Concluded Case

A 60 yr old patient with h/o intake Att drugs for 2 1/2 yrs followed by injectable Att drugs 10yrs back now with co hemoptysis on and off with unctrolled diabetes and foot ulcer. Repeated wound debridement done and still slough is not controlled Investigations are attached Pus c/s shows Klebsiella pneumonia Dx and management pls

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Xray chest shows dilated hilum rt side Fissural thickening noted consistent with h/o old pulmonary tuberculosis Foot shows non healing ulcer with heavy slough . Since pt is diabetic this looks to be c/o vasculoneuropathic ulcer Debridement Irrigate with NS and h2o2 Dress with insulin infiltration and placentrax gel Offloading of weight Rest to foot Control diabetes strictly Broadspectrum antibiotics like lenazolinid and Cefuroxime If no improvement it may need below knee Amputation

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Xray chest shows dilated hilum rt side Fissural thickening noted consistent with h/o old pulmonary tuberculosis Foot shows non healing ulcer with heavy slough . Since pt is diabetic this looks to be c/o vasculoneuropathic ulcer Debridement Irrigate with NS and h2o2 Dress with insulin infiltration and placentrax gel Offloading of weight Rest to foot Control diabetes strictly Broadspectrum antibiotics like lenazolinid and Cefuroxime If no improvement it may need below knee Amputation

Thanx dr Abi santhi
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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Biopsy from edge of ulcer, AFB AND CBNATT from the discharge from the ulcer need to be done . CXR dies not show any PTB activity , but only old TB sequel Arterial colour Doppler to assess vascularity of the limb, Vascular Surgeon consultation, and stenting if needed . Right control of DM with insulin . Rest. . Antibiotics according to C and S , and metronidazole, Fluconazole Dressings , debridement , Informing patient and relatives, that amputation may be an inevitable option later .

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Continue with surgical wound debridment and washing it with norma saline and povidone 10% everyday. Topical antibiotics like mupirocyn ointment2% bd Oral antibiotics metro 400mg tds Ceftriaxone Monitor RBG every day to regulate blood sugar to facilitate healing.

Dilated Hilum Rt. Side & thickened minor fissure are elevated, Old PTB, Doing ESR, Serum ADA, CBNATT, QFT,

Right hilum and thickened minor fissure are elevated. Scarring right upper lung. Old PTB.

Control blood sugar strictly, AV doppler of affected limb, Higher antibiotics according to pus and blood Culter and sensitivity report, Dressing with h2o2, betadin also local application of honey will give u drametic response, sadly but may be if not responding amputation is last option. Thanks

Foot shows healing ulcer , it may take lot of time , I mean more than 6 months or above , do regular dressing by norml sline , woundspray , megaheal gel .....no povidone iodine .........see the developing condition otherwise go for plastic surgery .........go for regular antibiotics like piperacillin and tazobactum ....along with vitamin C orally ......

Sharp debridementemnt should be done antibiotics should be started according c and s...after debridement keep patient vaccum assisted closure dressing which helps in healing and removes slough and serous fluid ......make the wound clean ...

Arterial n venous Doppler study of limb Linezolid 600mg bd H2o2 , betadine wash Debridace n silverx heal ointment Sugar control with basal bolus

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