DM
Male patient of age 45 Chief Complaints Rise in blood sugar Diagnose 2 years ago Weight lose Body pain Excessive Appetite Non healing wound with itching History History of taking medication since two years from different hospital but not relief Vitals Bp:110/74 Pulse:100 Physical Examination Weak Investigations Dated 10/11/2020 Cbc: hb11 Platelates:1.80 Esr:35 Hb1ac 9.2 Bs pp:250 Fasting:340 Diagnosis Dm 2 Management He had taken Galvas met 500/50 one bd Plus Glim 2 one bd On present Rx after blood reports Tab:Glycomet gp2 850/2 one bd Tab:Galvas 50 one bd Cap:meganeuron pg one hs Blood sugar in control after 2 weeks of rx Body pain relief But He suffers loose stools since medication start What to do to maintain body fluid and control loose stool by maintaing tight glycemic control?? Is insulin therepy should advice or not???
Review the line of treatment Both vildagliptin and pioglitazone are insulin sensitisers iwill prefer either of two As you have stepup glimiperide to 2mg Add tab dapagliflozin 10mg 1od So far loose motions are concerned known side effects of metformin hence lower the dose to 500mg Add racecordil or Rifaximin for loose motions with vit b12 and pre/probiotics Keep electrolyte balance
Loose motions are caused due to over dise of Networking. Just reduce to 500mg. Check Thyroid profile. Dapagliflozin 10 mg OD with any dise with Glimperide w mg . Vitamin supplements
Diabetic debility due to uncontrolled diabetes. Needs diabetic dietary supplements and antioxidant regularly. Physical activity or exercise for mental health and physical health. INSULIN ??? CONSULT WITH AN ENDOCRINOLOGIST FOR THE BETTER TREATMENT AND MANAGEMENT.
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Dx. Rx. since 3yrs. on and of after taking various treatment. 23yr old male worker. burning+itching++. no any other complaint.
Dr. Akshay Ingole6 Likes50 Answers - Login to View the image
Friends today I am discussing about a serious problem which most of the people shy to share with their doctor which is Hypoactive Sexual desire disorder. If you have little interest in sex, and it's causing distress in your life, you may have hypoactive sexual desire disorder. Learn about treatment options for this sex disorde Just because you aren’t interested in sex doesn’t mean you are sexually dysfunctional. However, if your disinterest is causing distress in your life, then you may be diagnosed with hypoactive sexual desire disorder (HSDD). An estimated 30 to 39 percent of women in any given population will report little or no interest in sex at any given time in their lives. This may not cause personal problems or constitute a sex disorder, especially if the woman is single and not actively engaged with a partner. When a lingering lack of desire, however, is coupled with distress, which is believed to be the case in about 12 percent of women and a roughly estimated 5 percent of men — and if other issues, such as an abusive partner are ruled out — then HSDD may be diagnosed. Although “lack of sexual fantasy” used to be included in the official HSDD definitions, this is no longer universally used as a determinant of healthy sexuality; not all sexually healthy adults fantasize. “Some people don’t want to have sex. If it’s not causing distress, it’s not dysfunction,” “The most important clinical determinant for HSDD in women is when the woman is unreceptive. She has a good relationship. She likes her partner. But she’s not able to respond to overtures. She says, ‘I feel nothing. I feel numb. I feel empty.’” Because of the personal nature of sexual desire, HSDD can be difficult to track, quantify, and treat. Studies do consistently show that HSDD can affect both women and men. Prevalence within the male population is less studied, but some researchers believe women may be at least twice as likely to have HSDD, which is why much of the research is pointed at women. Why Do More Women Have Hypoactive Sexual Desire Disorder? Some researchers believe the greater number of female HSDD cases may be related to the way most women approach sexuality: hypoactive sexual desire disorder can be psychologically, as well as physically, based. A woman’s desire for sex is often predicted by a greater number of factors in both realms working together — including relationship satisfaction and health, personal and partner well-being, and physical and emotional responses to lovemaking. The same researchers speculate that sexual disinterest among some women may be related to sexual inhibition, conditioned in women by longstanding cultural tradition. In addition, they suggest that a lack of sexual desire in some women may not constitute a disorder at all, but rather may be a natural protective mechanism against having too many children, which has evolved over time. Hormones. Hormone and other changes during menopause can make HSDD more prevalent for middle-aged, post-menopausal women than for younger, pre-menopausal women. Men can also experience hormonal changes, specifically low testosterone levels that can interfere with sexual desire Being in an active relationship. Most people living with HSDD who seek help are in a relationship. Sometimes a man or woman will seek help at the request of his or her partner. Nine out of 10 women who seek help do so because their partner is in distress. Emotional or mental health issues. This can include partner dissatisfaction, sexual communication and sexual performance issues, general life stress, and such potentially complicated psychological problems as body image issues and depression. Physical health conditions. These can include diabetes, arthritis, heart disease, hypothyroidism, and menopause. Treatment Options for Hypoactive Sexual Desire Disorder Sometimes just having a frank conversation with your partner can solve your HSDD. You also may choose to talk with your doctor, who may ask you about your relationship history and about past psychological issues related to your sexuality. Your doctor may also look for underlying medical conditions. You may ultimately be helped by: Individual or couples sex therapy. Treatment of an underlying medical condition. Hormone therapy. Hormone balancing therapy for women and testosterone supplementation for some men with low testosterone levels can increase sexual desire.
Dr. Rajesh Gupta9 Likes18 Answers - Login to View the image
HSDD Hypoactive Sexual Desire Disorder. Decreased Libido in Women. Women's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some medications used for mood disorders also can cause low sex drive in women. Physical causes A wide range of illnesses, physical changes and medications can cause a low sex drive, including: Sexual problems. If you have pain during sex or can't orgasm, it can reduce your desire for sex. Medical diseases. Many nonsexual diseases can affect sex drive, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. Medications. Certain prescription drugs, especially antidepressants called selective serotonin reuptake inhibitors, are known to lower the sex drive. Lifestyle habits. A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal. Surgery. Any surgery related to your breasts or genital tract can affect your body image, sexual function and desire for sex. Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive. Hormone changes Changes in your hormone levels may alter your desire for sex. This can occur during: Menopause. Estrogen levels drop during the transition to menopause. This can make you less interested in sex and cause dry vaginal tissues, resulting in painful or uncomfortable sex. Although many women still have satisfying sex during menopause and beyond, some experience a lagging libido during this hormonal change. Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby also can contribute to changes in your sexual desire. Psychological causes Your state of mind can affect your sexual desire. There are many psychological causes of low sex drive, including: Mental health problems, such as anxiety or depression Stress, such as financial stress or work stress Poor body image Low self-esteem History of physical or sexual abuse Previous negative sexual experiences Relationship issues For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as: Lack of connection with your partner Unresolved conflicts or fights Poor communication of sexual needs and preferences Trust issues see your Gynaecologist !
Dr. R. Nihar Mohapatra17 Likes16 Answers - Login to View the image
A 35 years man suffering with small ulcer, oozing transparent sticky fluid. H/O- painful corn was cut by nail, then the ulcer developed. Chilly pt. Appetite-moderate Craving- sweet Thirst- moderate Perspiration- less Stool-regular Urine- normal Mind- introverted Sentimental Want to be alone Please respected doctors suggest medicine
Dr. Debasish Sasmal5 Likes14 Answers - Login to View the image
Friends today I am discussing about Severe skin problem Psoriasis. What is psoriasis? Psoriasis is a chronic autoimmune condition that causes the rapid buildup of skin cells. This buildup of cells causes scaling on the skin’s surface. Inflammation and redness around the scales is fairly common. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes, these patches will crack and bleed. Psoriasis is the result of a sped-up skin production process. Typically, skin cells grow deep in the skin and slowly rise to the surface. Eventually, they fall off. The typical life cycle of a skin cell is one month. In people with psoriasis, this production process may occur in just a few days. Because of this, skin cells don’t have time to fall off. This rapid overproduction leads to the buildup of skin cells. Scales typically develop on joints, such elbows and knees. They may develop anywhere on the body, including the: hands feet neck scalp face Less common types of psoriasis affect the nails, the mouth, and the area around genitals. type 2 diabetes inflammatory bowel disease heart disease psoriatic arthritis What are the different types of psoriasis? There are five types of psoriasis: Plaque psoriasis Plaque psoriasis is the most common type of psoriasis. The AAD estimates that about 80 percent of people with the condition have plaque psoriasis. It causes red, inflamed patches that cover areas of the skin. These patches are often covered with whitish-silver scales or plaques. These plaques are commonly found on the elbows, knees, and scalp. Guttate psoriasis Guttate psoriasis is common in childhood. This type of psoriasis causes small pink spots. The most common sites for guttate psoriasis include the torso, arms, and legs. These spots are rarely thick or raised like plaque psoriasis. Pustular psoriasis Pustular psoriasis is more common in adults. It causes white, pus-filled blisters and broad areas of red, inflamed skin. Pustular psoriasis is typically localized to smaller areas of the body, such as the hands or feet, but it can be widespread. Inverse psoriasis Inverse psoriasis causes bright areas of red, shiny, inflamed skin. Patches of inverse psoriasis develop under armpits or breasts, in the groin, or around skinfolds in the genitals. Erythrodermic psoriasis Erythrodermic psoriasis is a severe and very rare type of psoriasis. This form often covers large sections of the body at once. The skin almost appears sunburned. Scales that develop often slough off in large sections or sheets. It’s not uncommon for a person with this type of psoriasis to run a fever or become very ill. This type can be life-threatening, so individuals should see a doctor immediately. What are the symptoms? Psoriasis symptoms differ from person to person and depend on the type of psoriasis. Areas of psoriasis can be as small as a few flakes on the scalp or elbow, or cover the majority of the body. The most common symptoms of plaque psoriasis include: red, raised, inflamed patches of skin whitish-silver scales or plaques on the red patches dry skin that may crack and bleed soreness around patches itching and burning sensations around patches thick, pitted nails painful, swollen joints Not every person will experience all of these symptoms. Some people will experience entirely different symptoms if they have a less common type of psoriasis. Most people with psoriasis go through “cycles” of symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely. When you have no active signs of the condition, you may be in “remission.” That doesn’t mean psoriasis won’t come back, but for now you’re symptom-free. Is psoriasis contagious? Psoriasis isn’t contagious. You can’t pass the skin condition from one person to another. Touching a psoriatic lesion on another person won’t cause you to develop the condition. It’s important to be educated on the condition, as many people think psoriasis is contagious. What causes psoriasis? Doctors are unclear as to what causes psoriasis. However, thanks to decades of research, they have a general idea of two key factors: genetics and the immune system. Immune system Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In the case of psoriasis, white blood cells known as T cells mistakenly attack the skin cells. In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. This mistaken attack causes the skin cell production process to go into overdrive. The sped-up skin cell production causes new skin cells to develop too quickly. They are pushed to the skin’s surface, where they pile up. This results in the plaques that are most commonly associated with psoriasis. The attacks on the skin cells also cause red, inflamed areas of skin to develop. Genetics Some people inherit genes that make them more likely to develop psoriasis. If you have an immediate family member with the skin condition, your risk for developing psoriasis is higher. However, the percentage of people who have psoriasis and a genetic predisposition is small. Approximately 2 to 3 percent of people with the gene develop the condition, according to the National Psoriasis Foundation. Read more about the causes of psoriasis. Diagnosing psoriasis Two tests or examinations may be necessary to diagnose psoriasis. Physical examination Most doctors are able to make a diagnosis with a simple physical exam. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause similar symptoms. During this exam, be sure to show your doctor all areas of concern. In addition, let your doctor know if any family members have the condition. Biopsy If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy. The skin will be sent to a lab, where it’ll be examined under a microscope. The examination can diagnose the type of psoriasis you have. It can also rule out other possible disorders or infections. Most biopsies are done in your doctor’s office the day of your appointment. Your doctor will likely inject a local numbing medication to make the biopsy less painful. They will then send the biopsy to a lab for analysis. When the results return, your doctor may request an appointment to discuss the findings and treatment options with you. Psoriasis triggers: Stress, alcohol, and more External “triggers” may start a new bout of psoriasis. These triggers aren’t the same for everyone. They may also change over time for you. The most common triggers for psoriasis include: Stress Unusually high stress may trigger a flare-up. If you learn to reduce and manage your stress, you can reduce and possibly prevent flare-ups. Alcohol Heavy alcohol use can trigger psoriasis flare-ups. If you excessively use alcohol, psoriasis outbreaks may be more frequent. Reducing alcohol consumption is smart for more than just your skin, too. Your doctor can help you form a plan to quit drinking if you need help. Injury An accident, cut, or scrape may trigger a flare-up. Shots, vaccines, and sunburns can also trigger a new outbreak. Medications Some medications are considered psoriasis triggers. These medications include: lithium antimalarial medications high blood pressure medication Infection Psoriasis is caused, at least in part, by the immune system mistakenly attacking healthy skin cells. If you’re sick or battling an infection, your immune system will go into overdrive to fight the infection. This might start another psoriasis flare-up. Strep throat is a common trigger. Treatment options for psoriasis Psoriasis has no cure. Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into three categories: Topical treatments Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis. Topical psoriasis treatments include: topical corticosteroids topical retinoids anthralin vitamin D analogues salicylic acid moisturizer Systemic medications People with moderate to severe psoriasis, and those who haven’t responded well to other treatment types, may need to use oral or injected medications. Many of these medications have severe side effects. Doctors usually prescribe them for short periods of time. These medications include: methotrexate cyclosporine (Sandimmune) biologics retinoids Light therapy This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the rapid cell growth. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis. Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms. Some people may use the same treatment their entire lives. Others may need to change treatments occasionally if their skin stops responding to what they’re using. Learn more about your treatment options for psoriasis. Medication for psoriasis If you have moderate to severe psoriasis — or if psoriasis stops responding to other treatments — your doctor may consider an oral or injected medication. The most common oral and injected medications used to treat psoriasis include: Biologics This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous (IV) infusion. Retinoids Retinoids reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return. Side effects include hair loss and lip inflammation. People who are pregnant or may become pregnant within the next three years shouldn’t take retinoids because of the risk of possible birth defects. Cyclosporine Cyclosporine (Sandimmune) prevents the immune system’s response. This can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Side effects include kidney problems and high blood pressure. Methotrexate Like cyclosporine, methotrexate suppresses the immune system. It may cause fewer side effects when used in low doses. It can cause serious side effects in the long term. Serious side effects include liver damage and reduced production of red and white blood cells. Learn more about the oral medications used to treat psoriasis. Diet recommendations for people with psoriasis Food can’t cure or even treat psoriasis, but eating better might reduce your symptoms. These five lifestyle changes may help ease symptoms of psoriasis and reduce flare-ups: Lose weight If you’re overweight, losing weight may reduce the condition’s severity. Losing weight may also make treatments more effective. It’s unclear how weight interacts with psoriasis, so even if your symptoms remain unchanged, losing weight is still good for your overall health. Eat a heart-healthy diet Reduce your intake of saturated fats. These are found in animal products like meats and dairy. Increase your intake of lean proteins that contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flax seeds, and soybeans. Avoid trigger foods Psoriasis causes inflammation. Certain foods cause inflammation, too. Avoiding those foods might improve symptoms. These foods include: red meat refined sugar processed foods dairy products Drink less alcohol Alcohol consumption can increase your risks of a flare-up. Cut back or quit entirely. If you have a problem with your alcohol use, your doctor can help you form a treatment plan. Consider taking vitamins Some doctors prefer a vitamin-rich diet to vitamins in pill form. However, even the healthiest eater may need help getting adequate nutrients. Ask your doctor if you should be taking any vitamins as a supplement to your diet. Learn more about your dietary options. Living with psoriasis Life with psoriasis can be challenging, but with the right approach, you can reduce flare-ups and live a healthy, fulfilling life. These three areas will help you cope in the short- and long-term: Diet Losing weight and maintaining a healthy diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants. You should also limit foods that may increase your inflammation. These foods include refined sugars, dairy products, and processed foods. Stress Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flare-ups and ease symptoms. Try the following to reduce your stress: meditation journaling breathing yoga Emotional health People with psoriasis are more likely to experience depression and self-esteem issues. You may feel less confident when new spots appear. Talking with family members about how psoriasis affects you may be difficult. The constant cycle of the condition may be frustrating, too. All of these emotional issues are valid. It’s important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis. Psoriasis and arthritis Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flare-ups and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues. This condition typically affects joints in the fingers or toes. You may also be affected in your lower back, wrists, knees, or ankles. Most people who develop psoriatic arthritis have psoriasis. However, it’s possible to develop the joint condition without having a psoriasis diagnosis. Most people who receive an arthritis diagnosis without having psoriasis have a family member who does have the skin condition. Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility. As with psoriasis, losing weight, maintaining a healthy diet, and avoiding triggers may also help reduce psoriatic arthritis flare-ups. An early diagnosis and treatment plan can reduce the likelihood of severe complications, including joint damage. Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is between 15 to 35 years old. According to the World Health Organization (WHO), some studies estimate that about 75 percent of psoriasis cases are diagnosed before age 46. A second peak period of diagnoses can occur in the late 50s and early 60s. According to the WHO, males and females are affected equally. Caucasians are affected disproportionately. People of color make up a very small proportion of psoriasis diagnoses. Having a family member with the condition increases your risk for developing psoriasis. However, many people with the condition have no family history at all. Some people with a family history won’t develop psoriasis. Primary Homoeopathic Remedies Arsenicum album People likely to respond to this remedy usually are anxious, restless, and compulsively neat and orderly. They are often deeply chilly, experience burning pains with many physical complaints, and become exhausted easily. The skin is dry and scaly and may tend to get infected. Scratching can make the itching worse, and applying heat brings relief. Graphites People needing this remedy often have a long-term history of skin disorders. The skin looks tough or leathery skin with cracks and soreness. Itching is often worse from getting warm, and the person may scratch the irritated places till they bleed. Trouble concentrating, especially in the morning, is also often seen when this remedy is needed. Petroleum This remedy is often indicated for people whose physical problems are aggravated by stressful emotional experiences. It is especially suited to individuals with extremely dry skin, and problems that involve the palms and fingertips. The person may feel a cold sensation after scratching, and the skin is easily infected and may look tough and leathery. Itching will be worse at night, and from getting warm in bed. People who need this remedy may also have a tendency toward motion sickness. Sepia This remedy may be helpful to a person who feels dragged out and irritable, often with little enthusiasm for work or family life. The person's skin may be look dry and stiff. Psoriasis may appear in many places on the body, including the nails and genitals. Signs of hormonal imbalance are often seen (in either sex), and problems with circulation are common. Exercise often helps this person's energy and mood. Sulphur Intensely burning, itching, inflamed eruptions that are worse from warmth and bathing suggest a need for this remedy. Affected areas often look bright red and irritated, with scaling skin that gets inflamed from scratching. This remedy is sometimes helpful to people who have repeatedly used medications to suppress psoriasis (without success). Other Remedies Calcarea carbonica This remedy is suited to people who are easily fatigued by exertion, sluggish physically, chilly with clammy hands and feet, and often overweight. Skin problems tend to be worse in winter. Typically solid and responsible, these people can be overwhelmed by too much work and stress. Anxiety, claustrophobia, and fear of heights are common. Cravings for sweets and eggs are often also seen when Calcarea is needed. Mercurius solubilis People who seem introverted and formal—but are very intense internally, with strong emotions and impulses—may benefit from this remedy. They tend to have swollen lymph nodes and moist or greasy-looking skin, and are very sensitive to changes in temperature. The areas affected by psoriasis may become infected easily. Mezereum A person who needs this remedy usually is serious, and often feels strong anxiety in the region of the stomach. Scaly plaques may itch intensely, thickening or crusting over if the person scratches them too much. Cold applications relieve the itching (although the person feels generally chilly and improves with warmth). People who need this remedy often have a craving for fat, and feel best in open air. Rhus toxicodendron When this remedy is indicated for a person with psoriasis, the skin eruptions are red and swollen, and often itch intensely. Hot applications or baths will soothe the itching—and also muscle stiffness, toward which these people often have a tendency. The person is restless, and may pace or constantly move around. A craving for cold milk is often seen when a person needs this remedy. Staphysagria This remedy may be helpful to individuals whose psoriasis has developed after grief or suppressed emotions. Any part of the body can be involved but the scalp is often affected. People who need this remedy often seem sentimental, meek and quiet, and easily embarrassed — but often have a strong internal anger or deeply-buried hurt.
Dr. Rajesh Gupta8 Likes11 Answers
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