Nonalcoholic fatty liver disease (NAFLD) is a growing problem that is associated with the metabolic syndrome. The goal of the present study was to evaluate for ethnic differences in NAFLD and clinical correlates of NAFLD. The study population consisted of 567 patients seen at an urban obesity clinic. Elevated aminotransferase levels were used as a surrogate marker for NAFLD. The prevalence of elevated aminotransferases was highest in Hispanics (39%), followed by Caucasians (28%), and African Americans (12%). In univariate analysis, elevated aminotransferase levels were associated with ethnicity (Hispanic > African American, P < 0.001, and Caucasian > African American P = 0.030), hypertriglyceridemia (P < 0.001), and male gender (P < 0.001). The pattern of results was confirmed in multivariate analysis, except that the differences between Caucasians and African Americans was no longer significant. In conclusion, in an obesity clinic population, elevated aminotransferase levels and hypertriglyceridemia were most common in Hispanics and least common in African Americans.

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A 70-year-old male presented to the dermatology outpatient department with history of multiple erythematous to skin coloured nodules all over the face, head and neck region and upper trunk for one and a half years. Examination revealed multiple painless nodules of varying sizes predominantly over the face and neck [Table/ Fig-1], some of which showed hyperpigmentation. No crusting or discharge was noted.He had no history of pain, itching, fever, loss of sensation, history of injury or history of travel to any endemic area. However, on further questioning, he revealed a history of being investigated multiple times and getting treated at various peripheral centres for Hansen's disease. The treatment was started based on clinical nature of lesion as biopsy facility was not available at that centre. The patient also underwent Fine Needle Aspiration Cytology (FNAC) at some peripheral centre which was reported as chronic inflammatory lesion only. Based on the FNAC report, a biopsy was done which was reported as leishmaniasis and the patient was treated for the same. Getting tired of the treatment he received without results, the patient decided to visit a higher centre.On further investigations at our centre, his blood haemogram was normal with ESR of 40 mm at the end of first hour. Blood sugar, liver function and renal function tests were normal. ELISA test for HIV was non-reactive and his CD4 count was normal. ELISA test for kala azar (k-39 antigen) was negative. Serology for Mycobacterium Leprae was negative. Radiograph chest and ultrasonogram abdomen were within normal limits.Clinically, a diagnosis of post kala azar dermal leishmaniasis/cutaneous cryptococcosis was considered following which a skin biopsy from the edge of the lesion and slit skin smear was performed. Microscopy revealed few ill-defined granulomas and giant cells both in the epidermis and dermis along with multiple tiny round to oval yeast forms [Table /Fig-2a,b] with a surrounding clear halo suggestive of histoplasmosis. Special stains-silver methenamine [Table /Fig-3a,d] Periodic Acid Schiff (PAS) revealed histoplasma capsulatum lying singly and in clusters. Stain for Fite, Acid Fast Bacilli (AFB), mucicarmine (to rule out cryptococcus) was negative and a diagnosis of primary CHP was given considering the clinical picture, investigations and histo pathology. Now, the patient is responding well to the oral fluconazole therapy and is on close follow up. DISCUSSIoNPrimary CHP is very rare and occurs usually by local trauma or inoculation or inhalation. Its association has been commonly seen in immuocompromised individuals however difficulty arises in patients who are immunocompetent and not hailing from endemic region

situation such frequent visits to hospital for seeking care; will expose the expectant mothers and their fetuses to COVID-19 infection. Pregnant women because of physiological alterations in immune and cardiorespiratory systems fall under vulnerable group to develop complications due to virus even though are not at an increased risk of getting infected as compared to the general population. 5

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