A Ratepayers' hand-book. Showing concisely the method of assessment. Aryabhishak Athava Hindusthanano Vaidharaj Purvardha Tatha Uttarardha.,.

Author contributions: Adhvaryu MR and Vakharia BC conducted the clinical trial; Adhvaryu MR, Reddy MN and Vakharia BC designed research; Adhvaryu MR and Reddy MN devised the formulation and carried out pilot studies; Adhvaryu MR, and Vakharia BC analyzed data; and Adhvaryu MR, Reddy MN and Vakharia BC wrote the paper. Correspondence to: Meghna R Adhvaryu, Bapalal Vaidya Botanical Research Centre, Department of Biosciences, Veer Narmad South Gujarat University, 110, Nehru Nagar Society, Ichchhanath Road, Surat 395007, India. Telephone: +91-2 Fax: +91-2. AIM: To evaluate the ability of Curcuma longa (CL) and Tinospora cordifolia (TC) formulation to prevent anti-tuberculosis (TB) treatment (ATT) induced hepatotoxicity. METHODS: Patients with active TB diagnosis were randomized to a drug control group and a trial group on drugs plus an herbal formulation.

Isoniazid, rifampicin, pyrazinamide and ethambutol for first 2 mo followed by continuation phase therapy excluding Pyrazinamide for 4 mo comprised the anti-tuberculous treatment. Curcumin enriched (25%) CL and a hydro-ethanolic extract enriched (50%) TC 1 g each divided in two doses comprised the herbal adjuvant. Hemogram, bilirubin and liver enzymes were tested initially and monthly till the end of study to evaluate the result.

RESULTS: Incidence and severity of hepatotoxicity was significantly lower in trial group (incidence: 27/192 vs 2/316, P. INTRODUCTION During the first few years of introduction of Isoniazid (INH), it was considered so safe that in 1963, The American Thoracic Society recommended for all tuberculin-positive persons to receive a year of INH chemoprophylaxis regardless of age or duration of the tuberculin positivity[]. A retrospective study reported a 1% incidence of clinical hepatitis and a 0.1% death in patients taking INH chemoprophylaxis[]. A large multicenter prospective surveillance study by United States Public Health Service revealed a 1% incidence of hepatitis and 0.06% deaths from hepatitis due to INH[]. After introduction of Rifampicin (RMP), several reports suggested that hepatitis was more frequent and severe in patients receiving both INH and RMP than in those receiving INH alone[]. For preventing acquired resistance and a successful treatment; it is recommended to start with a combination chemotherapy containing INH, RMP, and Pyrazinamide (PZA)-one more hepatotoxic agent- with or without ethambutol for the initial 2 mo followed by a continuation phase of 4-6 mo of INH + RMP[]. It is well known that drug induced hepatotoxicity is a potentially serious adverse effect of anti-tuberculosis treatment (ATT) containing INH, RMP and PZA[].

Preventive therapy of latent TB with 2-mo course of RMP and PZA has been associated with fatal and severe hepatotoxicity more often than does 6 mo of INH therapy or curative treatment of clinical TB[-]. Similar high risk was observed with PZA and ethambutol or a fluoroquinolone when given to contacts of multi-drug resistant TB patients[]. Now integrating these observations with the fact that about one third of the world’s population has latent TB and roughly 9 million cases of active TB emerge annually resulting in 2-3 million deaths[], exemplifies the magnitude and importance of the problem, especially when most new cases occur in the most populated nations like India and China[]. Alba video camcorder drivers. Also, a higher risk of hepatotoxicity has been reported in Indian patients (up to 11.5%) than in their western counterpart (up to 4.3%)[]. In a study of European patients, the incidence of ATT induced hepatotoxicity was found to be 18.2% in group having risk factors like, old age, extensive TB, malnutrition, alcoholism, HIV and chronic viral hepatitis B and C infections, as against 5.8% in group without risk factors indicating the significance of risk factors[]. The only measure available for managing ATT induced hepatotoxicity in clinical cases is stopping the offending agents, once there is an evidence of liver damage and reintroducing the same after normalization of liver enzymes[,]. To reduce the incidence of hepatotoxicity in latent TB patients, recommendations for drugs and patient selection criteria have been revised several times by organizations like Center for Disease Control, American Thoracic Society, Joint Tuberculosis Committee of British Thoracic Society, and Hong Kong Tuberculosis Service etc., but until today no drug has been developed for prevention of hepatotoxicity.