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Diabetes mellitus is a disease known for its multifaceted complications, and foot ulceration is one of the most devastating complications carrying significant socioeconomic impact. 1 It has been found that 40-70% of all nontraumatic amputations of the lower limbs occur in patients with diabetes. 2,3 Furthermore, many studies have reported that foot ulcers precede approximately 85% of all amputations performed in diabetic patients. 3 Lower extremity amputations are at least 10 times more common in people with diabetes than in nondiabetic individuals in developed countries. 4 Out of all nontraumatic lower limb amputations, 50% occur in diabetics, mostly as a result of foot ulcers. 1 The prevalence of foot ulcers ranges from 4% to 10% among persons diagnosed with diabetes mellitus; the condition is more frequent in older patients. 2,5 It is estimated that about 5% of all patients with diabetes present with a history of foot ulceration, while the lifetime risk of diabetic patients developing this complication is 15%. 6,7 Diabetics in India are more prone to develop neuropathic foot ulcers because of the prevalent habit of barefoot walking. A major biomechanical factor in 560788D STXXX10.

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Tuberculosis of the thyroid gland is a rare entity even in countries like India where tuberculosis is endemic. The patients may present with thyroid swelling, inflammation and very rarely thyroid dysfunction. Caseous necrosis and epithelioid cell granulomas on fine-needle aspiration cytology and histopathological examination are diagnostic. We present two cases of thyroid gland tuberculosis. One patient had subclinical thyrotoxicosis with presentation mimicking acute bacterial thyroiditis. The other patient had a solitary thyroid nodule with normal thyroid function. Involvement of other organs was absent in both cases. Proper diagnosis may avoid unnecessary surgical interventions.

Aim: To determine the efficacy of maximum and optimum dosages of hydroxychloroquine (400 and 200 mg once daily) treatment combined with insulin along with metformin and Glimepiride in Type 2 diabetes patients who are poorly controlled and relationship to be evaluate between high-sensitive C-reactive protein (Hs-CRP) and glycosylated haemoglobin (HbA1c) levels in such patients. Methods: In a multicentre,open-labelled comparative observational study, randomised 240 patients [mean age 56.44 years and mean body mass index (BMI) 33.20 kg/m 2 , mean glycosylated haemoglobin (HbA1C) 8.58% ; mean duration of diabetes 13.7 years] with type 2 diabetes who were poorly controlled with a high stable insulin dose (≥30 Units/day for ≥30 days),glimepiride (2mg/day) and metformin (1000 mg/day) were randomly allocated to either hydroxychloroquine 200 or 400 mg once daily for 6 months (24 weeks). Results: At completion of 6 months (24 weeks), statistically significant, dose-dependent mean decreases from baseline were seen in both the hydroxychloroquine 200 and 400 mg groups for HbA1C (-.8 and-1.3%, respectively) (p<0.0001), fasting plasma glucose (FPG) (-22.5 mg/dl and-33.2 mg/dl, respectively) (p<0.0001) and postprandial plasma glucose (PPG) (-34.6 mg/dl and-49.8 mg/dl, respectively) (p<0.0001). Insulin dosage also decreased significantly in both the groups (-3.6 and-9.8 IU/day, respectively; p ≤ 0.05) from baseline. Insulin dose has reduced in significant number of patients. In the present study of type 2 diabetes patients, we found that hs-CRP levels correlated with HbA1c levels. Conclusions: In type 2 diabetes patients who are poorly controlled, addition of hydroxychloroquine (HCQ) to insulin along with Glimepiride and Metformin significantly improved glycemic control in a dose-dependent manner and was generally well tolerated. In type 2 diabetes patients who are poorly controlled by oral antidiabetic or insulin or in combination, reduction in hs-CRP highly influence HbA1c reduction.