Is dengue emerging as important cause of acute liver failure in endemic regions?

Dengue virus infection continues to be major public health problem in large part of world.The epidemiology of dengue viral infection is becoming increasingly complex and has substantially changed over almost past six decades not only in terms of prevalent strains and geographical locations but also in terms of disease severity and atypical presentations.Though liver is the most common organ affected but is generally asymptomatic.We present a case of infant with severe dengue who died of fulminant hepatic failure and showed pan lobular necrosis on post mortem liver biopsy.The case is being presented to highlight life threatening complication of dengue in young children,and dengue viral infection as a cause of acute liver failure in endemic areas.Thus dengue fever should also be considered as one of the differential diagnosis in children presenting with fever and fulminant hepatic failure in endemic regions.

Chronic hepatitis E–an emerging disease in an immunocompromised host

Chronic hepatitis E virus(HEV)infection is increasingly being reported in immunosuppressed individuals with HIV,patients with haematological malignancy and transplant recipients.The diagnosis of cirrhosis and liver failure post chronic HEV is controversial due to lack of standard diagnostic criteria.The treatment benefits of ribavirin in chronic HEV of genotype 1 are not well reported.We report a case of chronic HEV infection of genotype 1 leading to chronic liver disease in a child cured of acute leukaemia.Our report also highlights the successful use of ribavirin for eradicating chronic HEV infection and its subsequent survival benefits.Chronic hepatitis E may be an emerging disease of immunosuppressed patients and should be suspected in the presence of cryptogenic transaminitis.Ribavirin is an effective therapy for controlling HEV.

Comparative analysis of real-world data of frequent treatment sequences in metastatic prostate cancer

Background:The incidence of prostate cancer is increasing worldwide.A significant proportion of patients developmetastatic disease and are initially prescribed androgen deprivation therapy(ADT).However,subsequent sequences of treatments in real-world settings that may improve overall survival remain an area of active investigation.Materials and methods:Data were collected from 384 patients presenting with de novo metastatic prostate cancer from 2011 to 2015 at a tertiary cancer center.Patients were categorized into surviving(n=232)and deceased(n=152)groups at the end of 3 years.Modified sequence pattern mining techniques(Generalized Sequential Pattern Mining and Sequential Pattern Discovery using Equivalence Classes)were applied to determine the exact order of the most frequent sets of treatments in each group.Results:Degarelix,as the initial form of ADT,was uniquely in the surviving group.The sequence of ADT followed by abiraterone and docetaxel was uniquely associated with a higher 3-year overall survival.Orchiectomy followed by fosfestrol was found to have a unique niche among surviving patients with a long duration of response to the initial ADT.Patients who received chemotherapy followed by radiotherapy and those who received radiotherapy followed by chemotherapy were found more frequently in the deceased group.Conclusions:We identified unique treatment sequences among surviving and deceased patients at the end of 3 years.Degarelix should be the preferred formof ADT.Patients who received ADT followed by abiraterone and chemotherapy showed better results.Patients requiring palliative radiation and chemotherapy in any sequence were significantlymore frequent in the deceased group,identifying the need to offer such patients the most efficacious agents and to target them in clinical trial design.