Exposure to Cold

11,/f first time in this winter.diagnisus?needed test? treatment?

An 78 year old male presented with this skin condition. He has a history of a quadruple coronary artery bypass grafting procedure and transapical transcatheter aortic-valve replacement What is the cause of this appearance? What diagnosis will you make?

POST VIRAL COUGH… Persistent cough lasting >3 weeks following the acute symptoms of an upper or lower respiratory tract viral infection. Such patients are considered to have a subacute cough because the condition lasts for less than 8 weeks. The chest radiograph findings are normal and the cough eventually resolves in most of the cases on its own but in few patients persists…. and lead to unnecessary investigations.. The exact pathogenesis of the post viral cough is not known, But it is thought to be due to…    the extensive inflammation and disruption of upper and/or lower airway epithelial integrity. In lower airway, this is often associated with the accumulation of an excessive amount of mucus hypersecretion There is also transient airway and cough receptor hyperresponsiveness; All of the above pathology contribute to the subacute cough No treatment guidelines are available. Therapy with antibiotics has no role except complicated by bacterial sinusitis The use of inhaled ipratropium may be helpful. Cough suppressant like dexromethorphan should be used to suppress the upper airway component Inhaled corticosteroids with or without bronchodialator may be used for a short period to tackle the bronchial inflammation. Associated gastroesophageal reflux disease, which may be a complication of the vigorous coughing may need treatment. Post viral cough is very common in our clinical practice both in children and adults.. Keeping this diagnosis in D/D and patience is needed in most of the cases.. It saves cost of investigations and treatment… I hope it will be helpful…..

A close relative (53yrs, female, hypertensive, no history of diabetes and tobacco) was admitted in ICU for 15 days due to severe viral pneumonia/ARDS. The pneumonia is now almost cured, but the patient has developed these gangrene like dead cells on her fingers. Most likely cause is a thrombus developed in wrist due to pic line used during pneumonia treatment. The vascular surgeons took a call to not take surgical intervention at that time due to severity of lung damage and started heparin. She is out of ICU for last 1 week, but still getting fever multiple times everyday. All the blood tests for bacterial infections are coming negative. The doctors at the hospital are saying that they will wait for sometime and then probably amputate the affected area. Is there any way to heal this without surgery? Also, could gangrene be cause of fever? Edit: I have attached the image of Doppler report. Also heparin is going on for last 20 days.

What is this? 86y/o DM pt with this darkened area since 15days initially there was pain now no pain but sensation present pt is suffering frm dementia doesn't remember how it happened Dm under control with actrapid TDS , n Lantus at night .Help me DX n give proper advice fr further management