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Amodio P.,University of Padua | Bemeur C.,University of Montréal | Butterworth R.,Center Hospitalier Of Luniversite Of Montreal Montreal | Cordoba J.,University of Barcelona | And 5 more authors.
Hepatology | Year: 2013

Nitrogen metabolism plays a major role in the development of hepatic encephalopathy (HE) in patients with cirrhosis. Modulation of this relationship is key to the management of HE, but is not the only nutritional issue that needs to be addressed. The assessment of nutritional status in patients with cirrhosis is problematic. In addition, there are significant sex-related differences in body composition and in the characteristics of tissue loss, which limit the usefulness of techniques based on measures of muscle mass and function in women. Techniques that combine subjective and objective variables provide reasonably accurate information and are recommended. Energy and nitrogen requirements in patients with HE are unlikely to differ substantially from those recommended in patients with cirrhosis per se viz. 35-45 kcal/g and 1.2-1.5g/kg protein daily. Small meals evenly distributed throughout the day and a late-night snack of complex carbohydrates will help minimize protein utilization. Compliance is, however, likely to be a problem. Diets rich in vegetables and dairy protein may be beneficial and are therefore recommended, but tolerance varies considerably in relation to the nature of the staple diet. Branched chain amino acid supplements may be of value in the occasional patient intolerant of dietary protein. Increasing dietary fiber may be of value, but the utility of probiotics is, as yet, unclear. Short-term multivitamin supplementation should be considered in patients admitted with decompensated cirrhosis. Hyponatremia may worsen HE; it should be prevented as far as possible and should always be corrected slowly. Conclusion: Effective management of these patients requires an integrated multidimensional approach. However, further research is needed to fill the gaps in the current evidence base to optimize the nutritional management of patients with cirrhosis and HE. © 2013 American Association for the Study of Liver Diseases.


PubMed | McGill University, Center Hospitalier Of Luniversite Of Montreal Montreal, University of Montréal and University of CalgaryCalgary
Type: | Journal: Frontiers in aging neuroscience | Year: 2016

Mild cognitive impairment in Parkinsons disease (PD) has been linked with functional brain changes. Previously, using functional magnetic resonance imaging (fMRI), we reported reduced cortico-striatal activity in patients with PD who also had mild cognitive impairment (MCI) vs. those who did not (non-MCI). We followed up these patients to investigate the longitudinal effect on the neural activity. Twenty-four non-demented patients with Parkinsons disease (non-MCI: 12, MCI: 12) were included in the study. Each participant underwent two fMRIs while performing the Wisconsin Card Sorting Task 20 months apart. The non-MCI patients recruited the usual cognitive corticostriatal loop at the first and second sessions (Time 1 and Time 2, respectively). However, decreased activity was observed in the cerebellum and occipital area and increased activity was observed in the medial prefrontal cortex and parietal lobe during planning set-shift at Time 2. Increased activity in the precuneus was also demonstrated while executing set-shifts at Time 2. The MCI patients revealed more activity in the frontal, parietal and occipital lobes during planning set-shifts, and in the parietal and occipital lobes, precuneus, and cerebellum, during executing set-shift at Time 2. Analysis regrouping of both groups of PD patients revealed that hippocampal and thalamic activity at Time 1 was associated with less cognitive decline over time. Our results reveal that functional alteration along the time-points differed between the non-MCI and MCI patients. They also underline the importance of preserving thalamic and hippocampal function with respect to cognitive decline over time.


PubMed | Center Hospitalier Of Luniversite Of Montreal Tour Saint Antoine, Center Hospitalier Of Luniversite Of Sherbrooke Sherbrooke, Ecole Polytechnique de Montréal and Center Hospitalier Of Luniversite Of Montreal Montreal
Type: Journal Article | Journal: The HIM journal | Year: 2015

To conduct a systematic review of the literature describing the impact of speech recognition systems on report error rates and productivity in radiology departments.The search was conducted for relevant papers published from January 1992 to October 2013. Comparative studies reporting any of the following outcomes were selected: error rates, departmental productivity, and radiologist productivity. The retrieved studies were assessed for quality and risk of bias.The literature search identified 85 potentially relevant publications, but, based on the inclusion and exclusion criteria, only 20 were included. Most studies were before and after assessments with no control group. There was a large amount of heterogeneity due to differences in the imaging modalities assessed and the outcomes measured. The percentage of reports containing at least one error varied from 4.8% to 89% for speech recognition, and from 2.1% to 22% for transcription. Departmental productivity was improved with decreases in report turnaround times varying from 35% to 99%. Most studies found a lengthening of radiologist dictation time.Overall gains in departmental productivity were high, but radiologist productivity, as measured by the time to produce a report, was diminished.


PubMed | University of Quebec at Montréal and Center Hospitalier Of Luniversite Of Montreal Montreal
Type: | Journal: Frontiers in psychology | Year: 2015

We previously reported finding that performance was impaired on four out of five theory of mind (ToM) tests in a group of 21 individuals diagnosed with paranoid schizophrenia (pScz), relative to a non-clinical group of 29 individuals (Scherzer et al., 2012). Only the Reading the Mind in the Eyes Test did not distinguish between groups. A principal components analysis revealed that the results on the ToM battery could be explained by one general ToM factor with the possibility of a latent second factor. As well, the tests were not equally sensitive to the pathology. There was also overmentalization in some ToM tests and under-mentalisation in others. These results led us to postulate that there is more than one component to ToM. We hypothesized that correlations between the different EF measures and ToM tests would differ sufficiently within and between groups to support this hypothesis. We considered the relationship between the performance on eight EF tests and five ToM tests in the same diagnosed and non-clinical individuals as in the first study. The ToM tests shared few EF correlates and each had its own best EF predictor. These findings support the hypothesis of multiple ToM components.

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