BackgroundHepatitis infection from non‐hepatotropic viruses such as dengue virus (DENV) is increasing worldwide. There is increasing recognition of the changing epidemiology and atypical presentations of DENV infection including acute liver failure (ALF). There is paucity of data regarding incidence, disease characteristics, and markers of prognosis in patients who develop DENV‐related ALF.MethodsWe aimed to study the incidence, clinical features, laboratory characteristics, and determinants of outcome in patients of DENV presenting with ALF. We reviewed all patients with DENV infection and focused on DENV‐related ALF from 2014 to 2017. Diagnosis of DENV and ALF was confirmed by serological tests and standard criteria, respectively.ResultsThirty‐six patients (20 men, mean age 32.3) developed ALF among 10 108 patients with DENV infection (0.35%). Twenty‐one patients died (58.3%). Although bilirubin, aspartate and alanine aminotransferase, and international normalized ratio were markedly elevated in all patients with DENV ALF, there was no statistically significant difference between survivors and non‐survivors. Lactate levels, pH at admission, and model for end‐stage liver disease (MELD) score were the only predictors of mortality. Lactate levels were significantly higher in non‐survivors (11.5 ± 4.2 mmol/L) than survivors (6.3 ± 3.6 mmol/L) (P < 0.001). MELD score in non‐survivors (26.7 ± 10.2) was significantly higher than in survivors (20 ± 7.2) (P = 0.039). Receiver operator characteristic curve showed lactate or pH to be a superior prognostic marker than MELD with an area under the curve of 0.80, 0.79, and 0.70, respectively.ConclusionDengue hepatitis progressed to ALF in 0.35%. Development of ALF was associated with a high mortality (> 50%). Lactate level, pH, and MELD score at admission were significant determinants of outcome.

Human leukocyte antigens (HLA) have been linked to adverse drug reactions. Generally, HLA association is phenotype specific and is related to either liver or skin injury.HLA-A*13:01 has been linked to dapsone-induced severe cutaneous drug reactions and its role in drug-induced liver injury (DILI) is unclear. In our series, all of the four patients with immunoallergic dapsone DILI were carrying HLA-B*13:01 compared to its prevalence of 1-12% among Indians. HLA-B*13:01 plays a role not only in dapsone-induced severe cutaneous adverse reaction (SCAR) but also in dapsoneinduced liver injury with immunoallergic features and highlights the role of adaptive immune response in the pathogenesis of both liver and skin injury and associated other organ involvement.

BACKGROUND Coronary artery disease has emerged as the major cardiovascular disease of the era and also the commonest cause of premature death. Developing countries like India are expected to experience the greatest rise in cardiovascular disease burden over the next few years. In large part, this increase can be explained on the basis of major ongoing socio-demographic changes in developing countries and associated effects on the number of individuals at risk and the levels of cardiovascular risk factors. Atherosclerosis of the coronary vessels commonly causes ischaemic heart diseases. Recently, attention has been focused on the potential role of plasma markers of inflammation, especially C-Reactive Protein (CRP), as risk predictors among those at risk for cardiovascular events. Circulating levels of CRP were found to correlate with total infarct size in acute myocardial infarction and with prognosis. This study was conducted to identify the role of C-reactive protein in correlating the outcome in acute coronary syndrome. MATERIALS AND METHODS This is a case series study done in ICCU of VIMS, Bellary for a period of one year; 100 patients who came with history of typical angina chest pain and those who fit into the criteria for Acute Coronary syndrome with ECG showing either ST segment elevation or non-ST segment elevation myocardial infarction or unstable angina were included in the study. Detailed history, clinical examination and laboratory tests were the tools used to exclude these conditions. Apart from routine blood investigations, electrocardiography and transthoracic echocardiography was done in all patients. All patients were followed up and observed for the development of complications. RESULTS Out of the 100 patients studied, 44 patients had detectable C-reactive protein levels (equal to or more than 0.6 mg/dL). Out of these 34 patients had complications (including death), which was found to be statistically significant, thus correlating the CRP levels with complications. CONCLUSION Our study highlights a possible correlation between CRP levels and adverse outcome in acute coronary syndrome. Plasma CRP levels on admission serves to identify high risk patients in the setting of acute coronary syndromes and are also independent markers of adverse outcomes. The effective risk stratification provided may be of specific value for early therapeutic decisi on making and patient treatment in the heterogeneous population of patients presenting with acute coronary syndromes.

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