z
Reddi, Y.R., M.D., M.A.M.S., Professor and Head of the Department of Paediatrics, Osmania Medical College, Director of Paediatric Services, Institute of Child Health and Superintendent, Niloufer Hospital, Hyderabad, India. Rohini, K., M.D., D.C.H., Research Scholar, Kusuma, G., M.D., D.C.H., Assistant Professor of Paediatrics and Sudhakar Rao, V., M.D. (Ped.), D.C.H. (Bom.), D.A.B.P. (U.S.A.), F.A.A.P. Assistant Professor of Paediatrics Research.
Follow-up study
‘A’ treated with Liv.52, though almost all 31 cases came for initial follow-up study 1–2 weeks after discharge, repeat biopsy could be done only for 8 cases, 6–12 weeks after the first biopsy. Biopsy was repeated again after 1 year for 2 cases and 2 years later for one case. Most of them showed a definite histopathologcial improvement after 6–12 weeks with complete recovery in three of them and remained normal even after 1–2 years. For one case fibrosis was observed initially but repeat biopsy after 1 year revealed normal architecture of the liver.
In Group ‘B’ treated with prednisone, though definite clinical and biochemical responses were noted with steroids, histopathological changes were not significantly altered when compared to Group ‘A’. Repeat biopsy could be done for two cases and histologic examination revealed incomplete recovery after 6-8 weeks.
In Group ‘C’, steroids + Liv.52, only two cases could be followed-up. One case did not have any histologic lesion even at the time of admission. Repeat biopsy after 4 weeks showed incomplete recovery for the other case.
DOSAGE SCHEDULE
Since viral hepatitis is often a self limiting disease, a definite improvement in symptomatology restoration of liver function tests to normal have been observed even in Group ‘D’ with supportive treatment, though delayed. Three cases could be followed-up. Repeat biopsy done 4–8 weeks after the initial biopsy for 2 cases, showed incomplete recovery. Another case came for follow-up after 9 months and biopsy was repeated. Histopathological examination revealed persistence of spotty necrosis and fibroblastic reaction denoting incomplete recovery (see Table XVI).
CONCLUSIONS
Though the number of cases studied is small to draw definite conclusions, the following observations can be made:
1. Viral hepatitis is a common paediatric problem, incidence being high during late summer and winter.
2. The pre-school age group is more affected.
3. A fairly high incidence of diarrhoea and respiratory infection is observed.
4. A triad of symptoms anorexia, fever and jaundice is usually present.
5. Sixty cases were divided into 4 groups. Group ‘A’ was on Liv.52 alone, Group ‘B’ on prednisone, Group ‘C’ on Liv.52 + prednisone, Group D on multivitamin tablets.
6. All cases recovered completely though recovery was earlier in the Liv.52 treated cases. There were no side effects encountered with Liv.52 therapy.
7. Tender hepatomegaly was observed only in 54% of the cases, and hepatomegaly was absent in 1.6%.
8. Clearance of jaundice could be correlated well to declining hyperbilirubinemia.
9. Return of SGOT and SGPT to normal was earlier than serum bilirubin.
10. No correlation could be made between serum bilirubin and SGOT and SGPT values to histologic lesion in 23% of cases.
11. Histopathological changes were not significantly altered with steroid therapy whereas with Liv.52 histopathological recovery was dramatic.
SUMMARY
A two year study of 60 cases of viral hepatitis was undertaken.
Detailed clinical and laboratory studies were made.
The results were analysed and compared with those of other workers and Niloufer Hospital statistics.
The recovery was assessed by clinical, biochemical and histopathological responses which were studied in four different groups.
Results of therapy with Liv.52 were assessed and compared with control and prednisone treated cases.
A follow-up study was done with special emphasis on hepatosplenomegaly, LFT and repeat liver biopsy.
An attempt was also made to carry out a long-term follow-up study in cases of viral hepatitis particularly to find out the incidence of post-hepatitis cirrhosis.
REFERENCES
1. Barker, M.H., Capps, R.B. and Allen, J. Am. Med. Assoc. (1945): 128, 997.
2. Bianchil (1970): Morphologic features in biopsy diag. of V.H. Prog. In Liv. dis. Vol. III, New York.
3. Dave, D.S., Clinico-biochem. Study of I.H., Probe (1972): 4, 214.
4. Deshpande, Sheth, S., Study of 100 cases of I.H., Probe (1972): 2, 105.
5. Ducci, H. and Alesondri, H., Trt. Of Ac. Hep. with cortisone and A.B., Gastroenterology (1957): p.29.
6. Ducci, H. and Katz, Trt. of Ac. Hep. with cortisone and A.B., Gastroenterology (1955): 29, 381.
7. Dudley, F.J., Fox and Sherlock, S., (1972): ibid, 743, ibid. 1388.
8. Editorial, I.H. J.I.M.A. (1960): 34, 497.
9. Gupta, S., Khatri, R.L., Probe (1972): 12, 93.
10. Krugman, S. and Ward, R., Aet. epidem and prevention of V.H., Prog. Med virology (1962): 4, 87.
11. Libov, A.L., Chloroquine in V.H. + Advance effects fol. Steroid therapy. Ind. J. Paed. (1966): 33, 355.
12. Lichtman, S.S., Dis. of liver and G 'B' Third edition (1953): Loa Febiger, Philadelphia.
13. Lucke, Fatal ep. hep., Amer. J. Path. (1944): 20, 471.
14. Mallory, J.B., The path. of epi. hepatitis, J. Am. Med. Assoc. (1947): 734, 655.
15. Mukerjee, A.B. and Dasgupta, M., Trt. of V.H. with Liv.52, Indian Practitioner (1970): 6, 357.
16. Melnick, J.L., Water borne urban epi. Hep. (Delhi epi.) hepatitis fronteris, Boston, Little Brown, (1957): 241.
17. Nelson, Textbook of Paediatrics (1969): 9th edition.
18. Patel, G.T. Mruthyunjayanna, Probe (1972): 11, 112.
19. Polyacova, G.P., S. bilirubin and its relation to histolog. lesion, Ind. J. Paed. (1961): 28, 20.
20. Rappaport, R., Hep. Foll. Transf., J. Am. med. Assoc. (1945): 128, 932.
21. Ramalingam, V., Sundaravalli, N. and Raju, V.B., Liv.52 studies in I.H., Ind. Paed. (1971): 12, 839.
22. Reddy, D.J., Course of V.H. fol. steroid therapy, Ind. J. Path. Bact. (1961): p.174.
23. Schiff, L. and Gall, E. (1956): Dis. of liver by Schiff, L.P. 159, Philadelphia; 1. B Lipincott.
24. Sherlock, S. (1963): Dis. of liver and Biliary Syst. 3rd edin.
25. Shetana, H.F., The epidemic of V.H. in Delhi, Path. changes. Indian National Symposium (1956): p.95.
26. Sule et al. I.H.J. of Ind. Med. Prof. (1968): 12, 6391.
27. Viswanathan, R., Epidemiology, Ind. Med. Res. I.H. (1957): 45, 101.
28. Walshe, J.M., The effect of glutanic acid in hepatic failure, Lancet (1953): 1, 1075.
29. Wood, P.A., Path. aspects of epidem hepatitis, Arch. Path. (1946): 41, 345.
30. W.H.O. Export Committee on viral hepatitis, Wld. Org. Tech. Rep. Series (1973): No. 512.
Refference: http://www.himalayahealthcare.com/pdf_files/liv218.pdf
Role of Liv.52 and Steroids in the Management of Viral Hepatitis in Children
Reddi, Y.R., M.D., M.A.M.S., Professor and Head of the Department of Paediatrics, Osmania Medical College, Director of Paediatric Services, Institute of Child Health and Superintendent, Niloufer Hospital, Hyderabad, India. Rohini, K., M.D., D.C.H., Research Scholar, Kusuma, G., M.D., D.C.H., Assistant Professor of Paediatrics and Sudhakar Rao, V., M.D. (Ped.), D.C.H. (Bom.), D.A.B.P. (U.S.A.), F.A.A.P. Assistant Professor of Paediatrics Research.
Follow-up study
‘A’ treated with Liv.52, though almost all 31 cases came for initial follow-up study 1–2 weeks after discharge, repeat biopsy could be done only for 8 cases, 6–12 weeks after the first biopsy. Biopsy was repeated again after 1 year for 2 cases and 2 years later for one case. Most of them showed a definite histopathologcial improvement after 6–12 weeks with complete recovery in three of them and remained normal even after 1–2 years. For one case fibrosis was observed initially but repeat biopsy after 1 year revealed normal architecture of the liver.
In Group ‘B’ treated with prednisone, though definite clinical and biochemical responses were noted with steroids, histopathological changes were not significantly altered when compared to Group ‘A’. Repeat biopsy could be done for two cases and histologic examination revealed incomplete recovery after 6-8 weeks.
In Group ‘C’, steroids + Liv.52, only two cases could be followed-up. One case did not have any histologic lesion even at the time of admission. Repeat biopsy after 4 weeks showed incomplete recovery for the other case.
DOSAGE SCHEDULE
| Age in years | Group ‘A’ Liv.52 | Group ‘B’ Prednisone | Group ‘C’ Liv.52 + Prednisone | Group ‘D’ Supportive |
| 1–2 | Liv.52 2 tsf. b.d. | Prednisone 2mg/kg | Liv.52 + Prednisone | Tab. B.C. 1 b.d. Tab. Vit. C. 1 b.d. |
| 2–5 | Liv.52 2 tsf. t.i.d | For 2 wks 1 mg/wk | | |
| 5–10 | Liv.52 2 tsf. t.i.d. | For 1 wk ½ mg/kg/wk | | |
| 10–12 | Liv.52 2 tabs. t.i.d. | | | |
Since viral hepatitis is often a self limiting disease, a definite improvement in symptomatology restoration of liver function tests to normal have been observed even in Group ‘D’ with supportive treatment, though delayed. Three cases could be followed-up. Repeat biopsy done 4–8 weeks after the initial biopsy for 2 cases, showed incomplete recovery. Another case came for follow-up after 9 months and biopsy was repeated. Histopathological examination revealed persistence of spotty necrosis and fibroblastic reaction denoting incomplete recovery (see Table XVI).
CONCLUSIONS
Though the number of cases studied is small to draw definite conclusions, the following observations can be made:
1. Viral hepatitis is a common paediatric problem, incidence being high during late summer and winter.
2. The pre-school age group is more affected.
3. A fairly high incidence of diarrhoea and respiratory infection is observed.
4. A triad of symptoms anorexia, fever and jaundice is usually present.
5. Sixty cases were divided into 4 groups. Group ‘A’ was on Liv.52 alone, Group ‘B’ on prednisone, Group ‘C’ on Liv.52 + prednisone, Group D on multivitamin tablets.
6. All cases recovered completely though recovery was earlier in the Liv.52 treated cases. There were no side effects encountered with Liv.52 therapy.
7. Tender hepatomegaly was observed only in 54% of the cases, and hepatomegaly was absent in 1.6%.
8. Clearance of jaundice could be correlated well to declining hyperbilirubinemia.
9. Return of SGOT and SGPT to normal was earlier than serum bilirubin.
10. No correlation could be made between serum bilirubin and SGOT and SGPT values to histologic lesion in 23% of cases.
11. Histopathological changes were not significantly altered with steroid therapy whereas with Liv.52 histopathological recovery was dramatic.
SUMMARY
A two year study of 60 cases of viral hepatitis was undertaken.
Detailed clinical and laboratory studies were made.
The results were analysed and compared with those of other workers and Niloufer Hospital statistics.
The recovery was assessed by clinical, biochemical and histopathological responses which were studied in four different groups.
Results of therapy with Liv.52 were assessed and compared with control and prednisone treated cases.
A follow-up study was done with special emphasis on hepatosplenomegaly, LFT and repeat liver biopsy.
An attempt was also made to carry out a long-term follow-up study in cases of viral hepatitis particularly to find out the incidence of post-hepatitis cirrhosis.
REFERENCES
1. Barker, M.H., Capps, R.B. and Allen, J. Am. Med. Assoc. (1945): 128, 997.
2. Bianchil (1970): Morphologic features in biopsy diag. of V.H. Prog. In Liv. dis. Vol. III, New York.
3. Dave, D.S., Clinico-biochem. Study of I.H., Probe (1972): 4, 214.
4. Deshpande, Sheth, S., Study of 100 cases of I.H., Probe (1972): 2, 105.
5. Ducci, H. and Alesondri, H., Trt. Of Ac. Hep. with cortisone and A.B., Gastroenterology (1957): p.29.
6. Ducci, H. and Katz, Trt. of Ac. Hep. with cortisone and A.B., Gastroenterology (1955): 29, 381.
7. Dudley, F.J., Fox and Sherlock, S., (1972): ibid, 743, ibid. 1388.
8. Editorial, I.H. J.I.M.A. (1960): 34, 497.
9. Gupta, S., Khatri, R.L., Probe (1972): 12, 93.
10. Krugman, S. and Ward, R., Aet. epidem and prevention of V.H., Prog. Med virology (1962): 4, 87.
11. Libov, A.L., Chloroquine in V.H. + Advance effects fol. Steroid therapy. Ind. J. Paed. (1966): 33, 355.
12. Lichtman, S.S., Dis. of liver and G 'B' Third edition (1953): Loa Febiger, Philadelphia.
13. Lucke, Fatal ep. hep., Amer. J. Path. (1944): 20, 471.
14. Mallory, J.B., The path. of epi. hepatitis, J. Am. Med. Assoc. (1947): 734, 655.
15. Mukerjee, A.B. and Dasgupta, M., Trt. of V.H. with Liv.52, Indian Practitioner (1970): 6, 357.
16. Melnick, J.L., Water borne urban epi. Hep. (Delhi epi.) hepatitis fronteris, Boston, Little Brown, (1957): 241.
17. Nelson, Textbook of Paediatrics (1969): 9th edition.
18. Patel, G.T. Mruthyunjayanna, Probe (1972): 11, 112.
19. Polyacova, G.P., S. bilirubin and its relation to histolog. lesion, Ind. J. Paed. (1961): 28, 20.
20. Rappaport, R., Hep. Foll. Transf., J. Am. med. Assoc. (1945): 128, 932.
21. Ramalingam, V., Sundaravalli, N. and Raju, V.B., Liv.52 studies in I.H., Ind. Paed. (1971): 12, 839.
22. Reddy, D.J., Course of V.H. fol. steroid therapy, Ind. J. Path. Bact. (1961): p.174.
23. Schiff, L. and Gall, E. (1956): Dis. of liver by Schiff, L.P. 159, Philadelphia; 1. B Lipincott.
24. Sherlock, S. (1963): Dis. of liver and Biliary Syst. 3rd edin.
25. Shetana, H.F., The epidemic of V.H. in Delhi, Path. changes. Indian National Symposium (1956): p.95.
26. Sule et al. I.H.J. of Ind. Med. Prof. (1968): 12, 6391.
27. Viswanathan, R., Epidemiology, Ind. Med. Res. I.H. (1957): 45, 101.
28. Walshe, J.M., The effect of glutanic acid in hepatic failure, Lancet (1953): 1, 1075.
29. Wood, P.A., Path. aspects of epidem hepatitis, Arch. Path. (1946): 41, 345.
30. W.H.O. Export Committee on viral hepatitis, Wld. Org. Tech. Rep. Series (1973): No. 512.
Refference: http://www.himalayahealthcare.com/pdf_files/liv218.pdf
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