Glycemic control and its relationship to diabetic foot ulcers.

Glucosylhaemoglobin (HbA1) was estimated in 60 diabetic patients, 30 with foot ulceration and 30 without foot lesions. Peripheral neuropathy and vascular disease were commonly found in the ulcer' group. The mean HbA1 level in diabetics without ulcers was 9.77 +/- 2.34, while the corresponding level in diabetics with ulcers was 14.14 +/- 3.63. The difference in values is statistically highly significant (p less than 0.001) suggesting that foot ulcers are more likely to occur in poorly controlled diabetic patients.

Insulin oedema: an uncommon complication of insulin therapy.

A 45 year old markedly underweight man presented with polydipsia, polyuria and tingling sensation in both lower limbs of one month duration. Following insulin treatment, he developed gross fluid retention (peripheral oedema and puffiness of face) and a weight gain of 1.8 kg. The oedema occurred on the 3rd day after starting treatment and disappeared on the 7th day without the use of diuretics. Insulin oedema is an uncommon complication of insulin which may occur on introduction of insulin therapy or on increasing the dose, and may be due to the effect of insulin on vascular permeability and renal tubules.

Bacteriology of diabetic foot ulcers.

Seventy five diabetic foot ulcers were cultured using optimal aerobic and anaerobic microbiologic techniques. There were a total of 223 isolates (162 aerobes and 61 anaerobes) representing an average of 2.97 bacterial species per specimen. Mixed organisms were the most common isolates. Staphylococcus aureus was the commonest isolate being recovered in 60% of cases. Anaerobic organisms were isolated in 46 patients (61.33%) and the most frequent anaerobe isolated was Bacteroides fragilis. The other organisms predominantly isolated were Proteus, Klebsiella, Pseudomonas, Peptoccus and Clostridia. Antibiogram showed discouraging pattern with commonly used antibiotics. Metronidazole and gentamicin were the most effective antimicrobial agents against anaerobic and aerobic organisms respectively. Appreciation of the causative organisms in diabetic foot and their antibiotic sensitivity is essential for institution of appropriate antibiotic therapy.

Clinico-pathological profile of lymphomas in south India: a prospective rural referral hospital study of 103 cases.

A prospective clinical and histopathological study of 103 patients with lymphomas is reported. Of these, 72 (69.9%) had non-Hodgkin's lymphoma (NHL) and 31 (30.1%) had Hodgkin's lymphoma (HL). The median age at presentation was 34 and 43 years for Hodgkin's and non-Hodgkin's lymphoma respectively, which is lower than that seen in the West. Fever and superficial lymphadenopathy were the commonest presenting features and 'B' symptoms were present in over 60% of both groups. Seventy-five per cent of NHL and 64.5% of HL presented in stages III and IV of the disease.

Aetiology of diabetic foot ulceration.

A prospective study of 150 diabetic patients was undertaken with the aim of determining the factors associated with the development of foot ulcerations. Seventy five patients had foot ulceration and 75 had no foot lesions. Peripheral (78.7%) and autonomic (38.7%) neuropathy were more commonly found in the "ulcer" group, as were vascular insufficiency (49.3%) and hyperlipidaemia (60%). Renal failure (9.3%) and ketoacidosis (20%) were also commoner in patients with foot ulceration. Most, if not all, of the aetiological factors are related to prolonged uncontrolled hyperglycaemia.

HDL-cholesterol--a sensitive parameter of hepatic function in infective hepatitis.

HDL-cholesterol was estimated along with other biochemical parameters of hepatic function in infective hepatitis. Infective hepatitis was characterized by significantly decreased levels of HDL-cholesterol. Follow up studies indicated a good correlation of changes in HDL-cholesterol to severity of disease in all the cases whereas standard liver function tests showed equivocal changes in some cases. HDL-cholesterol may serve as a sensitive indicator of hepatic function in infective hepatitis.