We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection.In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 +/- 6.53 and 9.83 +/- 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 +/- 11.26 and 15.20 +/- 10.21V (P < 0.02), ankle brachial ratio was 1.05 +/- 0.19 and 1.14 +/- 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively.In the diabetic and the control group, VPT was 15.62 +/- 10.39 and 8.36 +/- 3.61 V (P < 0.01), ankle brachial ratio was 1.14 +/- 0.18 and 1.15 +/- 0.12, and the questionnaire scores were 57% and 40.3%, respectively.In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes.

To determine the lipid abnormalities in Type2 diabetes mellitus, a study was conducted in two parts. Part I included assessment of serum cholesterol and triglycerides in 100 non diabetic control subjects and 81 newly diagnosed diabetes. 55 patients of the latter group were followed up for one year, with quarterly lipid determination. Part II of the study included 168 diabetics who were already on therapy for a duration exceeding six months. In all subjects, a mean value of lipids was determined from two samples taken a fortnight apart. Serum cholesterol and triglyceride values were compared between controls, newly diagnosed diabetics at the time of enlistment and during their follow up. The lipid values were also linked to glycemic control, body weight, type of therapy and duration of therapy. In Part II of the study, similar comparison of the lipid values was made with caloric intake, body weight, glycemic control, body weight, type of therapy and duration of therapy. We found significantly raised triglyceride and cholesterol levels in diabetics as compared to controls. Patients already on therapy for diabetes (Group II) had significantly higher plasma triglyceride levels as compared to newly diagnosed diabetics (Group 1). Poor metabolic control and diet more than 2000 kilocalories was linked to significantly higher cholesterol levels. The mode of therapy (diet, chlorpropamide, or insulin) was not linked to either raised triglycerides or cholesterol. However, abnormal lipid patterns tended to normalise with therapy of diabetes.

A short course on Diabetology, attended by 83 doctors was evaluated. The doctors were divided into three groups. (Group I--basic qualification MBBS, Group II--MD in medicine or allied subject, Group III--Diploma in Diabetes Mellitus). The mean age group of all three groups were comparable. Pre-course evaluation of their knowledge of diabetes showed the best performance in Group III and poorest in Group I. Post-course evaluation showed significant improvement only in Group I and II. Maximal improvement in performance was seen in Group II. Mean time since passing the last professional examination was 14.8, 12.6 and 1.0 year respectively. The performance was not linked to time since passing the last examination. 14.5% of doctors were from a rural or semiurban setting. The precourse performance of rural doctors in the MD group was significantly poorer, but their post course performance was as good as the others. All doctors from rural or semiurban areas improved their performance postcourse, compared to 84% in the urban group. 74% of doctors had not attended any post graduate course after their basic degree. Their performance did not differ significantly from those who had attended such courses. 44.6% were Consultants, 26.6% were general practitioners, 12.0% were attached to institutions, 10.8% were in government service or armed forces and 6% were attached to teaching hospitals. The performance of the doctors was not linked to the type of practice. The doctors attending the course felt that the audiovisual presentation needed improvement.

Binding of human chorionic gonadotropin (hCG) to the specific, high affinity Leydig cell hCG receptor initiates testosterone (T) synthesis and secretion (Tsuruhara, Dufau, Cigorraga and Catt 1977). This stimulation response has been widely used to evaluate Leydig cell function in hypogonadal subjects. Protocols for T response to hCG have been proposed, using either intravenous (Maurer, Volkweim and Tamm 1973) or intramuscular {Anderson Marshall, Yang and Fraser 1972; Krischner, Lipsett and Collins 1965; Winter, Tarasaka and Fairman 1972; Smals, Gerlag, Pieters and Drayer 1979) route for administration of hCG. However, no general agreement exists on the optimum dose of hCG for stimulation, the timings of injections or whether single or multiple injections should be used {Anderson et al. 1972; Smals, Pieters, Boers, Raemakers, Hermus, Benraad and Kloppenberg 1984). This has been attributed to hCG induced receptor desensitization (Tsuruhara et al. 1977; Saez and Forest 1979) and estradiol-17B mediated block at 17-20 desmolase and 17a hydroxylase steps of T biosynthesis (Saez and Forest 1979; Smals et al. 1979; Smals et al. 1984). These data prompted us to compare the effects of single (SI) and multiple injections (MI) of hCG on plasma T, DHT and E2-17B in eugonadal men and patients with male gonadal dysfunction, each subject being tested by both modalities with minimal gap of three weeks between each test.

A case of pituitary acromegaly with multiple nonendocrine neoplasia is reported. The tumorogenic potential of growth hormone, prolactin and other growth factors is discussed.