Abstract OBJECTIVE: Previous animal work reported that hyperammonemia leads to opposing changes of GABAergic neurotransmission in terms of increase in the cerebellum and decrease in the cerebral cortex. In this study, we investigate GABAergic tone in the cerebellum in patients with hepatic encephalopathy (HE) at different stages of the disease and its relation to critical flicker frequency (CFF) and ataxia. METHODS: Cerebellar inhibition using transcranial magnetic stimulation was investigated in 15 patients with different stages of HE and 15 healthy controls. All patients were assessed using CFF and the score for assessment and rating of ataxia (SARA). RESULTS: Decreased cerebellar inhibition (CBI) was observed in manifest HE at interstimulus interval from 5 to 7 ms. However, the degree of CBI at 7 ms correlated significantly with disease severity measured with SARA and with CFF by trend. CONCLUSION: Reduced CBI in HE patients indicates affection of the cerebellar efferent pathway. The disease severity dependent increase of CBI magnitude supports the notion of disease stage dependent increase of GABAergic neurotransmission in Purkinje cells. SIGNIFICANCE: The results support previous animal experiments showing increase of GABA-ergic neurotransmission in the cerebellum and decrease in the motor cortex in HE.

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Aims: To evaluate changes in intraocular pressure (IOP) and anterior chamber depth (ACD) after uneventful phacoemulsification with intraocular lens (IOL) implantation. Study Design: Prospective interventional comparative study. Place and Duration of Study: Department of Ophthalmology, Assuit University Hospital, Assuit, Egypt between September 2016 and October 2017 . Methodology: 100 Patients with visually significant cataract (39 males (39%) and 61 females (61%). All patients underwent uneventful phacoemulsification. Intraocular pressure and ACD were measured preoperatively by using Goldmann applanation tonometer and Ultrasonography respectively , and at 1 week, 1 month, and 3 months postoperatively. Results: The postoperative ACD was higher than the preoperative value by 0.26± 0.06 mm at 1 week, 0.45±0.06 mm at 1 month, and 0.59±0.08 mm at 3 months postoperatively (P=.000). P 0.05 Original Research Article Abdallah et al.; OR, X(X): xxx-xxx, 20YY; Article no.OR.47792 2 was considered to indicate a statistically significant difference. The IOP at 1 week, 1 month, and 3 months postoperatively was lower than the preoperative value by 1.03±0.3 mmHg, 1.52±0.46 mmHg, and 2.14±0.62 mmHg, respectively (P=.001). Conclusion: This study revealed that there was a decrease in IOP and increase in ACD after cataract extraction by phacoemulsification. Patients with ocular hypertension, open-angle glaucoma, and narrow-angle glaucoma may benefit from cataract extraction.