Antioxidants and Zinc Improving Minimal Hepatic Encephalopathy In Truck Drivers; a Pilot Study
Condition: Minimal Hepatic Encephalopathy
MeSH terms: Hepatic Encephalopathy; Brain Diseases
Study type: Observational

Summary: 
      Minimal hepatic encephalopathy (MHE) can have a far-reaching impact on quality and ability to
      function in daily life and may progress to overt Hepatic Encephalopathy. Patients with MHE
      were missed in clinical follow up and are more exposure to work accident. The aim of the
      present study was to assess the effects of oral supplementation of antioxidant and zinc
      gluconate Versus Lactulose inTruck driver cirrhotic patients with MHE.
    

Detailed description: 
      The aim of the present study was to assess the effects of oral supplementation of antioxidant
      and zinc gluconate in patients with MHE. Zinc, may be considered as a cofactor of urea cycle
      enzymes, that deficient in cirrhotic patients; especially if associated, with malnutrition or
      encephalopathy . Zinc is essential for the synthesis of coenzymes that mediate biogenic amine
      synthesis and metabolism. Data from studies sustain that, there is a synergistic combined
      effect between systemic oxidative stress, and ammonia that is implicated in the pathogenesis
      of hepatic encephalopathy, so that the present study was designed to assess the effects of
      oral supplementation of antioxidant and zinc gluconate in cirrhotic Truck drivers patients
      with MHE.

      A prospective randomized controlled study comparing the effect of zinc and antioxidant
      supplementation plus lactulose on MHE versus lactulose alone. Patients who were diagnosed as
      having MHE were randomly assigned either to receive zinc and antioxidant plus lactulose
      (group A) or lactulose alone (group B, the control). Patients in group A received 175 mg zinc
      gluconate, 50000 iu vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus
      lactulose (30-60 ml in 2 or 3 divided doses), while patients in group B received 30-60 ml
      lactulose in 2 or 3 divided doses so that the patient passed 2-3 semi soft stools per day.
      The therapy was taken daily for 3 months or until the patients discontinued the study drugs
      for any reason (e.g. non compliance). All patients were followed up every month for treatment
      compliance and for development of any complications. The compliance with the therapy was
      assured primarily by ensuring increased stool frequency and a change to a softer consistency
      and by counting the number of bottles of lactulose consumed. None of the study, patients were
      specifically treated by other therapy for MHE within the study period (e.g. rifaximin).
    

Intervention name(s): 175 mg zinc gluconate, 50000 IU vitamin A, 500 mg vitamin C and 100 mg vitamin E once daily plus lactulose; dose 30-60 ml/day for 3 months; Lactulose
Intervention type(s): Dietary Supplement; Dietary Supplement
Intervention MeSH terms: Vitamins; Vitamin E; Vitamin A; Lactulose
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Consecutive patients (truck drivers) with liver cirrhosis were screened for MHE. The
        patients attended the Tropical and Neurology Outpatient clinics in Mansoura university
        Hospital, Mansoura
      
Keywords: Antioxidants; Zinc; Truck drivers