62yrs old male pt having this type of skin lesions shown in pictures since 2-3months.k/c/o Dm/CKD (on Dialysis)/Infiltrative liver. Pls sugest Dx Investigations Creat 4.56 Hb.8.0 RBS.191 Diagnosis Pls suggest Dx

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? PERIUNGUAL DERMATITIS.. WITH.. GANGRENE CHANGES.. UNCONTROLLED DIABETES..WITH CKD.. NEED'S.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. COLOUR DOPLAR STUDY.. WOUND MANAGEMENT WITH SURGEONS OPINION.. BS..ANTIBIOTICS WITH..NSAIDS AS PER REQUIREMENT.. SURGICAL INTERVENTION..

Tnx Dr Nikunj Satasiya
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Finger shows periungal dermititis Great toe shows gangrenous ulcer Since pt is diabetic and in renal failure as well as anaemic Rx finger needs to be cleaned and apply lobate-s oint twice daily For great toe Debridement of gangrenous tissue and dress regularly after irrigation with h2o2 and NS . Dress with bactigrass Orally broadspectrum antibiotics inj lenazolinid and inj Ceftriaxozone Keep monitoring of diabetes and renal e functions

Thank you sir
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There is gangrene of great toe. There is hyperkeratotic lesion on fourth finger base of nail It could be caused by peripheral vascular disease or it could be caused by embolism from atherosclerotic play Plaque, or secondary to infective endocarditis

Thank you Sir
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Gangrenous ulcer. Diabetic nephropathy seems to have been involved.. Cefuroxime Axetel 500 ng 1 tab BD.5 days. Salicylic acid + Clobetasol application. Dressing and aseptic cleaning. Consult vascular surgeon.

Thank you Sir
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1. Onchomycosis Finger. Needing oral antifungal treatment. 2. Gangrene great toe needing antibiotics and debridement, may be associated with PAD. 3. Glycemic control and Identify other CV risk factors.

Pt is in renal failure so which oral antifungal and antibiotics suitable ?
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Periungal dermatitis Gangrenous ulcer big toe Patient is diabetic & in Renal failure & Anemic Strict control of diabetes Debridment of ulcer T Bact oint dressings Tab Ceftum 1000 mg bd Nsaid orally

Thank you Sir
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Areas of fungal infection and gangrene are noted. Consider antifungal therapy Antiplatelets statins. Wound care and debridement. Tight glycemic control. Doppler study sos peripheral angiography.

Thank you Sir
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POSSIBLY .PEREPHERAL VASCULOPATHY AND THROMBOEMBOLISM SECONDARY. TO DM. AND. .HTN

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Dialysis affect nail Gangrene great toe Ct angiogram Opinion of vascular surgeon

Thank you Sir
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Peri fungal infections dermatitis Rx Tab levocetrizine 5 mg od Tab azithromycin 250 mg od Clobetasol ointment used at bed time and clean skin regularly potassium permanganate and bath keto soap Moisture lotion use and protection against dust particles and light sun light UV radiation cover skin

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