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Background: Diabetes is a chronic lifestyle disease which can be kept under control by some simple lifestyle modifications like blood sugar monitoring, dietary modification and exercise pattern. Diabetes mellitus (DM) appears to be a global epidemic and an increasingly major non-communicable disease threatening both affluent and non-affluent sections of the society. Methods: A cross-sectional study was conducted in tertiary care hospitals in Mangalore involving 109 participants. The study utilized the Summary Diabetes Self-Care Activities questionnaire to collect data. Practices were categorized as good or poor based on an average score, with scores above 75% indicating good and lower scores indicating poorer practices. Data analysis was performed using SPSS version 16.0. Results: The dietary modifications were good in 7.3% of the subjects, exercise behavior in 14.67%, foot care practices in 12.6% and sugar monitoring in only 1% of the subjects. Being male and married was associated with better self-care behaviors. People belonging to low socio-economic status had better dietary modification habits. Conclusion: Self-care activities with respect to diet and sugar monitoring are poor in the population studied. The self-care activities relating to exercise behavior and foot care are good. Improving self-care behavior among patients with diabetes in India should start with adequate targeted health education.

Objective: Atherosclerosis is a chronic condition characterized by impaired lipid homeostasis and chronic inflammatory pathology in large and mid-sized arteries. Myocardial infarction is caused by coronary artery thrombosis in a ruptured or unstable atherosclerotic plaque. Despite the emphasis on known triggering factors, such as hypertension and dyslipidemia, adverse events following MI, such as recurrence and mortality, are still high. Therefore, it is imperative to assess potential determinants of plaque instability. We evaluated markers of inflammation, extracellular matrix (ECM) remodeling, thrombosis, and lipids in first-time and recurrent MI (RMI). Methods: Two hundred patients diagnosed with MI within the first 24 h of the event were included in the study and categorized as first-time or recurrent MI. Serum levels of NF-κB, hs-CRP, TNF-α, IFN ν, IL-6, VCAM-1, MMP-9, stromelysin, TIMP-1, MCP-1, PAPP-A, vWF, Ddimer, PLA2, PON-1, Apo-B, Apo-A1, ox-LDL, and anti-oxidized LDL antibodies were analyzed by ELISA. We performed a multivariate logistic regression analysis for risk stratification. Results: The mean age of first-time MI patients was 52.4±25 years and that of recurrent MI patients was 55.9±24.6 years. RMI patients showed significant (p<0.05) upregulation of markers of inflammation (TNF-a), endothelial adhesion (VCAM-1), ECM remodeling (MMP-9, PAPP-A), and antioxidant PON-1 enzyme. First-time MI patients had significantly higher serum IL-6 and D-dimer levels than RMI patients. Risk categorization for RMI was determined at 0.5 cut-off utilizing proteomic indicators at 95% confidence interval. Conclusion: Non-lipid factors provide substantial insights into plaque instability. Multiple markers of inflammation, thrombosis, extracellular matrix remodeling, and paroxonase-1 are reliable indicators of recurrent myocardial infarction. [ABSTRACT FROM AUTHOR]

In this case, a woman in her 80s presented to the emergency department with signs and symptoms of acute pancreatitis that began after starting a course of doxycycline. Common aetiologies of acute pancreatitis, including alcohol use, gallstones and hypertriglyceridaemia were ruled out. Less common aetiologies, including recent Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure, hypercalcaemia, malignancy, infection and trauma, were also ruled out, making drug-induced acute pancreatitis the most likely aetiology. After consideration of her medication list, doxycycline was determined to be the offending medication. On discontinuation and treatment with fluids and analgesics, her condition slowly improved. This case illustrates a rare but severe complication of doxycycline use. Determining the aetiology of drug-induced acute pancreatitis is more difficult in older patients due to high rates of polypharmacy. Recognition of doxycycline as an aetiology of druginduced pancreatitis may allow earlier recognition and intervention in cases of suspected pancreatitis without a clear common aetiology in older patients with polypharmacy. [ABSTRACT FROM AUTHOR]

Acute graft-versus-host disease (GvHD) is a process that classically has been defined as occurring less than 100 days after stem cell transplant. When Stage IV cutaneous acute GvHD occurs outside this window, it can be difficult to distinguish clinically from toxic epidermal necrolysis (TEN). A 50-year-old man with diffuse large B-cell lymphoma who had undergone an allogeneic stem cell transplant 20 months previously was admitted for neutropenic septic shock. He developed a slowly progressing macular/papular eruption with multiple tender bullae found to be consistent with TEN-like Stage IV cutaneous acute GvHD on biopsy. It was discovered that the patient’s maintenance immunosuppression had been completely discontinued one month prior to admission in preparation for clinical trial enrollment, causing a late presentation of cutaneous acute GvHD. This case provides particular insight into the diagnosis and management of late-presenting acute GvHD given that it is the first reported case of Stage IV cutaneous acute GvHD more than 12 months after stem cell transplant. In the setting of decreased immunosuppression in a patient with a history of a stem cell transplant, acute graft-versus-host disease must be considered regardless of the time that has elapsed since transplant.