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

Table II: Shows age incidence of viral hepatitis at Niloufer Hospital and compared with the present series
Hospital Statistics			Present Series
Age	No. of cases	%	No. of cases	%
Less than 1 year	16	6.7	–	–
1–2 years	63	26.25	19	31.7
3–5 years	105	43.75	27	45.0
More than 5 years	56	23.3	14	23.3

The sex difference is not significant though in the worked out cases a higher incidence was observed in males.

Table III: Illustrates the sex incidence in the present series
Sex	No. of cases	%
Male	34	56.7
Female	26	43.3

Jaundice was observed in all cases but detected after admission in 5% of the present series. The average duration of jaundice prior to admission was 10 days but varied from 1-60 days.

Table IV: Showing duration of jaundice prior to admission
Duration	No. of cases	%
Less than 1 week	31	51.7
1–2 weeks	9	15.0
2–3 weeks	9	15.0
3–6 weeks	6	10.0
More than 6 weeks	2	3.0
Jaundice detected after admission	4	5.0

Table V: Illustrates the seasonal incidence of viral hepatitis
Month	No. of cases in hospital statistics	%	No. of cases in present series	%
January	21	8.7	3	5.0
February	16	6.6	4	6.6
March	19	7.9	1	1.6
April	19	7.9	5	8.3
May	14	5.8	3	5.0
June	22	9.1	8	13.3
July	14	5.8	1	1.6
August	37	15.4	9	15.0
September	21	8.7	9	15.0
October	18	7.5	5	8.3
November	24	10.0	8	13.3
December	17	7.0	4	6.6

In the present series a higher incidence was observed during late summer and winter months.

In the present series jaundice was observed in all cases and the depth of jaundice could be well correlated with the serum bilirubin levels though not with the histological lesion.

Table VI: Reveals the frequency of symptoms of viral hepatitis in the present series
Symptoms	No. of cases	%
Jaundice and yellow discoloration of urine	60	100
Fever	55	91.6
Asthenia	45	75.0
Anorexia	42	70.0
Clay coloured stools	34	56.0
Vomiting	28	47.0
Diarrhoea	27	46.0
Nausea	20	33.0
Pain in abdomen	18	30.0
Respiratory tract infection	14	23.3
Headache	13	21.6
Chills and rigors	7	11.0
Pruritus	5	8.0
Insomnia	5	8.0
Altered sensorium	1	1.6
Bleeding tendencies	1	1.6

Table VII: Shows the degree of jaundice as judged clinically in the present series
Degree of jaundice	No. of cases	%
Mild	48	80.0
Moderate	11	18.3
Severe	1	1.7

Table VIII: Illustrates the frequency of signs of viral hepatitis in the present series
Signs	No. of cases	%
Icterus	60	100.0
Hepatomegaly	59	98.0
Tender liver	31	51.0
Splenomegaly	21	35.0
Lymph node enlargement	21	35.0
Oedema Legs	4	6.0
Ascites	1	1.6
Bradycardia	1	1.6

Hepatomegaly was observed in 98% of the present series. Only in a single case it was not palpable though histopathological examination of the liver biopsy specimen revealed viral hepatitis.

Table IX: Illustrates the size of the liver in the present series
Palpable in midclavicular line in cm	No. of cases	%
1 cm	5	8.3
2–4 cm	41	68.3
5–6 cm	9	15.0
Not certain	4	6.7
No liver enlargement	1	1.7

The serum bilirubin level could be well correlated clinically with the depth of jaundice, there was no correlation between it and the histologic lesion.

It has been observed that 23% of the present series had normal SGOT and SGPT levels in spite of elevated serum bilirubin levels. On the other hand 12% of cases showing hepatic damage on histopathological examination had normal SGOT and SGPT values.

Though the initial levels of alkaline phosphatase were normal all the cases registered a fall in the levels 15 days after treatment.


Thymol turbidity values ranged from 3.8 to 10 units in the present series. After 15 days of treatment all cases showed normal values.

Table X: Shows the serum bilirubin levels in the present series on admission
Serum bilirubin mg%		Group ‘A’		Group ‘B’		Group ‘C’		Group ‘D’
Liv.52 %			Prednisone %		Liv.52 + Pred. %		Supportive %
0–5		98.7		60		60		84.6
5–10		10.3		30		40		15.4
10–15		–		10		–		–

Table XI: Shows the serum bilirubin levels 15 days after treatment with Liv.52, prednisone, both and routine supportive therapy (placebo)
Serum bilirubin mg%		Group ‘A’		Group ‘B’		Group ‘C’		Group ‘D’
Liv.52			Prednisone		Liv.52 + Prednisone		Supportive therapy
0–1		13.8		–		–		23.1
1–2		82.8		90		60		61.5
2–3		3.4		10		20		–
3–5		–		–		–		15.4
More than 5		–		–		20		–

Table XII: Shows improvement in biochemical tests 15 days after treatment
Biochemical test			Group ‘A’		Group ‘B’		Group ‘C’	Group ‘D’
Liv.52 %		Prednisone %		Liv.52 + Pred. %		Supportive therapy %
1. Bilirubin fall to less than 2 mg			96.6		90.0		66.6	84.6
2. Fall of SGOT to 40 units and below			89.4		77.7		75.0	81.8
3. Fall of SGPT to 40 units and below			85.7		55.5		–	72.7