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Introduction:The changes in the white blood cells counts and other blood parameters are well-recognized feature in sepsis. A ratio between neutrophils and lymphocytes can be used as a screening marker in sepsis. Even though new markers such as Procalcitonin and adrenomedullin have been rolled out in the field, implementation of these markers has been hindered by cost, accessibility, and proper validation. We looked for the ability of simple neutrophil-lymphocyte count ratio (NLCR) when compared to the gold standard blood culture method in predicting bacteremia, on patients presented to emergency department (ED) with features of suspected community-acquired infections.Materials and Methods:A comparative study done on 258 adult patients, admitted with suspected features of community-acquired infections. The study group included all patients who had positive blood culture results on index presentation at ED. Patients with hematological, chronic liver and retroviral diseases, patients receiving chemotherapy, and steroid medications were excluded from the study. The study group was compared with gender- and age-matched control group who were also admitted with a suspicion of the same, but in whom the blood culture results were negative.Results:There was no statistically significant difference for predicting bacteremia by NLCR (>4.63) and culture positivity methods (P = 1.00). NLCR of > 4.63 predicts bacteremia with an accuracy of 84.9%.Conclusion:In our setting, NLCR performs equally well with culture positivity, in detecting severe infection at the early phase of disease. The NLCR may, therefore, be used as a suitable screening marker at ED for suspected community-acquired infections.

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Hepatitis is mostly occurred by alcohol, drugs, or virus. Herpes simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures, but it is a fatal complication. Pregnant women are more vulnerable as the immunological changes during pregnancy suppress T-cell-mediated immunity promoting disseminated infection. Although HSV-associated hepatic failure carries a high-mortality risk, early intervention with acyclovir may prove to be life-saving. Here in, we report a case of 22-year-old female 8 weeks primigravida admitted with complaints of yellowish discoloration of eyes and urine and was provisionally diagnosed to have acute severe hepatitis with no hepatic encephalopathy or liver failure. Immunoglobulin M HSV test was positive, suggestive of HSV-induced hepatitis. Due to severe hepatic failure, living donor liver transplantation (left lobe with middle hepatic vein) was performed. She was treated with antivirals, immunosuppressants, and other conservative treatments. After few days her general condition was good, and laboratory investigations were stable. She was shifted out from intensive care unit. At the time of discharge, she was comfortable, vitals stable and wound was healthy. It should be considered in the differential diagnosis of any case of severe hepatitis with concomitant fever, abdominal pain, and elevated values of liver function tests with or without jaundice. The administration of intravenous acyclovir is inexpensive, without drug interactions, and safe even during pregnancy. Clinicians should be aware of HSV-induced hepatitis in immunocompromised patients and its risk factors.

Rabeprazole, a proton-pump inhibitor (PPI), commonly used in the treatment of gastroesophageal reflux disease, a condition caused due to regurgitation of acid from the stomach to the esophagus. Acute interstitial nephritis (AIN) is seen uncommonly even though it is an important adverse effect of these class of drugs. Here, we report a case of a 47-year-old male patient, a known case of peptic ulcer disease since 2 months, now presented with complaints of nausea and abdominal pain. He was on treatment with rabeprazole for the same. At the time of admission, his serum creatinine level (4.86 mg/dl) and blood urea nitrogen (75 mg/dl) were elevated. Ultrasonography showed changes in the renal parenchymal cells, and renal biopsy report was also suggestive of AIN. Rabeprazole-induced AIN was doubted, and thus, the drug therapy was stopped on the day four. He was symptomatically and clinically better after discontinuation of the drug. Using the Naranjo adverse drug reaction scale, we conclude that the probability of the incidence of AIN being induced by rabeprazole is probable (Naranjo probability score was eight). Early diagnosis of the adverse effect due to PPIs is essential for the instant withdrawal of the offending drug and resolution of symptoms.