Role of Liv.52 and Steroids in the Management of Viral Hepatitis in Children

INTRODUCTION

Viral hepatitis is one of the diseases which remains unconquered even in the Western countries. The incidence of the disease in advanced countries like U.S.A. is 33 per 1,00,000 population³⁰. Even in our country the incidence is steadily increasing and a lot of cases are seen almost all the year round. The clinical picture shows a great variation. The disease may be inapparent or evanescent. In children its course is usually mild⁹ but rarely predisposes to post-hepatitis cirrhosis, chronic cholestasis, subacute necrosis and hepatic failure.

There is so far no specific therapy for viral hepatitis, therefore it was considered desirable to ascertain the effects of Liv.52 and corticosteroids independently. A long term follow-up study was done with special emphasis on hepato-splenomegaly LFT and repeat biopsy to know the incidence of post hepatitis cirrhosis following viral hepatitis.

Liv.52 (Himalaya Drug Co. Pvt. Ltd.) is a herbal preparation and is found to have anabolic, aperient, diuretic, stomachic, haematenic and choleretic effects with protective and regenerative action on the liver and in all likelihood due to its different components. Thus it brings about definite although non-specific protective action on the liver in more than one way.

	Each tablet has processed extract of various plants	Each ml of Liv.52 drops or 2.5 ml of syrup contains:
Capparis spinosa	65 mg	17 mg
Cichorium intybus	65 mg	17 mg
Solanum nigrum	32 mg	8 mg
Cassia occidentalis	16 mg	4 mg
Terminalia arjuna	32 mg	8 mg
Achillea millefolium	16 mg	4 mg
Tamarix gallica	16 mg	4 mg
Mandur bhasma	33 mg

The exact mode of action of Liv.52 is still not fully understood. It stimulates hepatic function probably by reducing intra-hepatic congestions, thereby relieving cholestasis. It is also likely that it helps in quicker regeneration of hepatic parenchyma.^15,18


MATERIAL AND METHODS

A detailed study of 60 cases of viral hepatitis has been made during the period of 1971-73 in the Paediatric Wards of Niloufer Hospital with special reference of L.F.T., liver biopsy and trials with Liv.52 and prednisone. After careful detailed clinical evaluation as per detailed proforma, urine examination for bile and liver function tests were done on the day of admission. Later on blood was sent for haemogram, blood grouping and bleeding and coagulation time prior to biopsy. Liver biopsies were done initially in 47 cases with aseptic precautions under the cover of injection of Vitamin K.

Sixty cases of viral hepatitis were randomised into four groups: A, B, C and D. All patients were given routine supportive treatment like glucose, vitamins and rest in bed. The present trial on Liv.52 has been carried out on 31 cases of viral hepatitis (Group ‘A’). In Group ‘B’, 11 cases received supportive treatment as well as prednisone; Group ‘C’–5 cases received a combination of drugs, steroids and Liv.52; Group ‘D’-13 cases received only supportive treatment.

During the hospital stay, day-to-day progress was observed and after discharge, follow-up at weekly intervals, later at monthly intervals or whenever possible, was done in the Outpatient Department. Repeat biopsies were done in 15 cases after 3 to 12 weeks. A few cases were followed up even after a year.

OBSERVATIONS

Hospital statistics: Analysis of admissions, into the paediatric wards of the Niloufer Hospital during the years 1970 to 1972 is presented in Table I.

Table I: Shows the incidence, sex and mortality of cases of viral hepatitis during the years 1970-1972
Year	Total admissions	Total cases of viral hepatitis	Sex		Mortality
Male						Female
1970	9699	73	45	28	2
1971	9261	58	40	18	5
1972	9379	109	65	44	8

A higher incidence of viral hepatitis has been noticed during the pre-school period in the present series (Table II).