Background: Acute liver failure (ALF) is characterized by acute derangement of liver function and carries high mortality. Viral hepatitis is still one of the main causes of ALF in the India as well in world. A prospective case control study was carried with the aim to determine the effect of N-acetylcysteine (NAC) on survival of viral-ALF patients. Methods: 37 patients with a diagnosis of viral-ALF were included in the study. 18 patients received NAC infusion for 72 hrs whereas 19 patients in control group received placebo. The variables evaluated were demographic, biochemical, outcome and length of hospital stay. Results: Out of 37 viral-ALF patients, acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). The two groups were comparable for the various baseline characteristics (age, INR, bilirubin, ALT, creatinine, albumin, grade of encephalopathy, mean grade of coma etc.). Use of NAC was associated with a shorter length of hospital stay of survived patients (p=0.024). A total of 20 of 37 (54.1%) patients died with ALF complications; 7 (38.9%) patients belonged to NAC group and 13 (68.4%) patients to control group (p=0.079). HEV induced ALF showed significant improved in survival than Non HEV induced ALF with NAC administration (p=0.022). Conclusions: HEV was the most frequently cause of viral-ALF. Overall survival was not improved by NAC. HEV induced ALF showed significant improved in survival than Non HEV induced ALF with NAC administration. NAC reduced duration of hospital stay.

PURPOSE: Graves' orbitopathy (GO) is one of the most frequent orbital disorders and is the most common cause of proptosis in adults. GO is described as chronic inflammation of orbital and periorbital tissues. This study aimed to evaluate the risk factors for severe GO in patients with Graves' disease (GD). MATERIALS AND METHODS: This was a prospective cross-sectional study done on 52 newly diagnosed patients of GD with GO documented by thyroid 99m Technetium-pertechnetate scan at our center between May 2016 and May 2019. All patients underwent a comprehensive ophthalmological examination and laboratory and hormonal analysis. Clinical Activity Score (CAS) and severity were estimated as per the European Group on Graves Orbitopathy. Thirty-four patients with mild GO were compared with 18 patients with moderate-to-severe GO (severe) for baseline risk parameters. RESULTS: Majority of the patients had mild orbitopathy (34 [65.4%]) followed by moderate to severe (18 [34.6%]). CAS was active in 13.5% of the study group. There was a statistically significant male preponderance in severe GO. Current smoking increased the risk of severe GO ( P = 0.003). Duration of GD symptoms at presentation was statistically significantly longer in severe GO patients than mild GO ( P = 0.004). Thyrotropin receptor antibody (TRAb) titer significantly increased in severe GO group (6.2 ± 2.4 IU/L) when compared to mild GO (3.2 ± 1.6 IU/L) ( P < 0.001). TRAb positivity was similar between groups. Braley's sign, i.e., the differential intraocular pressure (IOP) of >6 mmHg, was statistically significantly higher in severe GO ( P < 0.001). Male gender, current smoking, TRAb >2 upper limit of normal (ULN), and differential IOP >6 mmHg were found to be associated with severe GO. CONCLUSION: Approximately 35% of the patients with GO have severe disease, with a higher risk in men. This study identified male gender, current smoking, TRAb >2 ULN, and differential IOP >6 mmHg to be associated with severe GO.

Purpose Emphysematous pyelonephritis (EPN) patients with type 2 diabetes (T2D) have severe complications and high morbidity with poor prognosis as compared to Pyelonephritis. The aim was to study clinical features, microbiological profile, complications of EPN and pyelonephritis in T2D patients. Methods This was a hospital-based prospective study done on 200 T2D patients with upper UTI. Various clinical, biochemical parameters and urine examination and culture were monitored. Patients were followed up for 6 months with respect to number of UTIs, glycemic control and renal parameters. Results Pyelonephritis was present in 180(90%) and EPN in 20(10%) of upper UTI patients. Longer duration of diabetes, presence of nephropathy, chronic kidney disease (CKD), hypertension (HTN), history of symptomatic UTI in a prior year, renal calculi and obstruction increase the risk of EPN. Patients with EPN commonly present with vomiting, flank pain altered sensorium and renal tenderness. Complications like diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), multiorgan dysfunction syndrome (MODS), acute kidney injury (AKI) and hypotension occur frequently in EPN as compared to pyelonephritis in T2D patients. Patients with EPN had poor glycemia and lower estimated glomerular filtration rate (eGFR) as compared to pyelonephritis. Bacteriuria was present in 90% and 66.7% of EPN and pyelonephritis patients respectively. E. coli was the most common isolate in both UTI groups. A significant number of EPN patients develop recurrent UTI. Patients with EPN have an improvement in glycemia on follow up, but renal parameters do not improve on follow up, while as pyelonephritis patients have an improvement in glycemia and renal parameters with intensive treatment. Recurrent UTI in upper UTI patients leads to worsening of glycemia and renal parameters. Conclusion Complications frequently occur in EPN patients as compared to pyelonephritis.

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