Dermatological Conundrum: Puzzling Pigmentation in Vitamin B Deficiency and Addison's Disease.

We report a case series of two patients who had similar skin pigmentation but were caused by vitamin B12 deficiency and Addison's disease. We further discuss the pathophysiology of skin hyperpigmentation in both of these disorders and the response to treatment. Our case report highlights the importance of the identification of simple bedside clinical signs to diagnose reversible causes of skin pigmentation.

Imparting knowledge is no more considered a paramount contribution.

I have been practising medicine in an under-served rural setting since 1976, and have published around 109 papers in PubMed-indexed journals - including The Lancet, BMJ, NEJM and several tropical medicine journals - on scorpion and snakebite cases causing acute life-threatening conditions. I have researched in detail, with restricted resources, the acute clinical effects of envenomation and management of scorpion and snakebite cases [1, 2]. In Mahad, the fatality rate due to refractory heart failure arising from autonomic storm evoked by scorpion venom was previously 30% [3].

Newer onset of diabetes mellitus and thyroid dysfunction in COVID-19: Study from rural India.

Background: Cytokine and bardykine storm plays important role in then pathogenesis of COVID-19 diseses, as result there are raised inflammatory markers and blood sugar.

Patients And Method: Patient with RTPCR positive with signs and symptoms of COVID-19 were investigated for fasting and postprandial blood sugar and glycoted hemoglobin percentage, inflammatory markers TSH and Covid antibodies.

Result: All the 17 cases detected newly onset of diabetes with normal HBA1c and raised thyroid stimulating hormones in five cases.

Stung to the Heart.

A 48-year-old woman with a history of scorpion sting was admitted with cardiogenic shock. Electrocardiogram showed ventricular tachycardia which reverted with magnesium sulphate after failed attempts with electrical cardioversion. Postcardioversion electrocardiogram showed Brugada pattern.

From quarantine room: Physician perspective.

This write-up is a brief reflection of a rural doctor couple, Dr. Himmatrao Saluba Bawaskar (HSB) and Dr. Pramodini Himmatrao Bawaskar (PHB), working in the remote area of Maharashtra state of India during COVID-19 pandemic.

Blood lead level among fuel station workers, Ganesh idol painters, persons with routine daily application lead containing black pigment to eyes and Garage workers.

Background And Aims: The aim of this study is to determine the lead level in blood, workers expose to lead.

Methods: 42 subjects blood was analyzes for Lead. 21,14,2,5 persons are from fuel station workers, idol painters, application of lead containing pigment to eyes and garage workers respectively.

Response to "Casteism in a medical college: A reminiscence".

I was a student of the Government Medical College (GMC), Nagpur, from 1970 to1975. Based on my own experiences, I agree completely with Anurag Bhargava's comments regarding casteism at GMC Nagpur (1). Caste stigma gets attached to you early in life and stays with you till you reach the grave.

Can doctors advise beyond the purely professional?

A 25-year-old woman, six-months pregnant, came to me in great distress. She said she had been happily married for five years. Unexpectedly, a minor accidental injury to her husband had revealed that he had been suffering from a brain tumour since 2012.

Authors' response to commentaries on "Emergency care in rural settings".

We are grateful to Kattula and Jain, Patil and Phutke for their comments on our article on rural emergency medical care and our real problems in rural practice, their management and the threat to our survival. We agree with most of their points and the solutions they have advocated.