Milk thistle for treatment of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease [NAFLD] is one the most common causes of chronic liver disorders in the Western world. These patients have many significant comorbidities. The therapeutic approach to NAFLD is based on lifestyle intervention, but there is no consensus on the ideal pharmacological treatment. Silybum marianum, commonly known as milk thistle [MT], is one of the oldest and most extensively researched plants in the treatment of liver diseases. Many studies have demonstrated that the active components of MT silymarin have many hepatoprotective properties. In recent years, several preclinical and clinical reports have described the efficacy of silymarin as a treatment for NAFLD. The chief aim of this review is to discuss the newest and most promising applications of MT in the treatment of NAFLD

receurrence risk of ischemic stroke in childhood

To determine the risk of recurrence of ischemic stroke in children and to evaluate the influence of etiological factors and underlying mechanisms on recurrence rate. Subjects and Thirty-six children [21 boys and 15 girls] with clinically and radiographically proven ischemic cerebral infarction were prospectively followed up over a period of 1-9 years [median 5 years 5 months]. The median age of onset of stroke was 8.4 years [1-16 years]. Patients with hemorrhagic stroke, neonatal infarction and sinovenous thrombosis were not included. The patients were analyzed according to the mechanisms and etiology of the initial and recurrent stroke event. For the initial stroke, cardioembolic [33.3%] and arteriopathic processes [36.1%] were identified as the most probable mechanisms of arterial ischemic stroke. Prothrombotic abnormalities were found in 4 children [11.1%]. Underlying pathology in the remaining 7 [19.4%] was not known. Recurrent ischemic infarction was diagnosed in 5 children [13.9%] within 5 days to 18 months [median 6 months] after the first stroke manifestation. In 3 of them stroke recurrence was due to cardiac or transcardiac embolism. Cardiac abnormality prior to the first stroke was detected in 1 child. Clinically silent multiple cerebral infarcts disclosed by MRI preceded the overt stroke episode in 2 patients. Congenital and acquired heart diseases were the most common cause of repeated stroke in our study. The risk of recurrence appeared to be fivefold higher in children with cardiac disease irrespective of the coexistence of other risk factors. The risk factors of stroke in children were multiple and overlapping. Consequently, recognition of the major one and its underlying mechanism is crucial for both effective therapeutic approach and the prevention of recurrence