood ammonia for the diagnosis of MHE. Secondary we followed the risk for development of overt hepatic encephalopathy (OHE). Methods: Fifty-four patients (male/female: 34/20; mean age 59.5yrs) with cirrhosis and 13 healthy controls matched by sex and age were included. Follow-up lasted 12 months. MHE was assessed using the psychometric hepatic encephalopathy score (PHES). Arterial ammonia blood concentrations and PHES were evaluated preand post-60 minutes of a 20 g oral glutamine load. Statistical analysis used paired t-test, relative operating characteristics (ROC) and multivariate logistic regression analysis. Results: At baseline, 29 (53.7%) out of 54 patients met the criteria for MHE, while post glutamine challenge, 43 patients (79.63%) had MHE (p < 0.0001). Arterial blood ammonia levels had significantly raised after glutamine challenge in the cirrhotic patients (baseline vs post glutamine: 85.2±20.8mg/dL vs 159.82±66.01mg/dL, p < 0.0001) as compared to controls values which remained unchanged. ROC analysis showed a pathological glutamine tolerance cut-off value of 124mg/dl. For baseline arterial blood ammonia the AUROC was 0.54 (CI: 0.402–0.680, p = 0.58), with no significant change post glutamine challenge (AUROC = 0.53, CI: 0.389–0.667, p = 0.77). In the follow-up 16 patients (29.62%) developed OHE. In multivariate model, MELD score (OR = 1.5187, 95%CI: 1.0690–2.1574, P = 0.0197), but not Child Pugh class, arterial blood ammonia, esophageal varices grading, was a strong independent predictor of OHE. Conclusions: In cirrhotic patients, OGC appears to improve the performance of psychometric tests, but not arterial blood ammonia for the diagnosis of MHE. MELD score has proven to be independently related with OHE in the follow up. Acknowledgements: This work was made possible by the project ‘Doctoral Scholarships for increasing competitiveness in the medical and pharmaceutical field’ POSDRU/88/1.5/S/58965.