A. Somani 1 , A. Jain 2 , V. Dixit 2 , S. Somani 3 1 Navjeevan hospital, 2 IMS, BHU, VARANASI, 3 Suvidha Introduction: Hepatic encephalopathy, a complex neuropsychiatric syndrome secondary to acute liver failure, chronic parenchymal liver disease or portal-systemic shunting, may possibly develop through mediators of endotoxin and tumor necrosis factor-alpha (TNF-). Several studies have shown that serum levels of (TNF-) are significantly elevated in patients with acute and chronic liver diseases, where these elevations are independent of the etiology of the underlying disease. It has been shown that plasma levels of TNF-correlate with the severity of hepatic encephalopathy (HE) in fulminant hepatic failure. However, still there is very few published data regarding the relationship between serum levels of TNF-and the presence or severity of HE in patients with chronic liver failure. Methods: The aim of this study is to determine the relationship between serum levels of TNF-and clinical grades of HE in patients with chronic liver failure. This prospective study included 149 consecutive male patients with alcoholic cirrhosis in various clinical grades of HE (according to West Haven criterion). Detailed clinical, biochemical and sonographic examination was done in all patients. Circulating levels of TNF-was measured using solid-phase ELISA. Results: The mean±SEM values of serum TNF-at presentation in patients with MHE (n=37), grade 1 (n=17), grade 2 (n=41), grade 3 (n=44), and grade 4 (n=10) were 6.2±0.4, 9.5±0.6, 15±0.7, 26.3±1.7, and 46±5 .9 pg/ml, respectively. Significant Positive correlation was found between serum levels of TNF-and severity of HE (Correlation Coefficient = 0.7). Conclusion: From the present study we can suggest that there is significant relationship between TNF-and HE in patients with alcoholic cirrhosis and it could be involved in its pathogenesis. Background: Acute hepatitis A (AHA) is one of the most common infectious diseases and usually a self-limiting disease. Although extrahepatic manifestations are not common, a few cases associated with acute renal failure (ARF) have been reported.