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affected environment during traumatic brain damage, which decreased acetaminophen-induced liver damage in rat upon
accelerates and facilitates the death of the cells. Improvement use of 150 mg/kg silymarin. The potential therapeutic effect
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of oxygen supply and blood supply to the brain cells, of N-acetylcysteine and silymarine on lung fibrosis of mice
correction of water and electrolyte disorders, intracranial model has been previously reported by Solhi et al. Silymarine
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pressure modulation, secondary hemorrhage prevention, therapeutic effect on urinary tract symptoms of prostatic
and preventing seizures were therapeutic strategies for hyperplasia has been also reported. The aim of this study
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reducing mortality and morbidity. For example, with high was to assess the possible effect of Silymarine on the
confidence, steroids have been associated with traumatic improvement of prognosis in patients with moderate and
brain injury due to increased mortality. In a study in 2014, severe traumatic brain injury.
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there was no apparent effect of lacosamide on improving the
prognosis of moderate to severe trauma after traumatic brain MATERIAL AND METHODS
injury in rats. In another study, a positive effect of citicoline The present study was designed as a clinical trial, which
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on the improvement of consciousness in severe brain trauma all subjects were selected from patients aged 18 to 65 years
patients was reported by Iranian researchers. The effect of suffering from moderate and severe traumatic brain injury,
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Ginseng’s herbal remedy was reported by Chinese researchers and with Glasgow Coma Scale (GCS) score < 12, who were
in January 2015, which its protective effect was remained referred to the emergency department of Valiasr Hospital in
unresolved. In a laboratory study on the animal samples, the Arak. After 12 hours, the patients were recruited according to
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effects of several substances, including endocannabioids, the general inclusion/exclusion criteria. All subjects were
were associated with promising results. N-acetylcysteine given written informed consent after explanation of study.
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and vitamins had significant effects in predicting and The patients were divided into two groups of intervention
modulating the stroke pathways of brain damage in rats. and placebo, each group was assigned 40 individuals. Patients’
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The effect of beta-blockers on the improvement of prognosis checklist with demographic and clinical data was completed
was published in a study in 2014, but requires further for each patient and the case and control groups were then
examination. Moreover, the positive effects of propranolol matched based on age, gender and severity of traumatic brain
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for limitation of secondary injury and reduction of mortality injury. The patients were divided into two groups of
in patients suffering from traumatic brain injury compared intervention and placebo, which each group was assigned 40
to other beta-blockers. The neuroprotective effects of individuals. Patients’ checklist with demographic and clinical
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progesterone on the improvement of traumatic brain injuries data was completed for each patient and the case and control
have already been reported. However, it’s ineffectiveness has groups were matched based on age, gender and severity of
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been reported by another study. A pervious study indicated traumatic brain injury. The control group received approved
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that estradiol improves functional outcome, after spinal cord therapies based on the indication, and the case group had
injury. Moreover, they reported Tamoxifen׳s effects during also received confirmed therapies for brain trauma in terms
late stages of spinal cord injury, indicating its potential as of indication, plus a 140 mg dose of silymarin every eight
long-term alternative treatment for these patients. Another hours for 7 days by oral gavage (oral or gavage), and placebo
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study had evaluated the efficacy and side-effects of was prescribed for the control group. After three months, the
cyclosporine-A in improvement of consciousness and level of prognosis of the patient according to GOS criteria
cognitive dysfunction of patients with diffuse axonal injury and variables such as age, gender, location (city or village),
after traumatic brain. They suggested that the administration the cause of the trauma (related injuries involving a fall from
of cyclosporine-A is not effective in the improvement of height, car, motorcycle, and bullet) and the site of the
consciousness and cognitive function, whereas it does not accident (street, road, home, work ), and patient’s level of
have any adverse effects. Silibinin has been described as an consciousness was recorded on the checklist based upon the
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active component of silymarin, a mixture of polyflavonoids GCS and patient arrivals to an accident and emergency
extracted from milk thistle. Silybin isolated from herbal plant department (in minutes). Brain trauma were divided into
is commonly used as a liver protection agents based upon the three groups including mild, moderate and severe as
hepatotoxic model. Silibinin has also had promising results previously described by Youmans Neurological Surgery. The
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for improving clinical outcomes of Amanita phalloides morbidity and mortality outcomes of the patient were
poisoning. Silibinin may be applied as an efficacious assessed in two moderate and severe groups regarding the
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therapeutic agent against estrogen receptor (ER)-negative standard table as previously described by Youmans
breast carcinoma cells. Silibinin has been also reported to neurological surgery. As matter of fact, mortality over a three
play an anti-neoplastic effect in many kinds of malignancies months’ period and morbidity at the end of the three months
including renal cell carcinoma, hepatocellular carcinoma, were evaluated in moderate and severe groups and then
glioblastoma, prostate, and skin, bladder, lung, and colon compared between the cases and controls.
cancers. Protective effects of silymarin against the toxic The criteria for inclusion was: (1) patients 18 to 65 years
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influence of malathion has been indicated in liver tissue of of age and both sexes; (2) moderate and severe brain trauma
fish based upon on the biochemical variable. It has been patients (with GCS score < 12); and, (3) Satisfactory informed
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previously revealed which the use of silymarin markedly consent for intervention from the patient. Exclusion criteria

Nazemi Rafi—Silymarine Effects on Prognosis of TBI ALTERNATIVE THERAPIES, JUL/AUG 2020 VOL. 26 NO. 4 9