SummaryA young farmer presented with cardiogenic shock 5 days after a scorpion sting. He was managed with norepinephrine, atropine and supportive measures and made a complete recovery. The role of atropine in treating scorpion sting has to be defined better. BACKGROUND

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A 50-year-old Asian Indian female with known hypertension presented with persistent vomiting but no other symptoms of meningism. Clinical examination and basic laboratory parameters were entirely normal except for significant hyponatremia. Further investigation was suggestive of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Subsequently, despite steady correction of hyponatremia, the patient developed generalised seizures. Cerebrospinal fluid (CSF) analysis performed was inconclusive. Screening for a chronic meningitis underlying SIADH, yielded positive blood and CSF titres for venereal disease research laboratory (VDRL), which were confirmed by Treponema pallidum haemagglutination (TPHA). The patient was treated for neurosyphilis and made a complete recovery. Hyponatremia resolved and she had no further episodes of seizures. She was tested for HIV infection which was negative. On follow-up, she remained TPHA positive but VDRL titres became negative.

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Introduction: Studies have shown that foot deformities such as claw foot, hammer toes can occur due to paralysis of intrinsic muscles of the feet which in turn pose a high risk for foot ulcerations, gait disturbances and falls alongside decreased sensations of the foot. Current guidelines for the screening of diabetic foot involves testing for sensations of the foot by the Semmes Weinstein Monofilament (SWM) test but testing for intrinsic muscle weakness is not done routinely. Based on available literature, onset of structural changes of the foot occurs earlier than loss of sensations hence this study was undertaken to identify intrinsic muscle weakness of the feet using a simple, test called Paper Grip test (PGT) in diabetics with normal sensations of the feet. Methodology:  An analytical cross-sectional study was conducted in JSS Hospital from November 2018 to September 2020 involving diabetic patients visiting Medicine OPD and admitted patients meeting inclusion criteria of this study. Necessary ethical clearance from the institutional ethics committee of JSS medical college was obtained. Functional status of intrinsic muscles of the foot was tested by PGT and the sensations of the sole of the foot was assessed by SWM.