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Background The fasting-state serum bile acid profile in nonalcoholic-fatty-liver-disease (NAFLD) has been reported to differ when nonalcoholic-steatohepatitis is compared to nonalcoholic-fatty-liver. However, there are few data comparing changes in NAFLD versus non-NAFLD or whether the bile acid profile differs according to the degree of fibrosis. Aim To examine the serum bile acid profile across the entire spectrum of NAFLD. Methods We performed a cross-sectional analysis of 2 complementary cohorts: a Twin and Family cohort of 156 participants, and a biopsy-proven-NAFLD cohort of 156 participants with fasting bile acid profiling using liquid-chromatography/mass-spectrometry. Results In the Twin and Family cohort (mean age 46.3 years and body-mass-index (BMI) 26.6 kg/m2), 36 (23%) participants had NAFLD (magnetic-resonance-imaging-proton-density-fat-fraction≥5%). Higher chenodeoxycholyl-conjugates (6.5% versus 9.0%,p=0.019) and lower glycohycholate (1.2% versus 3.6%,p<0.001) was observed in NAFLD compared to non-NAFLD-controls. In the biopsy-proven-NAFLD cohort (mean age 49.8 years, BMI 32.0 kg/m2), no differences in total bile acid were seen between nonalcoholic-fatty-liver versus nonalcoholic-steatohepatitis. The total unconjugated-bile acid significantly decreased across nonalcoholic-steatohepatitis categories (p=0.044). The distribution of stage of fibrosis was F0: 42.3%, F1: 32.7%, F2: 10.3%, F3: 8.3%, and F4: 6.4%. The total serum bile acid increased with increase in fibrosis-stage (p< 0.001). The primary-conjugated-bile-acid proportion increased (p< 0.001) whereas unconjugated-bile-acid (p=0.006), unconjugated-cholyl (p<0.001) and chenodeoxycholyl-conjugates (p<0.002) significantly decreased with increase in liver fibrosis stage. Conclusions Fasting-state serum bile acid profile alterations are seen across the entire spectrum of NAFLD. The total serum bile acids did not differ significantly between NAFLD versus non-NAFLD and nonalcoholic-fatty-liver versus nonalcoholic-steatohepatitis but were significantly perturbed progressively as liver fibrosis increases.

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Abstract. Post-kala-azar dermal leishmaniasis (PKDL) has important public health implications for transmission of visceral leishmaniasis (VL). Clinical and epidemiologic profiles of 102 PKDL patients showed that median age of males and females at the time of diagnosis was significantly different (P = 0.013). A significant association was observed between family history of VL and sex of PKDL patients (χ 2 = 5.72, P 0.01). Nearly 33% of the patients showed development of PKDL within one year of VL treatment. The observed time (median = 12 months) between appearance of lesions and diagnosis is an important factor in VL transmission. A significant association was observed between type of lesions and duration of appearance after VL treatment (χ 2 = 6.59, P = 0.001). Because PKDL was observed during treatment with all currently used anti-leishmanial drugs, new drug regimens having high cure rates and potential to lower the PKDL incidence need to be investigated.Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis caused by Leishmania donovani parasites in the skin after apparently successful treatment of patients with visceral leishmaniasis (VL) or those without a history of VL. It is characterized by macular, maculopapular, and nodular lesions in patients recovering from VL who are otherwise healthy.1 It occurs in nearly 10-20% of patients cured of VL within 1-5 years in India, and in approximately 50% of patients in Sudan within six months. [1][2][3][4] In the Indian subcontinent, kala-azar appears to occur at an interval of 10-15 years.5 Patients with PKDL have immense public health importance because they act as reservoirs of infection. 6Because there is no animal reservoir of L. donovani, in this sub-continent, it is important to detect patients with PKDL and treat them properly to prevent future outbreaks of VL. 7It has been reported that a large proportion of VL patients treated with sodium antimony gluconate (SAG) have a high probability of development of PKDL.8 It is not known whether other anti-leishmanial drugs have a similar posttreatment effect in development of PKDL. Clinical and epidemiologic aspects of PKDL are important for understanding transmission dynamics and defining VL control strategies. Because there is no mechanism currently available to detect PKDL cases at the community level, control strategies currently operational in disease-endemic areas would fail to achieve their goal of elimination. Therefore, we studied a cohort of PKDL cases diagnosed during 2007-2010 to identify clinical and epidemiologic features that are important to public health.The study was conducted at the Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India during June 2007-December 2010. A total of 102 confirmed patients with PKDL were enrolled in the study after providing informed consent. A semi-structured questionnaire was administered to each person to obtain demographic characteristics, area of residence, history of VL, relapse of VL, family history of VL or...

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