Autoimmune hepatitis unmasked by dengue infection - An unexplored and rare association.

Dengue hepatitis is mostly asymptomatic but can lead to liver failure. Autoimmune hepatitis is mainly the disease of females and a potentially treatable cause of chronic liver disease. We report a rare case in which autoimmune hepatitis was unmasked by Dengue infection. The patient was managed for AIH with steroids and azathioprine and became asymptomatic in 30 days. Dengue is a proven risk factor for many autoimmune conditions but its association with AIH is not studied.

Evaluation of Interleukin 6(Il-6), Tumor Necrosis Factor Alpha (Tnf-α) and Paraoxonase 1(Pon 1) in Obese and Non-Obese Metabolic Syndrome.

Metabolic syndrome is a multiplex of the risk factor for the development of type 2 diabetes and cardiovascular disease and it reflects the clustering of multiple risk factors resulting from obesity and insulin resistance. Despite its predominance in obese individuals, MS does occur in non-obese individuals. Many individuals characterized as normal weight as per their body mass index (BMI), have increased visceral adiposity thereby leading to an unfavorable inflammatory cytokine profile and altered PON levels. There are limited studies from India concerning inflammatory cytokines in obesity and MS in general and non-obese patients with MS in particular. MATERIAL: Study Design: An observational cross sectional comparative study was conducted which included 65 patients in each Obese and Non-obese Metabolic Syndrome group. The difference in biomarker profile between the two groups was studied. MATERIAL AND METHODS: Patients were subjected to detailed history, physical and anthropometric examination. NCEP-ATP III criteria were used for the diagnosis of Metabolic Syndrome. Patients were considered obese if BMI ≥ 25kg/m2. Normal weight individuals with MS were further subdivided into two groups based on the presence of abdominal obesity (WC cut off 90 cm for men and 80 cm for women). Blood samples were collected for analysis for FBS, Lipid Profile, and HbA1c. Blood samples for biomarker analysis were collected in clotted sample tubes followed by deep freezing and analyzed using ELISA kits. The results were interpreted according to manufacturer guidelines. OBSERVATION: There were no significant differences in IL-6, TNF-α, and PON 1 profiles among Obese and Non-obese Metabolic Syndrome. Moreover significant (p < 0.05) positive correlation was seen in TNF-α levels among patients with abdominal obesity than without abdominal obesity among the Non-obese group. CONCLUSION: TNF-α levels were significantly higher among patients with abdominal obesity than without abdominal obesity among the Non-obese group. There was no significant difference in IL-6, TNF-alpha, and PON 1 among Obese and Non-obese MS. This finding indicates that apart from adipose tissue, other factors are also responsible for the development of MS and its associated proinflammatory profile. There could be a significant contribution of genetic and epigenetic factors which need to be further explored.

Correlation Between Carotid Intima Media Thickness and Non-Alcoholic Fatty Liver Disease.

CONTEXT: Non-alcoholic fatty liver disease (NAFLD) is considered a potential independent risk factor for cardiovascular disease. Increased carotid intima-media thickness (CIMT) is a sign of early atherosclerosis and is linked to an increased risk of myocardial infarction, stroke, and peripheral vascular disease. AIM: To study correlation between CIMT and NAFLD and its association with increase in grades of NAFLD. Material and Study Design: An observational case control study of 40 cases and 40 controls (age and sex matched) was done. The difference of CIMT between the two groups was analysed. CIMT was also measured among the various grades of NAFLD cases. MATERIALS AND METHODS: 40 cases with NAFLD and 40 controls falling within the age group of 18-45 years were taken in the study. Patients with history of significant alcohol consumption, acute or chronic liver disease, diabetes mellitus, hypertension, malignancy, hypothyroidism and having dyslipidaemia, CAD and stroke were excluded from the study. All the subjects underwent abdominal and carotid ultrasound in order to assess NAFLD and CIMT measurement. The left and right common carotid artery was examined using PHILIPS HD11XE high-definition ultrasound system equipped with a 3-12 MHz linear array transducer in B mode. OBSERVATION AND RESULTS: There was a statistically significant difference between the 2 groups in terms of CIMT with a p value of <0.001. The mean CIMT in the Case group was 0.86 mm while in Control group was 0.52 mm. There was a significant difference between the 3 Grades of NAFLD in terms of CIMT with a p value of <0.001 with maximum CIMT being in Grade 3 of NAFLD. Body Mass Index, Alanine Transaminase, Aspartate Transaminase, Alkaline Phosphatase, Total Cholesterol, Triglycerides, Low Density Lipoprotein were also found to have statistical significant difference between cases and controls. Age, gender, Blood pressure, Fasting Blood Sugar, HbA1c, Hemoglobin, Total leucocyte Count, Platelet count, Serum Bilirubin, Total protein and Albumin were found to be statistically insignificantly different between cases and controls. CONCLUSION: CIMT is increased in NAFLD patients. Increase in CIMT is significantly correlated with increasing grades of NAFLD. Hence CIMT can be used as screening tests in NALFD patients to assess cardiovascular risks.

Association of high-sensitivity C-reactive protein (hs-CRP) with non-alcoholic fatty liver disease (NAFLD) in Asian Indians: A cross-sectional study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is an important etiology for the development of chronic liver disease worldwide. Its pathophysiology includes chronic low-grade inflammation. There are limited studies on the association of inflammatory markers with NAFLD. Hence, in the present research, we aimed to study the association of one such inflammatory marker hs-CRP with NAFLD in north Indian population. MATERIALS AND METHODS: For this cross-sectional study, 100 subjects of either sex above 18 years of age, being diagnosed as a case of NAFLD on the basis of ultrasonography and age, sex and BMI matched subjects fulfilling the inclusion and exclusion criteria were included. Anthropometric profile, high-sensitivity C-reactive protein (hs-CRP), HbA1c, and hepatic function tests were recorded. RESULTS: The baseline variables were matched for age, weight, BMI, waist-hip circumference ratio, and blood pressure. The HbA1c (P < 0.001), alanine aminotransferase (P = 0.002), alkaline phosphatase (0.002), and hs-CRP (P < 0.001) were elevated in subjects with NAFLD. The mean level of hs-CRP was significantly higher in subjects with NAFLD as compared to the control group (3.12 ± 1.42 mg/L vs 1.05 ± 0.44 mg/L, P < 0.001). The mean hs-CRP level was 1.42 ± 0.55 mg/L in grade 1, 0.98 ± 0.72 mg/L in grade 2 with P < 0.001, and 4.5 ± 1.11 mg/L in grade 3 with P < 0.001 when compared to grade 1.The comparative value of hs-CRP in the control group was found to be 1.05 ± 0.44 mg/L. On univariate analysis waist-hip circumference ratio (P = 0.035), HbA1c (P < 0.001), and hs-CRP (P < 0.001), showed a significant association with NAFLD. On logistic regression hs-CRP was found to have significant association with NAFLD even after adjusting waist-hip circumference ratio and HbA1C (odds ratio 1.311, 95% confidence interval 1.146-1.488, P < 0.001). CONCLUSION: In this cohort of north Indian population, hs-CRP showed independent relationships with NAFLD. Thus, hs-CRP may be used as a surrogate marker for the disease severity in NAFLD.