Studies with Liv.52 therapy in Infective Hepatitis
Sule, C.R., M.D., Pai, V.R., M.D., Damania, R.F., M.D., and Miss. Joshi, V.S., M.B.,B.S. Medicine Unit, Sassoon General Hospitals, and B.J. Medical College, Poona, India.
In the control series, i.e. Group I, the serum bilirubin was below 2.5 mg% in 9 cases out of 25 (36%) by the 19th day. The serum bilirubin level at intervals in the treated group was significantly reduced (Graphs 1 and 2). by the 19th day the serum bilirubin level was below 2.5 mg% in 19 cases out of 25 (76%) in Group II. In Group III, i.e. the entire series treated with Liv.52, 98 cases (78.4%) had serum bilirubin below 2.5 mg by the 19th day.
In the control series in Group I there were 11 cases out of 25 (55%) where SGPT levels reverted to normal, i.e. below 40 units/ml. This clearly indicates that in this control group parenchymal damage was still active even on the 19th day (Graphs 3 and 4).
In Group II (25 Liv.52-treated cases) the SGPT levels returned to normal, i.e. below 40 units/ml. in 19 out of 25 cases (76%) by the 19th day. In Group III (125 Liv.52-treated cases) the SGPT levels came to normal in 106 cases (84.8%) by the 19th day.
In the control series, Group I, the SGPT levels reverted to normal (15 units/ml.) by the 19th day in 12 cases out of 25 (48%), whereas the corresponding figures in Group II were 21 cases out of 25 (20%) – Graphs 5, 6 - and in Group III (125 cases treated on Liv.52), 98 patients (78.4%) had normal SGOT by the 19th day.
In our series of 125 cases (Group II and Group III) serum alkaline phosphatase was estimated regularly in only 56 cases.
In Group II in 19 cases out of 25 (76%), the level of serum alkaline phosphatase level reverted to normal, i.e. 3-13 K.A. Units by the 19th day.
In Group III out of the 56 cases where the estimations were regularly done, 40 cases (71.5%) reverted to normal by the 19th day. The comparative data for the control series in Group I is not available as this group was selected from other wards.
DISCUSSION
Till recently treatment has had little effect in altering the course of an ordinary case of acute infective hepatitis. Till today various drugs have been tried as therapeutic measures and various authors have claimed beneficial results with different drugs, (Sheila Sherlock, 1961).
Liv.52, an indigenous proprietary medicine, was claimed to be a hepatic stimulant: Kirtikar and Basu (1933). Sheth et al. (1960), Joglekar et al. (1963), Karandikar et al. (1963), Patel et al.(1963), have shown protective effects of Liv.52 against hepatotoxic agents.
Sule and others (1956) showed clinical improvement in diffuse hepatic fibrosis with ascitis.
We were particularly impressed by the clinical improvement shown by Liv.52 in cases of infective hepatitis. Murkibhavi et al (1957) have shown the usefulness of the drug in cases of jaundice in dogs.
It appears that the clinical improvement noticed is probably due to the action of the individual components. Marked improvement was seen in relieving the symptoms of nausea, vomiting, loss of appetite and abdominal pain with diarrhoea and constipation. Appetite and a feeling of well-being particularly improved with Liv.52 therapy. Pruritus was significantly relieved.
The biochemical investigations of enzyme studies, i.e. SGPT and SGOT and alkaline phosphatase show considerable fall in the Liv.52 cases. The serum bilirubin, as an index of the severity of jaundice, had dropped significantly in the cases treated with Liv.52 (Graphs 1 and 2). In 76% the serum bilirubin dropped below 2.5 mg% as against only in 48% in the control series. This indicates that the cholestasis was greatly relieved, possibly due to reducing the interhepatic oedema and cellular infiltration. It is probable that the cellular regeneration was also rapid. This hypothesis is supported by histological observations done by Joglekar et al (1963). They have shown active regeneration with prevention of necrosis and progressive fibrosis.
The exact mechanism of the protective effect of Liv.52 remains still unexplained and requires further long-term study with individual components and various combinations of drugs in Liv.52.
Similarly, it would be interesting to note the long-term study of follow-up observations in Liv.52-treated cases of infective hepatitis, particularly to find out the incidence of post-hepatitis syndrome, sub-acute infective hepatitis. It is significant that none of the patients in this present series treated with Liv.52 has so far reported back with the above.
In the present series of 125 cases, 4 cases were in coma. They received Liv.52 therapy along with steroids, antibiotics and routine regimen. Two of these cases recovered.
None of the cases treated with Liv.52 showed any untoward toxic symptoms.
SUMMARY
A three-year study of 150 cases of infective hepatitis was undertaken. The clinical improvement in symptoms is discussed.
An attempt is made to show the comparative improvement in certain well-known liver function tests like serum bilirubin, enzyme, SGPT, SGOT and alkaline phosphatase.
ACKNOWLEDGEMENT
We are thankful to Dr. F.J. Mendonca, Dean, B.J. Medical College and Sassoon General Hospitals, Poona, for permitting us to carry out this study.
REFERENCES
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