Hepatic encephalopathy An imbalance between aromatic amino acids (phenylalanine, tryptophan and tyrosine) and branched-chain amino acids (leucine, isoleucine and valine) has been described; this would lead to the generation of false neurotransmitters (such octopamine and 2-hydroxyphenethylamine). Dysregulation of the serotonin system, too, has been reported. Depletion of zinc and accumulation of manganese may play a role. Inflammation elsewhere in the body may precipitate encephalopathy through the action of cytokines and bacterial lipopolysaccharide on astrocytes. The diagnosis of hepatic encephalopathy can only be made in the presence of confirmed liver disease (types A and C) or a portosystemic shunt (type B), as its
Protocol Relating to the Status of Refugees the temporal and geographic restrictions. This was needed in the historical context of refugee flows resulting from decolonisation. However, the Protocol gave those states which had previously ratified the 1951 Convention and chosen to use the geographically restricted definition the option to retain that restriction. Protocol Relating to the Status of Refugees The Protocol Relating to the Status of Refugees is a key treaty in international refugee law. It entered into force on 4 October 1967, and 146 countries are parties. Where the 1951 United Nations Convention Relating to the Status of Refugees had restricted refugee status to those whose