Chronic ethanol-induced liver injury causes insulin resistance with inhibition of insulin-responsive genes needed for metabolism, remodeling, and regeneration. In contrast, the IGF-I and IGF-II signaling mechanisms remain relatively preserved, suggesting that insulin-regulated hepatic functions may be selectively vulnerable to the toxic effects of ethanol.

CytoSorb® (CytoSorbents Corporation, USA) is a novel sorbent hemoadsorption device for cytokine removal. The aim of this study was to examine the clinical use of CytoSorb® in the management of patient with septic shock. We used this device as an adjuvant to stabilize a young patient with multi-organ failure and severe sepsis with septic shock. A 36-year-old female patient was hospitalized with the complaints of malaise, general body ache, and breathing difficulty and had a medical history of diabetes mellitus type II, hypertension, obstructive sleep apnea, hypothyroidism and morbid obesity. She was diagnosed to have septic shock with multi-organ dysfunction (MODS) and a low perfusion state. CytoSorb® hemoadsorption column was used as an attempt at blood purification. Acute physiology and chronic health evaluation score, MODS score, and sequential organ failure assessment score were measured before and after the device application. CytoSorb application as an adjuvant therapy could be considered in septic shock.

Vascular leiomyomas of the foot are relatively rare benign soft tissue tumours which arise from the tunica media and present as painful or painless solitary subcutaneous nodules. We are reporting a rare case of vascular leiomyoma with a dystrophic calcification and a myxoid change.

There continues to be a need for improved medical management of diabetes patients with hypertension in primary care. While several care models have shown effectiveness in achieving various outcomes among these patients, it remains unclear what care model is most effective in improving blood pressure control in primary care. In this prospective study, 54 patients with type 2 diabetes mellitus and blood pressure of >140/90 identified through the registry, were randomized into three groups. Group A attended a nurse educator-conducted class on diabetes and hypertension, group B attended the same class and was asked to monitor their home blood pressure using provided device, and group C served as control (usual care). Of the 24 subjects who completed the study, only 20% achieved the target blood pressure of <130/80 and there was no statistical difference in mean systolic and diastolic blood pressures among the three groups (p > 0.05). Efforts to intensify management of hypertension among type 2 diabetes patients did not result in better blood pressure control compared to usual care. Studies looking into factors which limit patients’ participation in group classes and determining patients’ preferences in disease management would be helpful in ensuring success of any chronic disease management program.

ABSTRACT:We are presenting a case which reveals unmasking of Brugada pattern with aluminum phosphide (celphos) ingestion that could most probably be due to hypomagnesaemia caused by the chemical, though its direct toxic effect on cardiac tissue cannot be ruled out. Earlier low levels of magnesium has been shown to precipitate arrhythmias in susceptible individuals and low magnesium levels have been recorded in survivors of sudden death with underlying Brugada syndrome, this is the first case in which celphos induced hypomagnesaemia has unmasked the Brugada pattern in ECG that can increase susceptibility to life threatening arrhythmias. This case opens scope for further research on role of magnesium in celphos poisoning. KEY WORDS: Brugada Pattern, celphos, hypomagesaemia, cardiac tissue, arrhythmias. A CASE REPORT:A 20 years old male presented in the emergency department one hour after ingestion of two tablets of Celphos. He vomited 5 times before admission and was brought in a state of shock and altered sensorium. He did not complain of chest pain, palpitation or breathlessness. His pulse was 145/min, irregularly irregular with pulse deficit of 15 and poor volume. Systolic blood pressure was 80 mmHg and respiratory rate was18/min. His systemic examination did not reveal any positive finding except drowsiness. His routine blood investigations were within normal limits except serum magnesium level of 1.0 mmol/lt and serum potassium of 2.2 mEq/lt. ECG showed typical (type-I phenotype) of Brugada Syndrome with atrial fibrillation (AF) with heart rate of ~145/min. (Fig-1). Gastric lavage was done and patient was given I/V fluids with ionotropic support, I/V magnesium & potassium supplements and hydrocortisone. Patient's condition stabilized with treatment and next day serum electrolytes normalized except serum magnesium which still measured 1.2 mmol/lt & ECG showed persistence of the same pattern. ECHO showed normal cardiac functions. On day 4, serum magnesium level was 2.0 mmol/lt and ECG showed type III Brugada pattern (decreased ST elevation) with regular heart rate of 107/min (Fig--2). ECGs of his mother and brother were normal, however, the provocative tests and genetic testing were declined. Patient had to be discharged on persistent requests.