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.

Thyrotoxicosis: A paradox.

Incidence of thyroid dysfunctions including hypo- or hyperthyroidism is significantly increased. Hyperthyroidism is common in males, and hypothyroidism is often seen in females. Here, we report two female patients suffering from hyperthyroidism, but their signs and symptoms are totally opposite to each other.

Role of vaccination in COVID-19.

Immune response after first and second dose of covishield vaccination is studied. Both doses stimulate the immune response. We report here that there is rise in herd immunity.

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.

Post immunization COVID-19 disease.

One hundred and two patients reported to peripheral hospital, of these 73 (77%) and 23 (95%) suffered from COVID-19 disease, were immunized as per availability of Covishield 78 (77%) and Covaxin 24 (23%), respectively. Of these, three died (3%). Inflammatory markers were raised in Covishield vs.

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.

'Gym Tonic' and Quadriparesis.

We report a case of acute onset quadriparesis which occurred after consumption of some drugs which were illicitly prescribed to our young patient by his gym instructor. The deadly concoction of so-called gym-tonic (Cyproheptadine and dexamethasone) led to hypokalaemic paralysis in our patient.

Diagnosis of envenomation by Russell's and Echis carinatus viper: A clinical study at rural Maharashtra state of India.

Background: Envenoming by vipers and are common accidents faced by farmers and labors. Both viper venom toxins alter coagulation mechanism in the victim. The dose of snake antivenin to neutralize the venom is empirical and varies.

Preintensive care: Thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital.

Background: Coronary artery disease is a major cause of death in India. Sudden death preceded by chest pain is due to acute myocardial infarction. Villagers are aware and afraid of chest pain.

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.

Diagonal ear lobe crease: A premonitory diagnostic sign of impeding ischemic heart disease.

Introduction: In India, significant number of individuals suffers from ischemic heart disease (IHD). Majority of chest pain victim initially report to his family physician. At times, sudden death is the first and last manifestation of IHD.