A trial of Phyllanthus amarus in acute viral hepatitis.

The study was done to know whether the powders of Phyllanthus amarus plants favourably influence the duration of disease in patients with acute viraus B hepatitis when compared to placebo. The powders of the plant were given in capsule form (300 mg capsules--3 capsules--3 capsules thrice daily) and an antacid powder in similar capsule was used as placebo. Persons with encephalopathy, preexisting medical conditions or serum bilirubin above 350 iu/l were excluded from the study. Fifty seven patients were randomized to receive either the placebo (28 cases) or the drug (28 cases). The two groups were comparable at the time of entry. Two cases from the placebo and one from the placebo and one from the drug group dropped out of the study. The duration of disease (time taken for bilirubin to come to below 2 mg%) was taken as the outcome measure. The duration of disease in the two groups was compared by Cox's proportional hazards analysis after adusting for the variables that influence the duration of jaundice. Only initial serum bilirubin was an independent predictor of duration of jaundice. The an analysis showed that Phyllanthus amarus powders did not significantly reduce the duration of jaundice in persons with virus B hepatitis.

Ketotifen in prevention of indomethacin-induced gastropathy.

BACKGROUND: Therapeutic benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) are offset by their gastrointestinal side effects. We evaluated whether oral ketotifen, which prevents experimental NSAID-induced gastric mucosal injury, is superior to placebo in preventing NSAID-induced gastropathy. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Rheumatology clinic in a tertiary care hospital. PARTICIPANTS: A majority of the 53 subjects had rheumatoid arthritis (n = 36) or osteoarthritis (12). Those with comorbidity, gastrointestinal (GI) symptoms or abnormal endoscopic findings at entry were excluded. Persons on steroids or NSAIDs in the previous month were also excluded. The subjects were started on indomethacin 25 mg thrice daily. INTERVENTION: Subjects were randomly allocated to receive 2 mg ketotifen or placebo tablets. Compliance was measured by tablet count. OUTCOME MEASURE: At the end of every week a questionnaire was administered to elicit GI symptoms or adverse effects. Every patient underwent endoscopy after four weeks. RESULTS: Of 53 patients recruited (27 drug, 26 placebo), three (2 drug, 1 placebo) dropped out. The age, sex, NSAID use and clinical conditions were similar in the two groups. Eight in the drug group and 16 in the placebo group developed GI symptoms and/or endoscopic lesions (relative risk 0.51, 95% CI 0.27-0.95). The difference was significant on intention-to-treat analysis. CONCLUSIONS: Ketotifen significantly reduced the risk of GI side effects in patients on indomethacin.

Chloramphenicol and ciprofloxacin in enteric fever--cost-effectiveness.

Clinical decision analysis is a technique which is used to deal with uncertainities in clinical medicine. We used this technique to compare the cost-effectiveness of chloramphenicol and ciprofloxacin in the treatment of enteric fever. The study shows that the most economical alternative can be predicted if the cost of hospital stay and the sensitivity of the organism to chloramphenicol are known. Thus if the hospital costs are Rs 50/- per day, chloramphenicol will be the drug of choice if more than 52% of the organisms are sensitive to the drug. At lower levels of sensitivity to chloramphenicol, ciprofloxacin will be the drug of choice.

Serum rhodanese in goitre and calcific pancreatitis of tropics.

Rhodanese is one of the enzymes concerned in the detoxification of cyanide. Cassava intake and consequent cyanide toxicity are incriminated in the pathogenesis of goitre and calcific pancreatitis of tropics. So we studied the activity of rhodanese in these patients. 14 controls, 13 patients with pancreatitis and 12 with goitre were studied. The median (and range) of rhodanese in these groups were 82 (50-144), 110 (64-180) and 71 (22-160) units respectively. The serum rhodanese was significantly higher (P less than 0.05) in patients with pancreatitis when compared to the other groups. There was no significant difference between the serum rhodanese in patients with goitre and the controls. The presence of adequate amounts of rhodanese indicates that goitre and chronic pancreatitis are not produced by impaired cyanide detoxification.