Presuming that she can be diabetic as in history every existing disease and update mentioned but nothing posted about glysemic index so first check glysemic index. In view of her medical history her immune system is compromised. I am of the opinoin that this episod can not be related to Covid 19. Chronic ulcers or non-healing ulcers are defined as spontaneous or traumatic lesions, typically in lower extremities that are unresponsive to initial therapy or that persist despite appropriate care and do not proceed towards healing in a defined time period with an underlying etiology that may be related to systemic involvement. I have read about treatment of chronic non-healing ulcers using autologous platelet rich plasma.. Consult vascular surgeion.
Her leg ulcer is not related to any COVID disease. As there is history of uterine malignancy, gait instability , hypertension with chronic diastolic congestive heart failure- this leg ulcer is not healing because of her lowered immunity , associated peripheral vascular disease and decreased blood supply to limb . Get a colour doppler study of lower limb vessels done .to assess vascular flow to lower limb . Treatment- Elevation of limb at night Tab cilostazol 100 mg B.D to improve vascular flow. A little debridement. Topical dressings with mupirocin ointment after cleaning with betadine
Non healing Ulcer ( due to diabetes, immunocompromised , Vasculopathy ) not related to COVID 19. Needs further investigation and evaluation to conclude and treatment plan. Reassurance and counciling required. Multivitamin and antioxidant orally. ASD with betadine lotion apply sofra tullu gauge cover. Analgesic and antibiotics orally. Multivitamin and antioxidant orally. Keep legs raised . Wait for final confirmation after investigation.
A CASE OF LEG ULCER WITH PAST HISTORY OF HTN,CHF, HISTORY OF UTERINE CANCER LEADING TO IMMUNOCOMPROMISED PATIENT .THE TREATMENT IS BROAD SPECTRUM ANTIBIOTIC ANALGESIC , HYDROGEN PEROXIDE , MUPIROCIN OINT DRESSING WITH ZELONET AND ADVICE RBS,PPBS , DOPLAR STUDY OF THE LIMB.
IT'S A..CASE OF.. ? VASCULOPATHIC ULCER.. ? STASIS ULCER.. NEED'S TO WORK OUT AS PER PROTOCOLS AND NECESSARY INVESTIGATIONS.. WITH SURGEONS OPINION FOR WOUND MANAGEMENT.. WITH SURGEONS OPINION..
Appears to be nonhealing stasis uicer Treatment Amoxicillin500mg tds Hydrogen peroxide cleaning Mupirocin ointment dressing Blood sugar examination
SUGGESTIVE OF CHRONIC NON. HEALING ULCER NEEDS. FURTHER. EVALUATION ADVISABLE STANDARD PROTOCOL
It is nonhealing stasis ulcers Needs to avoid standing Normal saline dressings Sos ssg
Non healing ulcer do DM covid19 xray debriment of wound daily dressing with megaheal aug 625 bd vitc ultra cet r/0 varicose ulcer
non healing ulcer d/d varicose veins ulcer debridement antibiotic anti inflammatory drug do color Doppler
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Friends today I am discussing about Nail Abnormalities. What are nail abnormalities? Healthy nails appear smooth and have consistent coloring. As you age, you may develop vertical ridges, or your nails may be a bit more brittle. This is harmless. Spots due to injury should grow out with the nail. Abnormalities — such as spots, discoloration, and nail separation — can result from injuries to the fingers and hands, viral warts (periungual warts), infections (onychomycosis), and some medications, such as those used for chemotherapy. Certain medical conditions can also change the appearance of your fingernails. However, these changes can be difficult to interpret. Your fingernails’ appearance alone isn’t enough to diagnose a specific illness. A doctor will use this information, along with your other symptoms and a physical exam, to make a diagnosis. Abnormalities of the fingernail Some changes in your nails are due to medical conditions that need attention. See your doctor if you have any of these symptoms: discoloration (dark streaks, white streaks, or changes in nail color) changes in nail shape (curling or clubbing) changes in nail thickness (thickening or thinning) nails that become brittle nails that are pitted bleeding around nails swelling or redness around nails pain around nails a nail separating from the skin These nail changes can be caused by a variety of different conditions, including ones we describe below. Beau’s lines Depressions that run across your fingernail are called Beau’s lines. These can be a sign of malnourishment. Other conditions that cause Beau’s lines are: diseases that cause a high fever such as measles, mumps, and scarlet fever peripheral vascular disease pneumonia uncontrolled diabetes zinc deficiency Clubbing Clubbing is when your nails thicken and curve around your fingertips, a process that generally takes years. This can be the result of low oxygen in the blood and is associated with: cardiovascular diseases inflammatory bowel disease liver diseases pulmonary diseases AIDS Koilonychia (spooning) Koilonychia is when your fingernails have raised ridges and scoop outward, like spoons. It’s also called “spooning.” Sometimes the nail is curved enough to hold a drop of liquid. Spooning can be a sign that you have: iron deficiency anemia heart disease hemochromatosis, a liver disorder that causes too much iron to be absorbed from food lupus erythematosus, an autoimmune disorder that causes inflammation hypothyroidism Raynaud’s disease, a condition that limits your blood circulation Leukonychia (white spots) Nonuniform white spots or lines on the nail are called leukonychia. They’re usually the result of a minor trauma and are harmless in healthy individuals. Sometimes leukonychia is associated with poor health or nutritional deficiencies. Factors can include infectious, metabolic, or systemic diseases as well as certain drugs. Mees’ lines Mees’ lines are transverse white lines. This can be a sign of arsenic poisoning. If you have this symptom, your doctor will take hair or tissue samples to check for arsenic in your body. Onycholysis When the nail plate separates from the nail bed, it causes a white discoloration. This is called onycholysis. This can be due to infection, trauma, or products used on the nails. Other causes for onycholysis include: psoriasis thyroid disease Pitting Pitting refers to small depressions, or little pits, in the nail. It’s common in people who have psoriasis, a skin condition that causes the skin to be dry, red, and irritated. Some systemic diseases can also cause pitting. Terry’s nails When the tip of each nail has a dark band, it’s called Terry’s nails. This is often due to aging, but it can also be caused by: congestive heart failure diabetes liver disease Yellow nail syndrome Yellow nail syndrome is when the nails get thicker and don’t grow as fast as normal. Sometimes the nail lacks a cuticle and may even pull away from the nail bed. This can be the result of: internal malignancies lymphedema, swelling of the hands pleural effusions, fluid buildup between the lungs and chest cavity respiratory illnesses such as chronic bronchitis or sinusitis rheumatoid arthritis These are just some of the signs of abnormal fingernails. Having any of these signs isn’t proof of any medical condition. You’ll need to visit your doctor to determine if your condition is serious. In many cases, proper care of your nails is enough to correct their appearance. How to care for your nails You can prevent many nail abnormalities by taking good care of your nails. Follow these general guidelines to keep your nails healthy: Tips Don’t bite or tear at your nails, or pull on hangnails. Always use nails clippers and trim them after you bathe, when nails are still soft. Keep your nails dry and clean. Using sharp manicure scissors, trim your nails straight across, rounding the tips gently. If you have a problem with brittle or weak nails, keep them short to avoid breakage. Use lotion on your nails and cuticles to keep the nail and nail beds moisturized. Homoeopathic medicines for nail abnormalities Medicines according to Cause1 Cause Medicines From a hurt Ledum pal. Prick with a needle under the nail Allium cepa, Bovista, Sulphur; Hard work Rhus tox, Sepia; Prick near the nail Iodum; Splinters Baryta carb., Hepar sulph., Iodum, Lachesis, Nitricum acidum, Petroleum, Silicea, Sulphur; Splits of the skin adhering to the nails Allium cepa, Natrum mur. TABLE 2 Medicines according to the Sensation Sensations Medicines Irritable feeling under finger nails, relieved by biting them Ammonium brom. Itching-about roof of Upas tiente Pains-Burning under Sarsarparilla Pains, gnawing, beneath finger nails Alumina; Sarsaparilla.; Sepia Pains, neuralgic, beneath finger nails Berberis vulgaris Pains, neuralgic Alumina; Allium cepa; Colchicum Pains, smarting at roots Sulphur Pains, splinter-like, beneath toe nails Fluoric acidum Pains, ulcerative, beneath toe nails Antimonium crudum; Graphites; Teucrium Medicines according to Location1 Fig. Medicines according to location pastedGraphic.png TABLE 3 Medicines according to Pathology Pathology Medicines Atrophy Silicea Blueness Digitalis; Oxalicum Acidum Deformed-brittle, thickened (onchogryposis) Alumina; Anatherium; Antimonium crudum; Arsenicum album; Causticum; Dioscorea; Fluoricum acidum; Graphites; Merc. Sol.; Natrum muriaticum; Sabadilla; Secal cor..; Senecio aureus; Sepia; Silicea; Thuja.; X-ray. Falling off Brassica napus; Butyric acid; Helleborus faetidus; Helleborus Hangnails Lycopodium; Natrum muriaticum; Sulphur; Upas tiente Hypertrophy (onychauxis) Graphites Inflammation of pulp (onychia) Arnica; Calendula; Fluoricum acidum.; Graphites; Phosphorus; Psorinum; Sarsaparilla; Silicea; Upas tiente Inflammation, under toe nails Sabadilla Ingrowing toe nails Causticum; Magnetis polus austral.; Nitricum acidum; Silicea; Staphysagria; Teucrium; Tetrodymite Softening Plumbum met; Thuja Spots, white on Alumina; Nitricum acidum Trophic changes Radium brom Ulceration Alumina; Garphites; Merc. Sol.; Phosphorus; Sanguinaria; Sarsaparilla; Silicea; Teucrium; Tetrodymite Yellow color Conium maculatumDr. Rajesh Gupta5 Likes7 Answers
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this pt is 55 years old and he is chronic smoker .the pt is having this kind of legions since 2 years having pain in the leg and no other comorbidies kindly give the diagnosis and management of this ? thank u in advanceDr. Mohd Zishaan6 Likes17 Answers
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A 62 year diabetic male teacher by profession has developed pitting swelling on upper and inner side of left foot in the evening for 2 months. In each morning swelling subsided. About 2 weeks back, an ulcer formed on inner side left foot at the base of great toe, which is speading. Inspite of daily dressing, the ulcer is not getting healed. In adition, wound & other toes getting black. Patient is on oral hypoglycemic drugs. Blood sugar level is not under control, its fluctuating between 50 to 340. Friends, please provide your valueable advice.Dr. L.r. Ahirwar2 Likes30 Answers
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Hyperthyroidism Hyperthyroidism (overactive thyroid) is a condition in which the thyroid gland produces the high level of the hormone thyroxine. In other words, it can be called as overreactive thyroid. The thyroid gland is an organ located in the front of your neck and releases hormones that control your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. When the thyroid gland is overactive (hyperthyroidism) the body’s processes speed up and you may experience nervousness, anxiety, rapid heartbeat, hand tremor, excessive sweating, weight loss, and sleep problems, among other symptoms. Pathophysiology In hyperthyroidism, serum T3 usually increases more than does T4, probably because of increased secretion of T3 as well as the conversion of T4 to T3 in peripheral tissues. In some patients, only T3 is elevated (T3 toxicosis). T3 toxicosis may occur in any of the usual disorders that cause hyperthyroidism, including Graves’ disease, multinodular goitre, and the autonomously functioning solitary thyroid nodule. If T3 toxicosis is untreated, the patient usually also develops laboratory abnormalities typical of hyperthyroidism (ie, elevated T4 and 123I uptake). The various forms of thyroiditis commonly have a hyperthyroid phase followed by a hypothyroid phase. Causes A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Other causes of hyperthyroidism include: Excess iodine, a key ingredient in T4 and T3 Thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland Tumours of the ovaries or testes Benign tumours of the thyroid or pituitary gland Large amounts of tetraiodothyronine taken through dietary supplements or medication Risk factors Have a family history of thyroid disease Have other health problems, including Pernicious anaemia, a condition caused by a vitamin B12 deficiency Type 1 diabetes Primary adrenal insufficiency, a hormonal disorder Eating large amounts of food containing iodine, such as kelp, or use medicines that contain iodine, such as amiodarone, a heart medicine Older than age 60, especially if you are a woman Pregnant within the past 6 months Clinical manifestations The symptoms of hyperthyroidism include the following: An enlarged thyroid gland (goitre), which may appear as a swelling at the base of your neck Fatigue or muscle weakness Light periods or skipping periods. Weight loss Hand tremors Mood swings Rapid heartbeat Nervousness or anxiety Trouble sleeping Protruded eyeballs Skin dryness fine, brittle hair Heart palpitations or irregular heartbeat Increased frequency of bowel movements Breast development in men Complications Heart problems include atrial fibrillation and congestive heart failure An irregular heartbeat that can lead to blood clots, stroke, Brittle bones like osteoporosis Graves’s ophthalmology may exhibit eye problems including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Red, swollen skin. Thyrotoxic crisis. Diagnosis and Test Thyroid function blood test Thyroid function test is performed using a sample of blood obtained from the patient with hyperthyroidism. It is used to check the levels of: Thyroid-stimulating hormone (TSH) – a hormone produced by the pituitary gland (a gland at the base of the brain) that controls the production of thyroid hormones Triiodothyronine (T3) – one of the main thyroid hormones Thyroxine (T4) – another of the main thyroid hormones Your levels will be compared to what’s normal for a healthy person. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid. Radioactive Iodine Uptake Test To detect the way thyroid gland takes in and absorbs the orally given iodine dose and uses it to produce thyroid hormones. Conclusions are drawn based on the results obtained in this test. Thyroid scan A dye-injection or oral iodine dose test that enables visualization of the thyroid gland, which is seen on a computer. It helps to detect whether a region of the thyroid gland or the entire gland is affected. Ultrasound Scan – To detect the enlargement of the thyroid gland and surrounding structures. CT or MRI Scan – Scanning specified region if a tumour is suspected. Treatment and Medications No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, other medical conditions that may be affecting your health, and your own preference. Antithyroid Drugs: Drugs known as antithyroid agents-methimazole (Tapazole®) or in rare instances propylthiouracil (PTU)-may be prescribed to treat the hyperthyroidism by blocking the thyroid glands to secrete thyroid hormones. Methimazole is preferred due to less severe side-effects. These drugs work well to control the overactive thyroid, and do not cause permanent damage to the thyroid gland. Radioactive Iodine: Another way to treat hyperthyroidism is to damage or destroy the thyroid cells that make thyroid hormone. Because these cells need iodine to make thyroid hormone, they will take up any form of iodine in your bloodstream, whether it is radioactive or not. The radioactive iodine used in this treatment is administered by mouth, usually in a small capsule that is taken just once. Once swallowed, the radioactive iodine gets into the bloodstream and rapidly it is taken up by the overactive thyroid cells. The radioactive iodine that is not taken up by the thyroid cells disappears from the body within days over a period of several weeks to several months (during which time drug treatment may be used to control hyperthyroid symptoms), radioactive iodine destroys the cells that have taken it up. The result is that the thyroid or thyroid nodules shrink in size, and the level of thyroid hormone in the blood returns to normal. Thyroid surgery: Hyperthyroidism can be permanently cured by surgical removal of all or most of the thyroid gland. This procedure is best performed by a surgeon who has experience in thyroid surgery. An operation could be risky unless the hyperthyroidism is first controlled by an anti-thyroid drug or a beta-blocking drug, usually for few days before surgery, a surgeon may prescribe to take drops of nonradioactive iodine-either Lugol’s iodine or supersaturated potassium iodide (SSKI). This extra iodine reduces the blood supply to the thyroid gland and thus makes the surgery easier and safer. Beta-Blockers: Beta blockers do not stop thyroid hormone production but can reduce symptoms until other treatments take effect. Beta blockers act quickly to relieve many of the symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers. Propranolol (Inderal®) was the first of these drugs to be developed. Some physicians now prefer related, but longer-acting beta-blocking drugs such as atenolol (Tenormin®), metoprolol (Lopressor®), nadolol (Corgard®), and Inderal-LA® because of their more convenient once- or twice-a-day dosage. Prevention and Cure Patients being treated for hyperthyroidism need to follow-up with the physician for regular monitoring. For weight loss, fatigue and other complaints a proper nutritional plan is essential. To prevent further weakness, bone thinning and to maintain good health, it is necessary to follow a proper diet plan and healthy routine as advised by the physician. Taking calcium and vitamin D supplements may be considered with medical advice. Regular exercise can help to improve bone and heart health. For those suffering from eye disturbances or Grave’s ophthalmology, special care of the eyes can help. Some measures include wearing sunglasses, applying cool eye compresses, using lubricating eye drops and raising the head while sleeping to relieve pressure on the eyes.Dr. Shailendra Kawtikwar10 Likes20 Answers
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A 63 years old male patient, suffered from injury on back which was ignored by family for 20 days. At present pt.is admitted in hospital since 15 days. Pt.is unable to recognise family members at present. Please suggest treatment for wound healing.Dr. Pushpa Sharma6 Likes28 Answers