Concluded Case

55 yrs man with uncontrolled diabetes has asymptomatic , h/o rat bite of left great toe 6 yrs back, peripheral neuritis, tingling numbness+. dx

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LLeprosy with uncontrolled diabetes. both to be treated simultaneously. MDT & Insulin+ OHA. BI pre & post tt.

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Reason may have been rat bite ie 6yrs back but wound least cared hence to days presentation. It is diabetic foot with neuropathic ulcer gr toe all nails are showing onicomycosis Rt gr toe nail has been partially choped off and nail bed tissue shows blackening ie gangrenous changes Hence meticulous management required Rx control and monitor the diabetes regularly Debridement of ulcer toe with saline dressings and infiltration of insulin Manicuring of nails Coverage of broadspectrum antibiotics like lenazolinid600mg 1bd and Cefuroxime500mg bd and oral antifungals tab flucanazole or itracanazole200mg This will go a long way journey yo recovery

Thanx dr Shital Jadhav
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Uncontrolled DM, Onychomycosis, NHU left great toe with severe sensory loss & deformity (claw toes) Control of DM with insulin Send pus for c/s Emperically Pip-Taz 4.5g TID to be started & systemic as well as local Antifungal agents should be given Thoroughly debride the wound and remove the infected nail Daily dressing of wound with NS irrigation and Mupirocin Oint

Poor hygiene Since how long she have this wound? Since 6years? Since the rat bit or recently?? CONTROL SUGAR Pregabalin with methylcobalamine Corticosteroid local Antifungal local Here it's necessary to give oral corticosteroid but avoidable due to hyperglycemia For gangrene seek surgeon opinion Broad spectrum ANTIBIOTIC needed Massive Onycomycosis with bacterial infection Rule out Hansen's

Control DM with medicine,diet control and exercise. Inj ceftum 500 mg bd iv slowly. PCM ibu TDS Multivitamins and antioxidants orally. Clean area with diluted betadine lotion apply mupirocin oint locally. Keep area clean and covered with sofra tullu gauge. Improve general health and personal hygiene . regular monitoring and periodical evaluation required.

Thanks Dr Shital Jadhav
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Diabetic foot, both vascular and neural components. Infection of soft tissue seen with gangrenous areas. Under Lying OSTEOMYELITIS to be looked for. Hammer toe changes seen in other toes.

CONTROL SUGAR WITH OR WITHOUT INSULIN DNT USE SGLT2 INHIBITORS AND DIET control ASD ON REGULAR BASIS WITH SUMEG DOPPLER STUDY BOTH LEGS XRAY OF GREAT TOE TO CHECK FOR OSTEOMYELITIS DALACIN 600 MG TDS STATIN AND ACE INHIBITORS

LLeprosy with uncontrolled diabetes. both to be treated simultaneously. MDT & Insulin+ OHA. BI pre & post tt.

Rat bites are very common in India. Treat this ulcer as a Neuropathic ulcer at the tip of great toe on plantar aspect. There is a callus around the wound. Remove the callus by using 10 no. blade. The patient has severe neuropathy with claw toes. Watch his gait. He must be walking with the toes touching the ground and that is the reason for non healing wound for such a long time. Give him a metatarsal pad. Surgery like flexor tenotomy also can be offered. Proper Diabetic foot wear will help Off loading plays important role in healing of the Diabetic foot ulcer. You can dress him with hydrogel. And ofcourse control his blood sugar. Thanks for posting the case.

Necrosed diabetic infected great toe with onychomycosis CT angiogram xray usg must consult vascular surgeon raynods disease

Case of uncontrolled dm with neuropathic ulcer with gangreen treat pt with Insulin monitor blood sugar fasting pp Hba1c coverage of broad spectrum antibiotic pipzo 4.5 gm BD oral antifungal Tab Fluconazol 150 mg twice a week wound debridment with NS and mupirocin alternate day remove infected nail and necrosed tissue Tab pregabalin with methylcobalamin combination for 1 month multivitamin and antioxidants for 1month Tab Dalacin300 mg bd

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