Please suggest a valuable opinion and management

A 78yr male, known case of Diabetes Mellitus type 2, on insulin and oral hypoglycemic drugs. Also diagnosed with Parkinson's disease on the list of medications as mentioned below complains of weakness in bilateral lower limb with inability to walk but with support. What could be the cause? some doctors pertain it to prolonged use of insulin. How far is it true?

65 yr old male presented wid complaints of left sided weakness n tingling sensations n left side chest pain intermittently once or twice every month..b.p 160/100 .gcs 15/15 power 5/5 in all 4 limbs. has received ecosprin150/ clonazepam 0.5 n b12 in the past.been irregular on amlo/atenolol/telmisartan for b.p.kindly suggest further management.ecg wnl.

a 38 year old Male patient came to psychiatry opd with wife and brother ( informants - reliable and adequate) with complaints of giddiness, headache, tingling sensation and numbness in bilateral limbs with coarse tremors, disturbances in gait ( wide base gait with stamping of the feets) , visual disturbances ( both short and distant vision with blurring) wife reports low mood, decreased interaction and irritability. forementioned complaints present for past 5-6 months. The patient is a also a known alcoholic with consumption from last 5-6 years. Has h/o consumption of both English and country liquor ( desi, hath bhatti) ranging from two and half to three quarters with h/o binge drinking for 6 month. There have short intervals of abstinence with patient having tremors and headache. however the patient has been abstinent for past 4-5 months owing to above mentioned complaints that were gradually progressive. The patient has H/o head trauma 6 months backs falling roadside with H/o severe bleeding, patient was intoxicated then no Loss of consciousness, ENT bleed, seizures. the patient's major complaint is visual and gait disturbances with coarse tremors. with mood disturbances and irritability. provisional diagnosis with Differentials investigations treatment.

45yrs diabetic male.. with this tropic ulcer since 1 yrs.. Treated by various doctors .. The ulcer area heals and recurs again at the same spot.. Too much keratinization seen surrounding it .. No sensation of pain felt.. Debridement and dressing done (with megaheal) by me along with antibiotics (augmentin).. Tough diabetes is controlled and brought below 180 post lunch.. No other comorbidities present.. Kindly guide me with the management and m also worrisome regarding it reoccurring... Thank you...

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.......