Uncontrolled DM

A 46 yrs old man c/o bilateral pain localized in the legs while at rest, which improved 10 mts after onset but then resumed 30 mts later.He was admitted to the Emergency Dept where, in absence of other signs, he was diagnosed with bilateral sciatic pain and treated as an outpatient. Below are the photos, one showing the lesion,the second is HPE of muscular tissue. All vitals are WNL except for the past h/o Renal failure at the age of 18 yrs,caused by unknown inflammatory disorder, he was on tab Ramipril 2.5mg od, Aspirin 100mg od,Atorvastatin 10mg od for 3 yrs, after that stopped all.What is your diagnosis???

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? .

#ImageBasedQuestions A young man has a peripheral smear as shown below. Which of the following additional manifestations is he expected to have? State the reason for your answer. a. Purpura b. Pruritis c. Haematemesis d. Tingling and numbness of extremities

A male patient aged 63 years known case of T2DM with HTN with polyneuropathy has been under treatment from another GP reported to me for check up. He has been taking - TAB GLUCONORM G3 twice daily Tab Ajaduo 25 OD Tab. Telma 40mg OD His sugars are very much controlled. First visit on 23/05/2020 Complaints - paresthesia foot soles especially while sleeping and pain calf muscles,increased frequency of urine esp. at night and Vitals and RBS are normal too. I asked him to take same medicines gluconorm g3 and ajaduo as written above. I added tab Pregabid NT at bedtime + Tab Rejunex OD once daily + Vit D3 60K weekly + Tab Ultracet SOS and Tab Telma H OD. Ordered a panel of investigations and USG KUB. Second visit on 26/05/2020 His paresthesia on foot soles has been resolved almost 80%, but still has pain in calf muscles. Results of the panel investigations and USG KUB are - TFT -Normal Uric Acid - 8.5 HbA1C - 6.9 % VIt D3 - WNL VIT B12 - MARKEDLY ELEVATED (Also gives history of 12 injections of Vit B12 given I/M in the past) Lipid Profile is deranged as attached. GRADE 1 Prostatomegaly on USG KUB. My concerns are - 1) Paresthesia - We have to give pregabalin and Nortriptyline along with methylcobalamin 1500mcg once daily. Can I give pregabid NT and Rejunex OD at bedtime? 2) Uric Acid - As it is asymptomatic, and he has been taking empagliflozin for a long time, which actually aid in uric acid removal thru urine, but his uric acid levels are elevated instead. Is it necessary to burden this patient with a dose of furic 40 daily? 3)Regarding lipid profile, can I prescribe him cap maxepa OD afternoon along with a dose of Rosuvas F 15 mins before dinner. 4) Regarding prostatomegaly, Urimax D at bedtime? 5) As his Vit D3 are WNL, monthly once Vit D3 60k supplementation. 5) What to do regarding his elevated Vit B12 levels???

60 year old male presented with non healing ulcer since last 3 Year’s associate with itching with inflammation and pus discharge. Pedal edema since last 3 months. No History of fever and it’s an painless No H/o DM, HTN Personal History no smoking are using tobacco in any format On detailed examination It is case of Vericoseveins wits stasis Eczema And venous ulcer..... Laboratory investigation are normal Treatment Debridement done under aseptic environment. Tab Amoxicillin +Clavlonic acid started for 7 days Tab Moxifloxacin 400mg for 7 days Tab Acyclofenac and seratopeptidase started for 7 days Advices for alternative day dressing with bactigrass sheets started I requested all doctors for there valuable advice thanks