Cigarette smoking is a major cause of cardiovascular disease and is responsible for approximately 140,000 premature deaths from cardiovascular diseases each year. Cigarette smoke delivers a high concentration of oxidizing chemicals and exposure to these chemicals is associated to depletion of endogenous levels of antioxidants, which contribute to a number of the potential mechanism of cardiovascular disease. Altered blood coagulation, impaired integrity of the arterial wall, and changes in blood lipid and lipoprotein concentrations predisposes to coronary artery disease (CAD) in smokers. Aims and objective: To compare lipid profile in smokers and nonsmokers. Determine dose-dependent relationship, durational significance between smoking and lipid profile among smokers. Evaluation for CAD in both smokers and nonsmokers. Materials and methods: The study was carried out in 100 healthy male smokers and 100 healthy male nonsmokers selected from volunteers from RajaRajeswari Medical College, Bengaluru. All patients were subjected to fasting lipid profile, cardiac evaluation by doing ECG/ECHO/TMT in smokers and nonsmokers. Results: The mean duration of smoking was 6.6 years. The mean level of total cholesterol, LDL cholesterol, and triglycerides is significantly increased (p value > 0.001), whereas the mean level of HDL cholesterol is significantly low (p value > 0.001) in smokers compared to nonsmokers. There is a direct relationship exist between the severity of smoking and an increase in serum lipids. We have observed ECHO and TMT changes in smokers who have smoked for a duration of >6 years. Conclusion: We have observed that there is a direct relationship exists between the severity of smoking and an increase in the serum lipid profile levels as well as greater risk for the development of coronary heart disease. So, it is strongly recommended to avoid smoking for the benefit of cardiac health.

Aim and objective: To compare HbA1c levels with inflammatory markers that include a neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in controlled and uncontrolled diabetics. Materials and methods: Eighty-nine patients with type 2 diabetes mellitus (T2DM) were divided into two groups of controlled (HbA1c <7%) and uncontrolled (HbA1c >7%) diabetics. Recent laboratory data were used to collect HbA1c (glycated hemoglobin) levels, leukocyte count (WBC), hemoglobin (Hb), hematocrit (Hct), red blood cell distribution width (RDW), neutrophils, lymphocytes, and monocytes. The NLR and MLR were calculated from the laboratory data. Results: The mean age in controlled and uncontrolled diabetics was 58.30 and 55.62 years, respectively. The mean NLR in controlled and uncontrolled diabetics was 2.61 and 4.88. The difference was found to be statistically significant (p < 0.05). The mean MLR in controlled and uncontrolled diabetics was 0.2 and 0.24, but the difference was not statistically significant (p > 0.05). A weak positive correlation was found between HbA1c levels and the hematological indices and the results were statistically insignificant. Conclusion: The study yielded significant results in the difference between controlled and uncontrolled diabetics with respect to NLR. Although there was only a weak positive correlation found between glycated Hb levels and the hematological indices, the results showed that there is a significant difference in the NLR between the two groups. This proves that there is scope for use of these ratios as inflammatory markers in T2DM.

Nicolau syndrome (embolia cutis medicamentosa) is an uncommon complication of intramuscular injection leading to necrosis of skin and underlying tissue to a variable extent. I am reporting one such case who developed this complication after intravenous injection of diclofenac sodium. The aim of reporting this case is to create awareness among our colleagues and staff to exercise precautions during parental injection administration.

Background: Cutaneous leiomyoma is a rare, benign smooth muscle neoplasm of the skin. According to the origin of the tumor, there are three types of cutaneous leiomyomas: piloleiomyoma, angioleiomyoma, and genital leiomyoma. We present an uncommon case of cutaneous leiomyoma which, due to clinical similarities, had been previously misdiagnosed and managed as keloid. Case description: A 26-year-old woman with Fitzpatrick skin type 4/5 visited the outpatient department of dermatology for the treatment of a painful skin lesion on the left shoulder. The symptoms were not improving from previous treatment modalities, where she was diagnosed as having a keloid. After examination we sent for a skin biopsy. The specimen was sent for histopathological and immunohistochemical investigations, which revealed cutaneous leiomyoma. Conclusion: Cutaneous leiomyoma may be misdiagnosed as a keloid. The former is of clinical relevance as they may denote hereditary leiomyomatosis and renal cell cancer. Early recognition is of paramount importance and may be life-saving.

Introduction: The prevalence of diabetic foot in diabetes mellitus (DM) patients has increased enormously. Diabetic foot disease (DFD) is one of the debilitating complications caused by DM and is the leading cause of non-traumatic lower limb amputation. The majority of diabetic patients are not properly educated about foot disease and foot care. In this study, we tried to assess the awareness about foot-related problems among patients with DM visiting tertiary healthcare centers. We also assessed the practice of foot care among patients with diabetes. Materials and methods: This cross-sectional study was carried out in patients with DM attending tertiary healthcare centers after Ethical committee approval. The study was conducted in outpatient departments of endocrinology at tertiary care hospitals, in Bengaluru, using a predefined questionnaire. The results were analyzed using appropriate statistical methods. Results: One hundred and twenty-three patients with DM were recruited and given the questionnaire. The mean age of patients was 52.57 ± 12.45 years and the mean duration of diabetes was 11.7 ± 8.63 years. There were 40 male patients (32.5%) and 83 female patients (67.5%). Ninety people were from the urban (73.17%) and the remaining 33 people were from the rural area (26.83%). Out of 123, only 102 patients (82.5%) were aware that diabetes causes foot problems. Though most of them (72.5%) knew that uncontrolled diabetes can cause wound/ulcer, and 33% were aware that uncontrolled diabetes can lead to gangrene. Only 15% of patients were aware that DFD can lead to lower limb amputation. Forty-six patients (37.5%) were aware that smoking increases the incidence of DFD and 58 (47.5%) know that previous foot disease can increase the risk of foot problems in the future. Forty-three patients (35%) were aware that the presence of foot problems increases the risk of heart disease in diabetic patients. Eighty-six subjects (70%) were aware that there is specially customized footwear available for diabetic patients. One hundred and ten subjects (89.4%) were aware that good glycemic control from the beginning helps prevent diabetes-related foot problems. Only 49 subjects (39.8%) were taking care of their feet, of which only 18 patients examined and took care of the feet daily. About 120 people in the study used footwear outdoor (97.5%) and only 23 people (18.6%) used footwear both outside and inside the house. Three people in the study did not use footwear even outside the house. Conclusion: It is vital to educate the patients about foot disease and foot care as a part of diabetes management. By improving awareness, we can decrease the occurrences of foot disease, improve the quality of life, and promote the overall health of a diabetic individual.