Hairfall

K/c/o HTN (on amlodipine) K/c/o DM (on insulin inj ) K/c/o IHD - Rx PCI ć stent Smoker - 60 pack years - COPD+ Left alcohol since 15 years Came now with c/o bilateral limb swelling , breathlessness(Grade 3 NYHA ) and Dry cough H/o orthopnea H/o slipping of chappals + (neuropathy+) O/e . • perception of light -Left eye • right eye operated 3 years back , shining reflex + Pupils reactive • JVP >8 (elevated ) •PR : 80 , RR: 24 (no accesory muscles used ) , BP:160/100 . • hands ?! Any finding ?? • chest : CVS - Apex beat shifted out and down (6th IC ) S1S2 heard , no murmurs RS - B/l creps at axillary and infrascapular area . • abdomen -NAD • LL: pitting pedal edema extending upto knee . Feet - any other finding ???! CXR - cardiomegaly ¿ Any other relevant findings in hands/ feet or CXR ?! Opinions ?!?!

male 45 years history DM2, hypertension, diabetic neuropathy, 15 days ago dipped his both feet in warm water, he did not realize that was boiling, positive culture for S. aureus, treatment? .

ABC OF : RESTLESS LEG SYNDROME ( RLS ). MAY BE USEFUL. *** Restless leg syndrome (RLS) IS A COMMON CAUSE OF PAINFUL LEGS. The LEG PAIN of restless leg syndrome TYPICALLY EASES WITH MOTION of the legs and becomes MORE NOTICEABLE AT REST. Restless leg syndrome also features WORSENING of symptoms and leg pain DURING the EARLY EVENING OR LATER AT NIGHT....... Restless leg syndrome is often abbreviated RLS; it has also been termed SHAKING LEG SYNDROME. Nighttime involuntary jerking of the legs during sleep are also known as PERIODIC LEG/LIMB MOVEMENT DISORDER....... ***** Restless leg syndrome (RLS) FACTS :- ** RLS s a condition marked by UNPLEASANT LEG SENSATIONS WHILE RESTING....... ** Restless leg syndrome frequency LEADS TO INSOMNIA....... ** The CAUSE of restless leg syndrome is UNKNOWN IN MOST INDIVIDUALS, BUT MANY CONDITIONS have been ASSOCIATED WITH IT....... ** SYMPTOMS of restless leg syndrome are aching and an URGE TO MOVE THE LOWER EXTREMITIES....... ** TREATMENT of RLS is DIRECTED TOWARDS ANY UNDERLYING ILLNESS, IF KNOWN....... ** MEDICATIONS are AVAILABLE FOR RLS....... ** HOME REMEDIES for restless leg syndrome INCLUDE :- QUITTING SMOKING, REDUCING CAFFEINE, WEIGHT REDUCTION for the overweight, WALKING, QUININE WATER, and IRON SUPPLEMENTATION for those that are iron deficient....... ** RLS IS GENERALLY NOT CONSIDERED CURABLE, MAY PERSISTS LIFELONG BUT TREATMENTS CAN SUBSTANTIALLY LESSEN OR ERADICATE SYMPTOMS....... **** D / D :- Other CONDITIONS that my MIMIC restless leg syndrome include :- POOR CIRCULATIONTO THE LOWER EXTREMITIES, PARKINSON'S DISEASE, FIBROMYALGIA, MUSCLE DISEASES, JOINT CONDITIONS, NERVE PROBLEMS such as PERIPHERAL NEUROPATHY caused by diabetes (DIABETIC NEUROPATHY), and CIRCULATION DIFFICULTIES. *** IN CHILDREN, RLS IS OFTEN MISDIAGNOSED AS "GROWING PAINS." ***** CONDITIONS ASSOCIATED WITH RLS :- * PREGNANCY, * OBESITY, * SMOKING, * IRON DEFICIENCY AND ANEMIA, * NERVE DISEASE, * POLYNEUROPATHY (which can be associated WITH HYPOTHYROIDISM, HEAVY METAL TOXICITY, TOXINS, and many other conditions), * other hormone diseases such as DIABETES, and * KIDNEY FAILURE (which can be associated WITH VITAMIN AND MINERAL DEFICIENCY). *** SOME DRUGS AND MEDICATIONS HAVE BEEN ASSOCIATED WITH RLS INCLUDING : CAFFEINE, ALCOHOL, H2-HISTAMINE BLOCKERS and CERTAIN ANTIDEPRESSANT (such as amitriptyline....... ** OCCASIONALLY, RLS RUN IN FAMILIES. ** RECENT STUDIES have SHOWN that restless leg syndrome appears to become MORE COMMON AS A PERSON AGES. Also, POOR VENOUS CIRCULATION OF THE LEGS (such as with VARICOSE VEINS) can cause restless leg syndrome....... *** SYMPTOMS OF RLS :- Many different symptoms are described by people with restless leg syndrome, for example: LEG PAIN, CRAMPS, TINGLING, ITCHY, BURNING....... DIAGNOSIS OF RLS :- The National Institutes of Health (NIH) SAYS that FOUR CRITERIA must be met FOR the DIAGNOSIS OF RLS in a person (ADULT or CHILD) : 1. A STRONG URGE TO MOVE LEGS. This urge OFTEN, but NOT ALWAYS, occurs with UNPLEASANT FEELINGS in legs. 2. WHEN the disorder is SEVERE, patient also may have the URGE TO MOVE her/his ARMS. SYMPTOMS that start or get WORSE WHEN patient is INACTIVE. The urge to move increases when she /he is sitting still or lying down and resting. 3. RELIEF FROM MOVING. Movement, ESPECIALLY WALKING, HELPS relieve the unpleasant feelings. 4. SYMPTOMS that start or get WORSE IN the EVENING OR AT NIGHT. Rx :- TREATMENT of restless leg syndrome is first DIRECTED TOWARDS ANY UNDERLYING ILLNESS, if known. FOR EXAMPLE: BLOOD TESTING to reveal underlying IRON DEFICIENCY ANEMIA may reveal the underlying cause. If VARICOSE VEINS are thought to be the cause, then SURGERY to repair the circulation may be considered. REDUCTION OR ELIMINATION of CAFFEINE, NICOTINE, and ALCOHOL from a person's diet can be very HELPFUL. STOPPING SMOKING can significantly diminish or prevent symptoms. Getting BETTER SLEEP and EXERCISE can HELP some persons affected by restless legs. ** PREGNANT WOMEN who do not sleep well at night AND other PEOPLE WITH SLEEP DISORDERS MAY DEVELOP RLS. MEDICATIONS USED TO TREAT RLS :- Considering the situation MEDICATIONS used to treat restless leg syndrome INCLUDE : NATURAL SUPPLEMENTS (such as IRON), CARBIDOPA-LEVODOPA, OPIOIDS, CARBAMAZEPINE, CLONAZEPAM, DIAZEPAM, TRIAZOLAM, TEMAZEPAM, BACLOFEN, BROMOCRIPTINE, CLONIDINE, GABAPENTIN, GABAPENTIN ENACARBIL, ROPINIROLE and PRAMIPEXOLE.......

55 m kco uncontrolled DM peripheral diabetic neuropathy no ho any trauma; b/l dorsalis paedis palpable ...what is a most appropriate method of dressing

50year old Male,known case of diabetes on irregular treatment presented with pain,swelling,ulcer with discharge and discolouration of Left big toe since 2weeks... Diagnosis and management?