Liv.52 Therapy in Viral Hepatitis
Patel, G.T., M.D., Mruthyunjayanna, B.P., M.D., Seetharam, T.D., M.B.,B.S. and Channe Gowda, A.C., M.B.,B.S., Medicine Unit, Victoria Hospital and Bangalore Medical College, Bangalore, India.
Table VI shows comparative data of thymol turbidity and ESR in the two Groups A and B, on admission and after 14 days of therapy.
Table VI: Comparative Data of Thymol Turbidity and ESR in the Groups “A” and “B” — Before and after therapy |
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|
Thymol Turbidity Units |
ESR Westergren, mm/hour |
||||||||||||||||||||||||
|
No. of patients |
0-5 |
5-10 |
10-15 |
15-20 |
20-30 |
Over 30 |
0-5 |
5-10 |
10-15 |
15-20 |
20-30 |
Over 30 |
|||||||||||||
Group A |
On admission |
— |
4 |
7 |
5 |
6 |
3 |
2 |
1 |
5 |
6 |
9 |
2 |
|||||||||||||
After therapy |
3 |
5 |
4 |
7 |
2 |
4 |
2 |
4 |
3 |
7 |
6 |
3 |
||||||||||||||
Group B |
On admission |
— |
3 |
4 |
10 |
8 |
2 |
1 |
2 |
4 |
8 |
10 |
2 |
|||||||||||||
After therapy |
3 |
11 |
8 |
2 |
1 |
2 |
4 |
10 |
7 |
3 |
1 |
2 |
||||||||||||||
Table VII shows comparative evaluation of biochemical improvement after therapy.
Table VII: Comparative Evaluation of Biochemical Improvement after Therapy. |
|||||||||
Values after two weeks of therapy |
Group A (25 cases) |
Group B (27 cases) |
|||||||
No. of cases |
Percentage % |
No. of cases |
Percentage % |
||||||
1. |
Serum bilirubin (below 5 mg.%) |
7 |
28 |
20 |
74.0 |
||||
2. |
SGPT (below 100 units/ml.) |
6 |
24 |
15 |
55.6 |
||||
3. |
SGOT (below 50 units/ml.) |
11 |
44 |
21 |
77.8 |
||||
4. |
Serum alkaline phosphatase (between 3-13 K.A. units) |
8 |
32 |
17 |
63.0 |
||||
5. |
Thymol turbidity (below 15 units) |
12 |
48 |
22 |
81.5 |
||||
6. |
ESR (Westergren, below 15 mm/hour) |
9 |
36 |
21 |
77.8 |
||||
DISCUSSION
In Liv.52 treated cases, improvement in symptomatology was remarkable as compared to the control group. After Liv.52 therapy, patients had a subjective sense of well-being and appetite improved in all these cases. Relief from nausea, vomiting, abdominal pain constipation and pruritus was rapid. The laxative effect of Liv.52 is a desirable action as it tends to lessen the pre-disposition to comatose state. None had any restlessness or precoma in Liv.52 series. In control series, two cases were restless and two cases were precomatose.
During this illness, the adult patient loses about 10 lb. in weight (Sherlock, 1968). Marked loss of weight occurred in all the cases of control group with an average loss of 4.1 kg. as against 1.6 kg. in Liv.52 series. In Liv.52 series, in two cases bodyweight remained fairly constant and in nine cases (33.3 per cent) average gain in weight of 1.1 kg. was recorded. This is an advantage in treating viral hepatitis and can be attributed to the anabolic effect of Liv.52 (Damle and Deshpande, 1966; Kale et al, 1966; Mathur, 1969; Kulkarni and Joglekar, 1970;; Mukerjee and Dasgupta, 1971; Dayal et al, 1971).
The serum bilirubin dropped below 5 mg% in 74 per cent of cases in Liv.52 series as compared to 28 per cent in control series. Hyperbilirubinaemia as an index of severity of jaundice remarkably regressed in Liv.52 treated cases. Serum alkaline phosphatase, which is a more sensitive index of bile stasis than the serum bilirubin level, remarkably reverted to normal in 63 per cent of cases in Liv.52 series as against 32 per cent in control series.
These observations affirm the efficacy of Liv.52 in clearing up the intrahepatic cholestasis, possibly by reducing the intrahepatic oedema and cellular infiltration in portal tracts. The protective and regenerative action of Liv.52 on liver (which has been confirmed by various experimental, clinical, biochemical and histopathological studies) may also help to relieve the cholestasis. Serial liver biopsy was possible in a limited number of cases in our series and the histological study revealed that the initial acute hepatic cell necrosis was restored to the normal reticulin framework of the liver lobule after Liv.52 therapy.
Serial transaminase estimations showed considerable fall after Liv.52 therapy. SGPT was below 100 units/ml in 24 per cent of cases in control series as against 55.6 per cent in Liv.52 series and SGOT was below 50 units/ml in 44 per cent of cases in control series as compared to 77.8 per cent Liv.52 series.
As extremely sensitive indices, the transaminase levels reflect the extent of hepatic injury and continued elevation suggests that the disease is not yet resolved. Taken in conjunction with the improvement in symptomatology, serum bilirubin, alkaline phosphatase and hepatic histology, the rapid return of transaminase levels to normalcy after Liv.52 therapy strongly supports the protective and regenerative action of Liv.52 in viral hepatitis and affirms the observations made earlier.
After therapy, thymol turbidity was below 15 units in 48 per cent of cases in the control series, as compared to 81.5 per cent in Liv.52 series, indicating the efficacy of Liv.52 in reducing inflammation and also residual hepatic damage. Rapid fall of turbidity levels in Liv.52 series also reflects that complications (like chronic cholestasis and post-hepatic cirrhosis, in which the turbidity levels remain very high) are less likely after Liv.52 therapy. ESR values are also parallel with the turbidity levels. ESR was below 15 mm/hour (Westergren) in 36 per cent cases of control series as against 77.8 per cent in Liv.52 series. The rapid return of ESR to normalcy confirms the observations already made that Liv.52 reduces inflammation, promotes a rapid and uneventful recovery, thereby preventing residual hepatic damage. Our observations affirm those of Mukerjee and Dasgupta (1971) who studied cases of viral hepatitis after Liv.52 therapy by Bromsulphthalein test and liver biopsy, arriving at a similar conclusion.
SUMMARY
A study to evaluate the efficacy of Liv.52 in viral hepatitis was undertaken. In all 52 cases were studied — 25 cases served as control and 27 cases received Liv.52.
Clinical, biochemical (based on serum bilirubin, SGPT, SGOT, alkaline phosphatase, thymol turbidity and ESR values) and histological recovery was rapid and uneventful in Liv.52 - treated cases as compared to the control series.
We feel that Liv.52 richly deserves to be used as a routine treatment in all cases of viral hepatitis — particularly in our country, as death from this disease is much more common (because of poor standard of nutrition which increases the susceptibility of liver cells to necrosis) than it is in the Western countries.
ACKNOWLEDGEMENTS
We are thankful to Dr. M. Gurudas, Dean, Bangalore Medical College and Victoria Hospital, Bangalore, for permitting us to carry out this study.
We are grateful to Messrs. Himalaya Drug Co. Private Ltd., for the help and supply of Liv.52 tablets.
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Refference: http://www.himalayahealthcare.com/pdf_files/liv209.pdf
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