Respiratory Tract Infections in Children

Himalaya’s Health Digest for You • Vol LI • No 4 • Apr–Jun 2012
3 Health from Herbs
Clinical Studies
4
6 Health Tips
Product Feedback
6
7Health News
In Focus
8
9 Latest in Medicine
Fitness
10
10 Fact File
Event Calendar
10
11 Laugh a While
Respiratory Tract Infections in Children
Introduction
Pathophysiology
Acute respiratory tract
infections are one of the
most common self-limiting
illnesses evaluated in a
pediatric practice. Upper
respiratory tract infection
(URTI) or commonly known
as “common cold” occurs
frequently in young children
and is characterized by a
complex set of symptoms.
The URTIs are caused by
numerous types of viruses,
which include the rhinovirus,
coronavirus, parainfluenza,
respiratory syncytial virus
(RSV), adenovirus, human
metapneumovirus, and
influenza. The recently
discovered bocavirus has also
been found to be associated
with URTI. The specific
manifestations of URTIs
include rhinitis, sinusitis,
nasopharyngitis, epiglottitis,
laryngitis, laryngotracheitis,
and tracheitis. Being most
accountable for absence
from school and unnecessary
medical care, URTIs are
regarded as trivial among the
medical fraternity. However,
URTIs are the foremost causes
of mild morbidity in children.
A majority of URTIs spread
through person-to-person
contact of the infected
secretions. Viruses may
directly invade the mucosal
lining of the upper airway.
Bacterial infection may also
occur in a similar manner
but superinfection of a viral
infection may occur. The
infection may begin when
secretions get passed on from a
contaminated hand to the nose
or mouth. Droplet infection
results from direct inhalation
of respiratory droplets released
when infected person coughs
or sneezes. As viruses and
bacteria enter the body, they
come across various barriers
such as physical, mechanical,
humoral, and cellular immune
defenses. Hair lining the walls
of the nasal cavity, mucus
coating the upper respiratory
tract, and ciliated cells in
the lower respiratory tract
act as physical barriers in
trapping the pathogens and
transferring them up to the
pharynx from where they are
ingested into the stomach. The
adenoids and tonsils with their
immune cells play a role in
defense mechanism. Humoral
and cellular immunity help
reduce infections throughout
the respiratory tract. Apart
from these, the normal
nasopharyngeal flora defends
against the pathogenic
bacteria. Therefore, children
with a deficient humoral and
phagocytic immune function
are at a greater risk for a
difficult and extended course
of disease.
Incubation periods before
the manifestation of
EDITORIAL
Dear reader,
Acute respiratory tract infections
(RTI) are the most common
illnesses experienced in
childhood, primarily due to
developing/immature immune
defense system. It is approximated
that children usually will suffer at
least 3 to 8 respiratory illnesses
caused by virus every year. Peak
incidence of viral and bacterial
pharyngitis is seen in children
between 4 and 7 years.
The “Cover Page” article features
a review on the pathophysiology,
incidence, and natural history
of RTIs in children. The
“Clinical Studies” section of this
issue features the beneficial
effects of Septilin drops, a
phytopharmaceutical formulation
of The Himalaya Drug Company
effective in the management of
chronic and recurrent RTIs. The
section also features other articles
that discuss about the clinical
efficacy and safety of Koflet-H
lozenge, a newly introduced
product, in the management
of pharyngitis; Renalka syrup
in urinary tract infection, and
Hairzone in the management of
diffuse hair loss.
In addition to these, the issue
also discusses the health
benefits of Saraca indica and
Cissus quadrangularis in “Health
from Herbs” section. “In Focus”
section features a meta-analysis
that discusses the efficacy and
safety of Liv.52 in preventing
hepatotoxicity in patients
receiving antitubercular drugs.
Please write to us
at publications@
himalayahealthcare.com with
your feedback/suggestions on this
issue of Capsule.
symptoms will differ among
pathogens. The incubation
time for rhinoviruses and group
A streptococci is 1 to 5 days,
influenza and parainfluenza
viruses incubate for 1 to 4
days and RSV for a week.
Narrowing of the airway at the
level of epiglottis and larynx
due to inflammation may
cause compromized airflow
which is critical in children.
A thorough understanding
of the natural history of the
disease, warning signs, and
sequelae is indispensable for
the management of childhood
URTIs.
Incidence
The incidence of URTI
differs by age. The rates of
nasopharyngitis are highest
in children below 5 years
and it is approximated that
children usually will suffer at
least 3 to 8 respiratory illnesses
caused by virus every year.
Peak incidence of viral and
bacterial pharyngitis is seen
Happy reading!
– Editor
Did you like this new look of Capsule?
Type “CAPSULE-YES” or “CAPSULE-NO”
in the subject line and mail us at
[email protected]
2
• Apr–Jun 2012 • Vol LI • No 4
in children between 4 and 7
years. Epiglottitis generally
occurs in children between 2
and 7 years and is peak at the
age of 3 years. Laryngitis and
laryngotracheitis occurs in
children between 6 months and
6 years and peak incidence is in
second year of life.
Natural History of URTI
The natural history of URTI
in children has been better
documented with the advent
of sensitive and specific reverse
transcriptase polymerase chain
reaction techniques. The first
community-based natural
history study was conducted
in the Virginia, USA in which
81 children between 5 and 10
years of age were enrolled and
data was collected beginning
from the onset of symptoms to
the 10th day. Results showed
that rhinovirus was isolated
in almost 37 cases which
accounts to 50% of cases.
The commonest signs were
coughing and sneezing and
the most common symptoms
were nasal congestion and a
runny nose. All these signs and
symptoms continued for the
first week. The main inference
from the natural history data is
that coughing is very common
in children and can persist till
the ninth day whereas fever is
uncommon beyond the first
day and its persistence suggests
other causes such as influenza
or a bacterial complication
(otitis media or sinusitis).
Lower Respiratory
Disease Linked to
Rhinovirus
In two recent studies
conducted on hospitalized
children, it has been
documented that a significant
number of lower respiratory
diseases are caused by the
rhinovirus. In a US study, the
rhinovirus was isolated in about
26% of the children below
5 years of age, hospitalized
for acute respiratory disease.
The rhinovirus was identified
more frequently than the RSV
which was previously associated
with most of the lower airway
morbidities and a history of
asthma. Apnea was common
in infants below 6 months
of age. In a study conducted
in Spain, children below 2
years of age were enrolled and
the rhinovirus was associated
in 25% of the hospitalized
children. Multiple viruses were
detected in almost 40% of
children signifying a role of coinfection in the pathogenesis of
respiratory disease.
–– Excerpted from:
Cotton MF, et al. SA Fam Pract.
2008;50(2):6-12.
Recurrent infections are more common in children due to immature and imbalanced immune defense system. In
children with allergy, unresolved inflammatory response adds to the burden on the immature immune system. The
key to managing these infections lies in immunomodulation (boosting immune responses that protect the host and
reducing immune responses that affect the host). Septilin drops, from The Himalaya Drug Company, potentiates
immune defenses by increasing immunoglobulin levels, improving chemotaxis, and stimulating phagocytosis by
activating macrophages and increasing levels of polymorphonuclear cells; and reduces inflammation and allergy by
decreasing pro-inflammatory cytokines, eosinophils, and IgE levels. Septilin drops is indicated as a co-prescription
with anti-infective therapy, and for recurrent respiratory and ENT infections, skin and soft tissue infections, and
resistance to antibiotic therapy.
www.himalayahealthcare.com
Health from Herbs
Terminalia arjuna
Terminalia arjuna is native to the Indian
subcontinent. It is an evergreen tree with
yellow flowers and conical leaves and grows
up to 100 feet (30 meters). In Ayurvedic
medicine, Arjuna is the most frequently
prescribed herb for cardiovascular health.
The bark of T arjuna contains calcium salts,
magnesium salts, tannins, and glucosides.
It acts as a stimulant, tonic, and astringent.
In addition, it has been found to possess
antibacterial and antimutagenic properties.
It is used to treat hemorrhage, diarrhea,
dysentery, edema, skin problems, and
fractures.
Studies have shown that T arjuna possesses
cardioprotective effect. The results of an
experimental study suggested that T arjuna
English name
Arjuna
Sanskrit/Indian name
Arjuna
bark extract has a significant prophylactic and
therapeutic beneficial effect on protection of
heart against isoproterenol-induced chronic
heart failure possibly through maintaining
endogenous antioxidant enzyme activities,
inhibiting lipid peroxidation and cytokine
levels.1
Experimental studies have also revealed that
T arjuna bark exerts significant inotropic
and hypotensive effect, increases coronary
artery flow and protects myocardium against
ischemic damage. It has also been detected
to have mild diuretic, antithrombotic,
prostaglandin E(2) enhancing and
hypolipidemic activity. There is ample clinical
evidence of its beneficial effect in coronary
artery disease alone and along with statin.2
Allium sativum
Allium sativum is a scapigerous perennial
herb with underground compound bulb
and a smooth round stem, which is enclosed
with tubular leaf sheath. A sativum is
found throughout India and grows well
in mild climate. Some of the key chemical
constituents of A sativum are S-allyl-L-cysteine
sulfoxide (alliin), gamma-glutamyl-S-allyl-Lcysteine, and diallyl trisulfide.
In Western Europe and the US, A sativum
is one of the most popular herbs being
used to reduce risks associated with heart
disease. It has shown to prevent hardening
of arteries, reduce elevated blood cholesterol
levels, improve blood flow, and manage
hypertension.
Recently, a study was conducted to identify
the role of garlic oil in diabetes-induced
cardiomyopathy. Streptozotocin-induced
diabetic rats were administered with garlic
oil (0, 10, 50, or 100 mg per kg of body
References
weight) every two days for 16 days. The
researchers noted garlic oil to ameliorate
cardiac contractile dysfunction and apoptosis
in a dose-dependent manner, and concluded
that it has a significant potential in offering
protection against diabetes-induced
cardiomyopathy.3 Another recent research
has reported that A sativum homogenate
in combination with hydrochlorothiazide
(HCTZ) showed synergistic antihypertensive
and cardioprotective properties in rats with
hypertension and myocardial damage.4
English name
Sanskrit/Indian name
Garlic
Lasuna
A sativum is also reported to have antifungal, anti-platelet, diuretic, anti-cancer,
antihelminthic, aphrodisiac, and antibacterial
properties. The herb is found to be useful
in numerous medical conditions including
bronchitis, whooping cough, constipation,
asthma, fever, diabetes, dyspepsia, duodenal
ulcers, tuberculosis, hemorrhoids, sciatica,
leucoderma, and dental caries.5
1. Parveen A, et al. Cardiovasc Toxicol. 2011;11(1):48-57.
4. Asdaq SM, Inamdar MN. J Nat Med. 2011;65(1):81-88.
2. Dwivedi S. J Ethnopharmacol. 2007;114(2):114-129.
5. Warrier PK, Nambiar VPK. Indian Medicinal Plants: A Compendium of 500 Species.
Hyderabad, India: Orient Longman Private Limited; 1994:93.
3. Ou HC, et al. J Agric Food Chem. 2010;58(19):10347-10355.
www.himalayahealthcare.com
Apr–Jun 2012 • Vol LI • No 4 •
3
Clinical Studies
Koflet-H Lozenges in
Pharyngitis
An open, prospective
clinical trial was
conducted to evaluate
the role of Koflet-H
lozenges in the
treatment of mild-tomoderate pharyngitis.
This study included 50 patients in the age group of 18 to 60
years suffering from mild-to-moderate pharyngitis. A complete
head and neck examination was performed to exclude other
diseases and all the patients were instructed to take Koflet-H
lozenges 3 times a day for 6 days. No other medications or antiinflammatory drugs were taken during the study period. All the
patients were evaluated for their presenting symptoms at baseline,
day 3, and day 6.
Statistically significant improvements were observed in the signs
and symptoms of pharyngitis on the third and sixth day when
compared with their baseline values (Table 1). Also, there was a
major improvement in the hematological parameters as compared
to baseline values. None of the patients experienced any
significant adverse reactions during the entire study period and
Koflet-H lozenges relieved signs and symptoms of pharyngitis
such as throat congestion, cough, hoarseness of voice, pain, and
inflammation. The overall patient compliance and acceptance was
excellent. Therefore, it can be concluded that Koflet-H lozenges
are effective as well as safe in patients suffering from mild-tomoderate pharyngitis.
Table 1. Evaluation of Effect of Koflet-H Lozenges on Symptomatic Relief
Parameter
Throat congestion
Cough
Day 0
1.06 ± 0.24
1.02 ± 0.25
Hoarseness of voice
0.96 ± 0.20
Pain
0.98 ± 0.14
Inflammation
1.02 ± 0.14
Day 3
Day 6
1.96 ± 0.20
2.84 ± 0.37
P<.001
1.88 ± 0.33
a,b
P<.001
2.82 ± 0.39
a
P<.001
1.62 ± 0.49
a,b
P<.001
2.38 ± 0.49
P<.001
1.88 ± 0.33
P<.001
2.78 ± 0.42
a
P<.001
1.86 ± 0.35
a,b
P<.001
2.78 ± 0.42
a
a
a,b
Septilin Drops in the
Management of Respiratory
Tract Infections
An open label clinical trial was
conducted to evaluate the safety
and efficacy of Septilin drops
in the management of children
suffering from upper respiratory
tract infection (URTI). The
study included a total of
20 children with URTI in the
age group of 1 to 3 years. After physical examination including a
detailed examination of ear, nose, throat and chest, and recording
of vital signs, Septilin drops was given for a period of 2 weeks, at
a dose of 3.5 ml twice daily for children between 1 and 2 years
and 4 ml twice daily for children between 2 and 3 years. All the
children were followed up at the end of 4th day, 1 week, and 2
weeks, and the safety and efficacy evaluation of the product was
done during each visit.
Results of the clinical trial showed that Septilin drops significantly
reduces symptoms of URTI such as common cold, chronic
cough, pharyngitis, tonsillitis, and adenoiditis (Table 2). No
adverse reactions or withdrawal from trial were reported or
observed throughout the study period and the overall compliance
to the treatment was excellent. Therefore, it can be concluded that
Septilin drops is effective and safe in the treatment of URTI in
children.
Table 2. Percentage Response to Septilin Drops in Children with Upper
Respiratory Tract Infections
Sl. no. Respiratory tract infection
Response (%)
1
Common cold
83.33
2
Adenoiditis
60.00
3
Pharyngitis
80.00
4
Tonsillitis
75.00
5
Chronic Cough
71.43
–– Bhattacharya S. Data on file.
a
a,b
P<.001
P<.001
Statistical significance: “a” as compared to day 0 values and “b” as compared
to day 3 values.
–– Gautam D, et al.
Ind J Clin Pract. 2011;22(6):267-271.
4
• Apr–Jun 2012 • Vol LI • No 4
www.himalayahealthcare.com
Renalka Syrup in the
Management of Urinary
Tract Infection
Hairzone Solution for Diffuse
Hair Loss
The present clinical study was conducted to
evaluate the therapeutic and prophylactic
efficacy of Renalka syrup in urinary tract
infection (UTI). The study comprised 40
patients between the ages of 51 and 60 years.
There were 2 major groups of patients with
symptoms of UTI; one with indwelling
catheters comprising 21 cases and the other
without indwelling catheters, 19 cases.
Renalka syrup was given to all the patients at a dosage of 2
teaspoonfuls thrice daily before meals for 4 weeks. The patients
were followed up on a weekly basis and assessed for their clinical
signs and symptoms. Comparative study showed that efficacy
of Renalka syrup remained unaltered in both catheterized and
noncatheterized groups of patients (Table 3).
Hematological examination including the total leucocyte count
(TLC), differential leucocyte count (DLC), estimation of Hb%,
blood urea, and serum creatinine were done before, during, and
after the therapy. Results obtained showed that there are no
significant changes in the TLC, DLC, Hb%, blood urea, and
serum creatinine after therapy using Renalka syrup. Therefore,
it can be concluded that Renalka does not have adverse effects
on renal function and can be safely used to control symptoms of
UTI.
A clinical study was planned and
conducted to evaluate the safety
and efficacy of Hairzone solution
in diffuse hair loss. A total of 28
patients with diffuse hair loss
were included in the study. All
of them were advised to gently
massage the whole area of the
scalp with Hairzone solution,
leave it overnight and rinse off
in the morning. After 6 weeks,
efficacy of the therapy was
evaluated using parameters
such as moisturizing effect,
reduction in hair fall, and other
symptoms such as itching and dryness of scalp.
Results of the study demonstrated that most patients treated with
Hairzone solution showed a good response to the therapy. There
was a significant improvement (P<.0001) in the condition of
scalp with reduction in dandruff, denuded patches, and epidermal
changes in all the 28 patients at the end of 6 weeks of treatment
(Figure 1). None of the patients had any significant adverse
effects during the entire study period and overall compliance
to the treatment was adequate. Therefore, it can be concluded
that Hairzone solution is clinically safe and effective in the
management of diffuse hair loss.
Burning micturition
Percentage
No. of patients
Percentage
No. of patients
Percentage
No. of patients
Percentage
No. of patients
Table 3. Effect of Renalka Syrup on Symptoms of Urinary Tract Infection in
Patients With and Without Indwelling Catheter
Symptoms
Pretherapy
Posttherapy
With
Without
With
Without
indwelling indwelling indwelling indwelling
catheter
catheter
catheter
catheter
19
47.5
21
52.5
2
5
1
2.5
Increased frequency 19
of micturition
47.5
21
52.5
1
2.5
1
2.5
Figure 1. Clinical effect of Hairzone solution
–– Sahu M, et al.
Ind Pract. 2002;2(55):101-106.
www.himalayahealthcare.com
–– Agarwal U, et al.
Ind J Clin Pract. 2010;21(7):367-370.
Apr–Jun 2012 • Vol LI • No 4 •
5
Health Tips
Product Feedback
Eat Better
L
There is a massive amount of advice offered about what
constitutes a healthy diet. The vast majority of this advice
suggests to add or eliminate specific foods from plate. Most of
us have heard the dogma that around 30% of calories should
come from fat, about 10% to 15% from protein, and about 60%
from carbohydrates. The reality is that it does not matter what
percentage of calories in the diet come from fat or carbohydrates,
within reason. A wide range of ratios work as long as a person gets
sensible amount of all the vital nutrients required for maintaining
good health. The real secret to healthy eating lies in the following
3 simple guidelines. Adhering to these basic rules will help to
naturally adopt a more wholesome pattern of eating.
Eat Real Food
Whenever possible, consume foods that are whole, fresh, locally
grown, and made with as little processing and packaging as
possible. Real foods are delicious, nutrient-packed foods that are
free of additives and other artificial ingredients, unrefined, and
minimally processed. They include vegetables, fruits, legumes,
whole grains, low-fat and fat-free dairy foods, fish, and lean
meats.
Eat a Little Less
Women often ask how many calories they would require each
day. There is no easy answer to this question; it depends on many
factors. If a person is putting on additional pounds or needs to
take off weight, he/she will have to reduce the intake of food. If a
person is maintaining a healthy body weight, it indicates that he/
she is balancing energy intake well.
It is a good idea to limit the portion size of meal. The brain
requires about 20 minutes to register that the stomach is full, so
give some time for the brain to keep up with what and how much
of food is taken in. It would otherwise result in consumption of
more calories than what is actually needed.
Enjoy Your Meals
iv.52 is quite effective for all types of liver disorders. It helps
to alleviate vomiting during pregnancy and clear the bowels.
Many challenging cases of itching during pregnancy, which is due
to cholestasis, have been very well treated with Liv.52.
Liv.52 is effective, easily available, and well-tolerated by patients
including children.
– Dr Premvati
Faculty of Ayurveda, Institute of Medical Sciences
Banaras Hindu University, Varanasi - 221001
Uttar Pradesh
I
am acquainted with Liv.52 for many years, and find
unparalleled satisfaction with results. Antibiotic-induced
hepatitis is a challenging case for the practicing physician. Patients
get faster recovery when Liv.52 is prescribed as an adjuvant
therapy.
– Dr Khastagir BK
Gupta Colony, Kolkata - 700126
West Bengal
I
have been prescribing Liv.52 DS successfully for many years.
I have used the product personally also when I was suffering
from jaundice. The response to the product is excellent, and
the product is highly palatable. I have treated a resistant case of
jaundice (due to cirrhosis of liver) successfully with Liv.52 DS.
The product showed excellent response where other drugs had
failed.
– Dr Avnish Kumar Jain
Bartala Yaadgaar, Saharanpur - 247001
Uttar Pradesh
M
y experience with Liv.52 is nearly 3 decades now, and I
feel there is no better drug for liver disorders than Liv.52.
I have treated many challenging cases of viral hepatitis and
alcoholic fatty liver with Liv.52 successfully.
– Dr Om Prakash Gupta
19, Samrat Lane, Pitampura - 110035
Delhi
Eating is as much about satisfying your emotional and aesthetic
needs as your nutritional ones. Enjoy sharing meals with family
and friends. Create pleasant ceremonies around meals, no matter
how simple. Focus on quality, not quantity. Savor each bite of the
food rather than eating for fullness.
–– Excerpted from:
Health & Nutrition Letter. 2010;28(3):Suppl.
6
• Apr–Jun 2012 • Vol LI • No 4
www.himalayahealthcare.com
Health News
Driving After One
Drink
The blood alcohol limit for
driving in the United States is
0.08%, but even blood alcohol
levels as low as 0.01% increases
the risk of a potentially
deadly crash, according to a
study published in Addiction
in September. Drivers who
had such low blood levels of
alcohol and were only slightly
tipsy tended to have more
severe crashes than sober
drivers, the analysis of national
crash data revealed. Not only
can just one drink impair
driving skills and reaction
times, but slightly “buzzed”
drivers are also more likely to
speed and not wear seat belts.
That is why some countries
have lower blood alcohol limits
(0.03% in Japan and 0.02% in
Sweden).
–– Wellness Letter. 2012;28(4):8.
Human Papilloma
Virus Vaccine for
Oral Cancer?
The human papilloma virus
(HPV) vaccine given to girls
and young women to protect
against cervical cancer may
also protect against oral cancer.
www.himalayahealthcare.com
A recent study in the Journal
of Clinical Oncology found
that strains of HPV that cause
cervical and anal cancer are
causing an increasing number
of cases of oral cancer—mostly
in men, and usually of the
tonsils and base of the tongue.
For these cancers, the virus
is believed to be transmitted
via oral sex. Recently, a
CDC advisory committee
recommended that boys and
young men should also be
vaccinated to get protected
against oral
cancer.
–– Wellness Letter. 2012;28(4):1.
Take Blood Pressure
Medication in the
Evening
If you take blood pressure
medication, consider taking it
in the evening, rather than the
morning. A recent review from
the Cochrane Collaboration
evaluated 21 studies and found
that taking the drugs in the
evening results in slightly
lower 24-hour blood pressure
readings. In addition, a new
Spanish study (published in
Journal of the American Society
of Nephrology) of people with
hypertension and chronic
kidney disease found that
those who were told to take
at least one hypertension
drug at bedtime not only had
better blood pressure control,
but also had far fewer heart
attacks, strokes, and other
cardiovascular events over a
5-year period than those taking
the drugs in the morning.
–– Wellness Letter. 2012;28(4):8.
Smoking and
Breast Cancer
Another reason for women
to avoid smoking and
secondhand smoke—they
both increase the risk of breast
cancer after menopause,
according to an analysis of
data from nearly 80,000
participants in the Women’s
Health Initiative, published
in British Medical Journal.
Current smokers were 16%
more likely than lifetime
nonsmokers to develop breast
cancer, with those smoking
for many decades at the
highest risk. An increased risk
(averaging 9%) persisted for
up to 20 years after women
quit smoking. Women with
the greatest exposure to
secondhand smoke were also at
increased risk.
–– Wellness Letter. 2011;28(3):8.
Coffee Okay for
Hypertension
Under Control
It is okay to drink coffee, even
if one has high blood pressure
according to a recent review of
studies involving people with
hypertension. The studies on
the acute effects found that
in people who had abstained
from caffeine for 9
to
48 hours, 2 cups of
coffee (with 200
to 300 mg
of caffeine)
raised blood
pressure
7 points,
on average,
for up to 3
hours. But in studies lasting
2 weeks, daily coffee intake
did not increase blood
pressure, probably because
tolerance to caffeine develops
in about a week. And longer
observational studies found
no link between habitual
coffee consumption and
cardiovascular risk. If
hypertension is not under
control, however, one should
avoid high doses of caffeine,
the researchers advised.
–– Wellness Letter. 2011;28(3):8.
Apr–Jun 2012 • Vol LI • No 4 •
7
In Focus
Liv.52 in the Prevention of Hepatotoxicity in Patients Receiving
Antitubercular Drugs: A Meta-analysis
Dange SV
Ind J Clin Pract. 2010;21(2):81-86.
Aim
The aim of this study was to conduct a meta-analysis on
the efficacy and short- and long-term safety of Liv.52 as a
hepatoprotective in tuberculosis (TB) patients receiving anti-TB
drugs, as published in 8 controlled clinical trials.
Materials and Methods
A meta-analysis of 8 clinical studies conducted between 1970
and 1992 in 689 tubercular patients receiving antitubercular
treatment (ATT) along with Liv.52 or placebo was taken up for
this study (Table 1). Duration of the treatment varied from 4
weeks to 1 year. Children below the age of 2 years received 10 to
20 drops of Liv.52, 3 to 4 times daily. Children in the age group
of 2 to 5 years received 20 drops of Liv.52, 3 times daily. Children
aged >5 years and adults received 1 to 2 teaspoonfuls of Liv.52
syrup 3 times daily, or 1 to 2 tablets of Liv.52, 2 to 3 times daily.
Improvement in various parameters of hepatotoxicity, such as
hepatomegaly, anorexia, weight gain, general well-being, and liver
function test (alanine aminotransferase [ALT]), and improvement
in the ultrasonographic findings of the hepatobiliary system were
taken into consideration. Changes in various parameters from
baseline values and those at the end of the study were pooled
and analyzed cumulatively using Fischer’s exact test or unpaired
Students t test. Statistical analysis was performed using GraphPad
Prism Software (version 4.03).
Results
Results of the meta-analysis showed a statistically significant
improvement in hepatotoxicity in patients receiving anti-TB
drugs and Liv.52. Significant improvements were observed
in associated symptoms such as anorexia, weight gain, and
hepatomegaly. The protective effect of Liv.52 against hepatotoxic
reaction caused by ATT was further substantiated by a significant
reduction in ALT values and alleviation of gastrointestinal
symptoms due to hepatitis (Table 2). No adverse effects were
8
• Apr–Jun 2012 • Vol LI • No 4
reported or observed due to Liv.52 during the study period and
the compliance to the drug therapy was good.
Conclusion
Therefore from the above findings, it can be concluded that
Liv.52 acts as a hepatoprotective in the hepatotoxicity of TB
patients receiving ATT.
Table 1. Details of the 8 Studies Included in the Meta-analysis of Liv.52 in
Patients Receiving ATT
Trial
No. of
Sl. No.
Name
Year
Duration
design
patients
4.
Dabral, et al.
1976
DBPCT*
4 weeks
95
2.
Indirabai, et al.
1970
CT**
4 weeks
50
3.
Mrs Saxena
1971
CT
30 days
100
4.
Ashish Khare
1992
CT
6-8 weeks
70
5.
Brij Kishore, et al.
1978
CT
4 weeks
81
6.
Kumar and Shishupal Ram
1975
CT
1 year
50
7.
Galitsky, et al.
1997
CT
8 weeks
143
8.
Purohit, et al.
1988
CT
1 month
100
-
-
-
689
Total
*DBPCT: Double blind, placebo controlled trial; **CT: controlled trial
Table 2. Efficacy of Liv.52
ATT
Parameters
ATT + Liv.52
Before
After
Before
After
3*
Effect on gastrointestinal symptoms and
symptoms related to hepatitis
Effect on anorexia
82
44
82
163
160
220
16*
Effect on weight gain
190
178
186
23*
Effect on hepatomegaly (regression of liver
size)
Effect on general well-being
25
0
25
24*
25
0
25
21*
Effect on increase in ALT# levels
82
15
82
1**
Statistical analysis: Fischer’s exact test; *P<.0001 as compared to ATT alone
#
Initial values of ALT <40 U, **P<.0003 as compared to ATT alone
www.himalayahealthcare.com
Latest in Medicine
Urinary Tract Infection as a Risk
Factor for Autoimmune Liver
Disease
Smyk DS, et al.
reproduced the known key features of chronic telogen effluvium
and diffuse cyclical hair loss: acute exacerbations, periodicity,
and only minimal reductions in long-term hair volume. These
results suggest that chronic telogen effluvium may be secondary
to a reduction in the variance of anagen and also this pathological
state represents a new functional type of recurrent hair shedding.
Clin Res Hepatol Gastroenterol. 2012;36(2):110-121.
Autoimmune liver diseases include autoimmune hepatitis
(AIH), primary biliary cirrhosis (PBC), and primary sclerosing
cholangitis. Recurrent urinary tract infections (UTI) have been
strongly associated with PBC, and to a lesser extent with AIH.
These observations were initially based on the observation of
significant bacteriuria in female patients with PBC. Larger
epidemiological studies demonstrated that there was indeed a
strong correlation between recurrent UTI and PBC. AIH has not
been linked to recurrent UTI in epidemiological studies; however
treatment of UTI with nitrofurantoin can induce AIH. As
Escherichia coli is the most prevalent organism isolated in women
with UTI, it has been suggested that molecular mimicry between
microbial and human PDC-E2 (the main autoantigenic target in
PBC) epitopes may explain the link between UTI and PBC.
Chronic Telogen Effluvium is due
to a Reduction in the Variance of
Anagen Duration
Gilmore S, Sinclair R.
Australas J Dermatol. 2010;51(3):163-167.
The authors of this study sought to investigate the follicular
dynamics of chronic telogen effluvium and diffuse cyclical hair
loss using a previously validated computer simulation known as
the follicular automaton. They were able to simulate reductions
in both the mean and variance of anagen duration, and thus
investigate their consequences with respect to both hair volume
and hair shedding.
Results of the study showed that reducing the mean anagen
duration results in loss of hair volume without prominent
fluctuations in hair fall: findings that reproduced the key features
in androgenetic alopecia. In contrast, a reduction in the variance
of anagen duration generated follicular dynamics that accurately
www.himalayahealthcare.com
The Natural History of Acute Upper
Respiratory Tract Infections in
Children
Mitra A, et al.
Prim Health Care Res Dev. 2011;12(4):329-334.
Acute upper respiratory tract infections (AURIs) in children are
one of the most common reasons for people seeking advice from
general practitioners (GPs); however, little is known about the
natural history of AURIs in terms of the length and severity of
symptoms, because the majority of illnesses are contracted at
home.
After an initial pilot study to test the feasibility of parents
recording symptoms in a diary based on the Canadian Acute
Respiratory Illness and Flu Scale (CARIFS), a random selection of
primary schools operating in the region was carried out in order
to minimize selection bias. Meetings were arranged at 20 schools
to obtain written consent from parents and to give out diaries
with a stamped addressed envelope. The diaries recorded daily
symptom severity for one episode of AURI and the data were
analyzed.
Diaries were returned from 223 children, of whom 146 had had
an AURI. The average age was 8 years, and there were almost
equal numbers of boys and girls. The most frequent symptoms
were runny nose, cough, feeling unwell, and sore throat. There
was a biphasic distribution with systemic symptoms in the first
3 days characterized by fever, poor sleep, irritability, not playing,
and headache. By day 4, symptoms localizing the infection to the
upper respiratory tract appeared with runny nose, cough, sore
throat, and poor appetite; these continued into the second and
occasionally third week. Most symptoms lasted for 5 to 11 days,
with a median length of 7 days for all symptoms. Symptoms
defined by parents tended to be scored less for severity than
symptoms defined by children.
Apr–Jun 2012 • Vol LI • No 4 •
9
Fact File
Fitness
Climb Your Way to Health
Resistance of Microorganisms
Many of us actually do not
have the time to exercise in
a gym, as we are either busy
at our workplace or follow
a sedentary lifestyle. There
is an option that keeps you
in shape as well as boosts
your stamina and general
fitness—stair climbing. Avoid
elevators and escalators and
take the stairs!
• Resistant micro-organisms cause infections that normally
do not respond well to conventional treatment leading to
prolonged illness and higher risk of death.
• Resistant micro-organisms emerge, spread, and persist due to
inappropriate and irrational use of antimicrobial drugs.
• About 440,000 new cases of multidrug-resistant tuberculosis
come into sight each year leading to at least 150,000 deaths.
• Antimicrobial resistance to earlier generation antimalarial
medications such as chloroquine and sulfadoxinepyrimethamine is prevalent in most malaria endemic countries.
• Hospital-acquired infections are mainly because of the highly
resistant strains of bacteria, particularly the methicillinresistant Staphylococcus aureus.
Stair climbing is the most
useful and least expensive
workout that anybody can
have. Walking up and down
stairs is an effective exercise, as
it burns up your calories and
strengthens leg muscles. It also
improves blood circulation
and reduces risk of heart
diseases. Making stair climbing
a regular physical activity can
help in shedding excess weight
and maintaining healthy
bones, joints, and muscles.
For every 30 minutes spent
in walking the stairs, you can
burn up to 300 calories based
on how intense the workout
is. Stair climbing as an exercise
can be started with 25 steps
at a time and then slowly
increased. It is found that
climbing two steps at once
exercises the major leg muscles
(quadriceps) and the buttocks
(gluteal muscles).
Climbing stairs more beneficial than swimming
According to a study, stair
climbing burns out at least 250
percent of more calories than
that is lost during swimming
for the same duration.
Climbing a flight of stairs 2
times a day regularly for a
period of 1 year can help to
lose up to 12 pounds. At the
same time, there should be a
monitored calorie intake.
Promotion of stair climbing at workplace linked
to greater effects in the
overweight
A study conducted in a 5-story
building using an intervention
such as posters promoting
weight loss in the lobby and
similar messages between
floors, proved that there is
a definite increase in stair
climbing in a workplace owing
to an intervention. The greater
effect of the intervention
among overweight individuals
implies that stair climbing may
be a type of acceptable physical
activity or exercise for people
who want to control their
weight.
References
1. Wellness Letter. 2012;
28(4):6.
2, Eves FF, et al. Obesity.
2006;14:2210-2216.
–– Source: World Health Organization. 2012.
Event Calendar
8th Australasian Viral Hepatitis Conference
Date: September 10 to 12, 2012
Venue: Auckland, New Zealand
For more details, visit:
http://www.hepatitis.org.au/
Pharma Competitive Intelligence Conference &
Exhibition
Date: September 11 to 12, 2012
Venue: Parsippany, New Jersey,
United States
For more details, visit:
http://pharmaciconference.com/
International Conference on Schizophrenia
Date: September 21 to 23, 2012
Venue: Chennai, Tamil Nadu,
India
For more details, visit:
http://www.icons-scarf.org/
Editor in chief: Dr Pralhad S Patki • Managing Editor: Dr Jayashree B Keshav • Editorial Team: Shruthi VB, Dr Latha, Shahina KR • Layout Artists: Dayananda Rao S, Santosh G
Edited and published by Dr PS Patki, MD. Printed at M/s Sri Sudhindra Offset Process, #97, DT Street, 8th Cross, Malleshwaram, Bangalore - 560 003
10
• Apr–Jun 2012 • Vol LI • No 4
www.himalayahealthcare.com
Laugh a While,
It’s Healthy!
In an American history discussion group, the professor was trying
to explain how society’s ideal of beauty changes with time.
“For example,” he said, “Take the 1921 Miss America. She stood
5 feet 1 inch tall and weighed 108 pounds. How do you think
she’d do in today’s version of the contest?”
The class fell silent for a moment. Then one student piped up,
“Not very well.”
“John,” the new guy replied.
The manager scowled. “Look, I don’t know what kind of a
namby-pamby place you worked at before, but I don’t call
anyone by their first name! It breeds familiarity and that leads to
a breakdown in authority,” he said. “I refer to my employees by
their last name only—Smith, Jones, Baker—that’s all. Now that
we got that straight, what is your last name?”
The new guy sighed and said, “Darling. My name is John
Darling.”
“Why is that?” asked the professor.
“For one thing,” the student said, “She’d be way too old.”
The manager said, “Okay, John, the next thing I want to tell
you...”
•••
Patient to optometrist: I’m very worried about the outcome of
this operation, doctor. What are the chances?
•••
Patient: Doctor, every time I eat fruit I get this strange urge to
give people all my money.
Doctor: Would you like an apple or a banana?
•••
An elderly widow and widower were dating for about five years.
The man finally decided to ask her to marry. She immediately said
“yes”.
Optometrist to patient: Don’t worry, you won’t be able to see the
difference.
•••
Teacher: What is the axis of the earth?
The next morning when he awoke, he couldn’t remember what
her answer was! “Was she happy? I think so, wait, no, she looked
at me funnily...”
Student: The axis of the earth is an imaginary line which passes
from one pole to the other, and on which the earth revolves.
After about an hour of trying to remember to no avail, he got on
the telephone and gave her a call. Embarrassed, he admitted that
he didn’t remember her answer to the marriage proposal.
Student: Yes, Sir.
“Oh”, she said, “I’m so glad you called. I remembered saying ‘yes’
to someone, but I couldn’t remember who it was.”
Teacher: Very good. Now, could you hang clothes on that line?
Teacher: Indeed, and what sort of clothes?
Student: Imaginary clothes, Sir.
•••
•••
“Now, Joseph,” said the teacher to the aggressive youngster,
“What do you think your classmates would think of you if you
were always kind and polite?”
“They’d think they could beat me up,” promptly responded
Joseph.
•••
The manager of a large office asked a new employee to come into
his office.
“What is your name?” was the first thing the manager asked.
A quarterly journal dedicated to the
emerging multidisciplinary field of
perinatal medicine
Indexed in EMBASE, the Excerpta
Medica database, CINAHL® database,
and Cumulative Index to Nursing and
Allied Health Literature® print index
To subscribe, write to us at:
[email protected]
“A goal is a dream with a deadline”
Worth Sharing
with You
— Napolean Hill
Write to Us
We would like to hear from you. Write to us at [email protected].
www.himalayahealthcare.com
Apr–Jun 2012 • Vol LI • No 4 •
11
ISSN 0927-9681
Only for reference by a registered medical practitioner, hospital, or laboratory.
Registered with the registrar of newspapers for India under R.N. 9073/63
Koflet -H
®
Relieves cough of varied etiologies
Quickly relieves throat irritation & inflammation
Exhibits local analgesic, antiseptic, and soothing properties
Koflet-H
www.himalayahealthcare.com
E-mail: [email protected]