Randomised double-blinded trial evaluating silymarin for chronic hepatitis C in an Egyptian village: study description and 12-month results.

BACKGROUND/AIMS: A double-blinded trial evaluating silymarin, an herbal supplement for liver disease, to prevent complications of chronic hepatitis C virus infection has not been done. SUBJECTS: One hundred and seventy-seven consenting residents of an Egyptian village with chronic hepatitis C virus were randomly assigned to receive either silymarin or multivitamin supplements. METHODS: Participants had baseline and follow-up clinical, ultrasound, blood tests and quality-of-life assessments. Community nurses visited weekly to ascertain compliance, distribute supplements and record adverse effects. RESULTS: At 12 months almost all of 141 remaining subjects reported feeling better, although symptoms and quality-of-life scores did not differ between the silymarin and multivitamin groups. Both the silymarin and vitamins were tolerated equally well; and >95% of supplements were taken by >95% of subjects. One in each group had no detectable hepatitis C virus antibodies while two in the silymarin group and three receiving multivitamins had undetectable hepatitis C virus RNA. Serum alanine aminotransferase elevations did not differ between groups. Serum hepatic fibrosis marker, hyaluronic acid and YKL-40, and abdominal ultrasound results were similar in both groups and may have progressed slightly at 12 months. CONCLUSIONS: The recommended dose of silymarin can be safely taken for 1 year and improves symptoms and general well-being, but has no effect upon hepatitis C virus viremia, serum ALT, or serum and ultrasound markers for hepatic fibrosis. More prolonged evaluation and a higher dose may be required to ascertain whether milk thistle supplements prevent complications of chronic hepatitis C virus.

Sonographic image of the newborn hip with positive Ortolani's sign.

In a screening program, 4438 newborns were examined sonographically and clinically in the first 12 hours after birth for congenital hip dysplasia. Seventy-three hips in 54 newborns were dislocated, as evidenced by positive Ortolani's signs. According to Graf's classification, all 73 hips should be Type IIC or worse, with Angle alpha less than 50 degrees and Angle beta for Type IIC of 72 degrees-77 degrees, and for Types D, III, and IV, greater than 77 degrees. Sonographic examination of the 73 hips according to Graf's criteria showed that only 16 hips were decentring and eccentric, confirming the clinical diagnosis, and the results were consistent with Graf's conclusion because their alpha-angles were less than 50 degrees and beta was greater than 77 degrees. In the remaining 57 hips, there was a disparity between alpha-angles and beta-angles. Judging by Angle alpha, these hips were of Types IB and IIA because their Angle alpha averaged 60.8 degrees (range, 51 degrees-74 degrees). Judging by Angle beta, these hips were decentring Type D or eccentric Type IIIA because their beta-angle averaged 91.3 degrees (range, 78 degrees-110 degrees). Because these 57 hips were dislocated clinically (positive Ortolani's sign) it was concluded that the beta-angle is a more accurate reflection of hip pathology in the newborn than the alpha-angle. It represents the cartilaginous roof of the acetabulum, which is soft and malleable, and reflects immediately any change in the position of the femoral head. Angle alpha, however, represents the hard bony roof, and any change in the position of the femoral head is not reflected immediately on it, because bony changes take longer to be seen or evidenced.

New liquid-membrane electrodes for direct determination of atropine in pharmaceutical preparations.

Solutions of atropinium 5-nitrobarbiturate in n-octanol and atropinium picrolonate in p-nitrotoluene are used as novel liquid ion-exchangers in electrodes that respond to the atropine cation. The performance characteristics of the two electrodes are almost identical: the response is linear for 10(-5)-10(-2)M atropine with a slope of 56.5 +/- 1 mV/concentration decade. The static response times are 30-90 sec and the potential readings are stable over the pH range 3-8. There is negligible interference from a number of inorganic and organic cations, and some common excipients. In the direct determination of 1-200 mug/ml of atropine, the average recovery with both electrodes is 98% (mean standard deviation 1.7%). Atropine has been determined in some pharmaceutical preparations with an average recovery of 98% (standard deviation 1.9%), the results being in agreement with those obtained by standard methods.