Objectives. The primary objective is to determine if 3 times a week SMS will improve adherence to diet and exercise. The secondary objective is to determine the mean change in body weight, body mass index and glycosylated hemoglobin A1c (HbA1c).Methodology. This is an open-randomized controlled trial conducted for 6 months which included 104 subjects. Z test of two proportions was used to determine difference in dietary and exercise adherence. Mean change in body weight, BMI and HbA1c were also determined.Results. After 3 months, significant difference is observed in mean HbA1c (SMS= 7.13 + 0.99, control= 7.53 + 0.91, p=0.034). At 6 months, significant difference is seen in mean number of meals/day (SMS=2.61 + 0.63, control= 2.29 + 0.72, p= 0.018), mean number of minutes/exercise (SMS= 37.40 + 14.87, control=31.44 + 10.82, p= 0.021) and mean HbA1c (SMS=6.99 + 0.86, control= 7.34 + 0.90, p= 0.0452).Conclusion. The use of SMS as an adjunct to the standard of DM care improved adherence to diet after 6 months in terms of mean number of meals, improved adherence to exercise after 6 months in terms of mean number of minutes/exercise and significant reduction in HbA1c levels after 3 and 6 months.

The traditional binary classification of gender is repeatedly challenged throughout history with the presence of transgenders. Under the umbrella of transgenderism is transsexualism which pertains to individuals who identify with or desire to become the opposite sex. Transsexualism or Gender Dysphoria is classified as a medical condition under ICD 10 and DSM-5. The proposed treatment is sex reassignment that includes all treatments carried out to adapt to the desired sex. Sex reassignment involves a multidisciplinary approach wherein the psychiatrist or mental health practitioner, endocrinologist and surgeon play active roles. Certain legal and ethical issues exist in the treatment of transsexualism. This article provides a review of psychological, medical and surgical issues in the evaluation and treatment of Transgender individuals, with an Asian perspective, and in the context of an actual case.

SUMMARYA 30-year-old Filipino man presented with a 11-year history of coarse facial features and progressive enlargement of hands and feet. Initial work-up revealed elevated insulin-like growth factor-1 and nonsuppressible growth hormone level after 75 g glucose challenge test. Initial cranial MRI performed in the year 2010 showed absence of pituitary adenoma. The patient was lost to follow-up. He again consulted in the year 2011 and a repeat cranial MRI and a dedicated pituitary MRI were performed and both did not reveal any pituitary mass. Further investigation included chest and abdominal CT scan, both of which did not show any neoplasm. At present, there has been no practice guideline on the management of acromegalic patients on whom the identifiable source cannot be found. The patient was given the option to undergo surgical exploration of the pituitary gland or medical treatment with somatostatin analogues. He decided to undergo surgery but has not given consent for the procedure.