AN EXPERIMENTAL STUDY TO EVALUATE THE HEPATOPROTECTIVE ACTIVITY OF NILITANDULIYADI LEHA IN PARACETAMOL INDUCED HEPATOTOXICITY IN WISTAR ALBINO RATS

Background: Paracetamol toxicity is currently the single most important cause for acute liver failure and is associated with significant number of deaths. Nilitanduliyadi leha is one among the formulation explained in the context of Vishahara yogas (anti-poisonous formulations) in the text Vishavaidya Jyotsnika. Objectives: To experimentally evaluate the hepatoprotective activity of nilitanduliyadi leha in paracetamol induced hepatotoxicity in Wistar albino rats. Methods: Albino Wistar rats of either sex weighing 200 – 250, g were selected and divided into four groups of six animals in each group (n = 6). Treatment was given for 7 days. Blood was drawn and sent for tests and important organs like liver and kidney were dissected out, cleaned to remove extraneous tissues, blotted to remove blood stain and weighed. A piece of liver tissue was preserved in 10% formalin for histopathological processing. Results: The formulation has helped in balancing the biochemical parameters studied almost as efficiently as the standard drug. In the antioxidant study also, the drug has given good results and shows even slightly more effective than the standard drug. The histopathology study also reveals mild protection and regeneration of tissues by the effect of test drug. Conclusion: This present study proves that the formulation is having a comparable hepato protective activity with that of silymarin.

Nefroprotective Effect of Gynura procumbens Extract Against Paracetamol Toxicity in Rats

ABSTRACT Excessive doses of paracetamol have the potential to cause acute kidney injury and even death. Gynura procumbens has been traditionally used as folk-medicine for kidney disease. This study aimed to examine the nephroprotective effect of Gynura procumbens leaf extract against paracetamol-induced nephrotoxicity in rats. Twenty-five male wistar rats (150-200 g) were divided into 5 groups. Healthy control group, placebo group, and 3 extract treatment groups that received either 100 mg/kg, 200 mg/kg or 300 mg/kg dose. The placebo (sodium carboxymethyl cellulose) or extract was given 4 consecutive days prior to paracetamol (2400 mg/kg) administration on day 5. Blood samples were withdrawn before treatment initiated (day 0), after treatment before paracetamol administration (day 5) and 24-hour after paracetamol administration (day 6). Blood samples were analyzed to obtain urea and creatinine levels. In addition, histopathological analysis was performed on the renal tissue. Paracetamol administration was shown to significantly increase the urea and creatinine levels, and the extract at 300 mg/kg dose was able to significantly prevent the elevation of the renal biomarkers. The histopathological analysis also revealed a significant reduction in renal histopathological injury in 300 mg/kg extract group. It can be concluded that the ethanolic extract of the Gynura procumbens at a dose of 300 mg/kg has a good protective effect on kidney function and tissue structure. Key words: Gynura procumbens, nephroprotective, paracetamol

Variation in the Care of Acute Liver Failure: A Survey of Intensive Care Professionals

<b><i>Introduction:</i></b> Acute liver failure (ALF) is a rare disease with potentially high mortality. We sought to assess the individual approach to ALF by intensive care unit (ICU) professionals. <b><i>Methods:</i></b> Cross-sectional survey of ICU professionals. Web-based survey capturing data on respondents’ demographics, characteristics of patients with ALF admitted to ICU, and their management. <b><i>Results:</i></b> Among 204 participants from 50 countries, 140 (68.6%) worked in Europe, 146 (71.6%) were intensivists, 142 (69.6%) admitted &#x3c;25 patients with ALF per year, and 166 (81.8%) reported &#x3c;25% of patients had paracetamol-related ALF. On patients’ outcomes, 126 (75.0%) reported an emergency liver transplantation (ELT) rate &#x3c;25% and 140 (73.3%) a hospital mortality rate &#x3c;50%. The approach to ALF in the ICU varied with age, region, level of training, type of hospital, and etiology (prescribing N-acetylcysteine for paracetamol toxicity, triggers for endotracheal intubation, measurement of and strategies for lowering serum ammonia, extracorporeal device deployment, and prophylactic antibiotics). <b><i>Conclusions:</i></b> The management of patients with ALF by ICU professionals differed substantially concerning the relevant clinical measures taken. Further education and high-quality research are warranted.

N-acetylcysteine therapy for ischaemic hepatic failure: a successful antidote

Acute liver failure (ALF) is characterised by severe liver injury with the onset of coagulopathy (INR ≥1.5) and encephalopathy in the absence of pre-existing liver disease. It is associated with a high mortality rate of 10-57%, which is largely driven by multi-organ failure, sepsis and cardiac arrhythmia. Current management focuses on identifying and treating the aetiology, providing supportive care and monitoring liver function. The use of N-acetylcysteine (NAC) therapy is well-studied in the treatment of paracetamol toxicity but is controversial in other causes of ALF. We reported the first case of ischaemic hepatic failure secondary to prolonged portal vein occlusion treated with 72 hours of NAC therapy. Although ischaemic hepatopathy is a relatively uncommon cause of ALF, it is associated with a high mortality rate. The case highlights how early use of NAC therapy may improve hepatic serology biomarkers and should warrant consideration in ALF secondary to ischaemic hepatopathy.

Evaluation of the Hepatoprotective And Nephroprotective Activities of Vitamin C and E in Paracetamol induced toxicity in Wistar Albino Rats

Free radical-mediated cell damage can be prevented by well-known antioxidant vitamins such as Vitamins E and C, and it has been reported that Paracetamol can cause hepatotoxicity at high doses. This study evaluated the efficacy of the combination of Vitamin C and Vitamin E in the prevention of renal and hepatic cell damage caused by paracetamol toxicity. Twenty-eight male albino rats were grouped into seven of four rats per group. Vitamin C at prophylactic dosage; (200mg, 150mg, 100mg, 50mg, 25mg) and Vitamin E at prophylactic dosage; (500iu, 400iu, 300iu, 200iu, 100iu) were administered orally to the rats in groups 1 through 5, respectively with concomitant administration 1000mg/kg bw of paracetamol twice daily for seven days. Group 6 was administered 1000mg/kg of paracetamol only (untreated), and Group 7 served as the normal control. The results revealed a significantly (P < 0.05) increase in serum ALT, AST, ALP, Urea and Creatinine of the group administered 1000mg/kg of paracetamol only. The prophylactic doses of ascorbic acid and α-tocopherol significantly (P < 0.05) decrease serum ALT, AST, ALP, Urea and Creatinine level compared to the untreated rats. This study validates that co-administration of ascorbic acid and α-tocopherol at the proposed prophylactic dosages could be used in the prevention of renal and hepatic cell damage caused by paracetamol toxicity.