Introduction: Weil's disease (Leptospirosis) is a relatively common worldwide zoonotic infection due to Leptospira spp. However, leptospirosis is underreported due to its low incidence in the United States and its variable presentation. Furthermore, leptospirosis-induced acute hepatic injury is extremely rare. The purpose of this case report to enlighten urban practitioners to consider testing for leptospirosis in patients with acute liver injury. We are reporting a rare case of leptospirosis induced acute liver injury. Case Description/Methods: A 38 year-old-male with no past medical history presented with 6-day history of fever, abdominal pain, N/V, fatigue and myalgia. On presentation patient was vitally stable, physical exam, ill appearing man with icterus sclera, mild tenderness in RUQ abdomen.

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Mucormycosis, caused by a group of moulds called mucormycetes, is a rare but potentially fatal infection if inadequately treated. It is often referred to as the so-called black fungus, the incidence of mucormycosis has risen more rapidly during the second wave compared with the first wave of COVID-19 in India. We reported a case of mucormycosis in a 50 years old male patient.

Wilson disease is an inherited disorder of copper metabolism with an autosomal recessive inheritance pattern (hepatolenticular degeneration). In this case, a 13-year-old child was seen with overall exhaustion, sporadic abdominal discomfort, and shrinking handwriting during the previous 12 months. On clinical examination there was hepatosplenomegaly. Routine blood work revealed anemia, leukopenia, thrombocytopenia, elevated total and indirect bilirubin, alkaline phosphatase and transaminitis. Serum ceruloplasmin is decreased, urine copper excretion is increased. Slit lamp examination revealed Kayser-Fleischer rings in both eyes. Ultrasonography (USG) abdomen confirmed hepatosplenomegaly, coarse echotexture of the liver. MRI Brain revealed the bilateral and diffuse and symmetric hyperintensity of caudate and lentiform nuclei, which are consistent with the neuro-parenchymal changes of Wilson's disease. We report this case due to its rare incidence and atypical presentation and to highlight the importance of clinical examination in reaching the diagnosis.

Introduction: Heart failure is one of the leading cause of hospitalization and death worldwide having a major impact on the health care systems. Risk stratification of these patients helps to achieve a better clinical outcome with a reduction in morbidity and mortality. Methods: This was a single centre prospective observational study wherein patients with acute decompensated heart failure were enrolled. All enrolled patients underwent detailed clinical history including symptomatology, risk factors for cardiovascular diseases and family history were recorded. All these patients underwent routine haematological and biochemical testing along with documentation of cardiac biomarkers viz. Troponin T and N-terminal pro brain natriuretic peptide (NT pro-BNP). All these patients were then followed for one year. Outcomes in form of in-hospital mortality as well as adverse cardiac events (mortality, rehospitalisation) were documented. Results: A total of 264 patients were included with mean age of 67.6 ± 9.8 years. In-hospital mortality was reported in 28 patients (10.6%) while 27 (10.2%) patients died over a year of follow-up. Patients with an in-hospital mortality were older and higher NYHA class and heart rate, lower ejection fraction, systolic and diastolic blood pressure and higher cardiac troponins and NT-pro BNP levels. Multivariate logistic regression analysis revealed that heart rate, NYHA class, systolic blood pressures, NT pro-BNP and creatinine were independent predictors of mortality. Conclusions: Our study showed that acute heart failure has a substantial in-hospital as well as one year mortality rates. Use of biomarkers leads to a better risk stratification and hence an impact on outcomes.